Cristina Ros1, Daniel Barnes2, Anna Fervienza1, Gabriella Oses3, Juan L Alcázar4, Sergio Martínez-Román1, Àngels Rovirosa3, Francisco Carmona1, Fernando Gómez2. 1. 1 ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain. 2. 2 Department of Radiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain. 3. 3 Department of Radiotherapy, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain. 4. 4 Department of Obstetrics and Gynecology, Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
Abstract
OBJECTIVE: To evaluate the utility of transvaginal ultrasound-guided thrombin injection (UGTI) to treat uterine artery pseudoaneurysms (UAPs) as an alternative to emergency arterial embolization. METHODS: Two females presenting with heavy vaginal bleeding were diagnosed with UAPs by pelvic CT scan. After UAP identification by transvaginal ultrasound, 2 cm3 of thrombin (Tissucol®; Baxter Healthcare Corporation, Munich, Germany) was slowly injected into the UAPs using a 30-cm long 22-gauge needle through a needle guide attached to the vaginal probe. The same procedure was performed in both cases, and the Doppler sign disappeared immediately and the bleeding stopped. RESULTS: We describe two cases of UAPs treated with transvaginal UGTI: one after intrauterine tandem and vaginal colpostat insertion for brachytherapy after diagnosis of cervical cancer (Case 1) and the other after the insertion of a levonorgestrel-releasing intrauterine device (Case 2). CONCLUSION: Transvaginal UGTI could be a minimally invasive tool to treat selected cases of UAPs with severe vaginal bleeding. Advances in knowledge: Transvaginal UGTI could avoid the need for uterine embolization and emergency hysterectomy in selected cases of UAPs diagnosed by CT scan.
OBJECTIVE: To evaluate the utility of transvaginal ultrasound-guided thrombin injection (UGTI) to treat uterine artery pseudoaneurysms (UAPs) as an alternative to emergency arterial embolization. METHODS: Two females presenting with heavy vaginal bleeding were diagnosed with UAPs by pelvic CT scan. After UAP identification by transvaginal ultrasound, 2 cm3 of thrombin (Tissucol®; Baxter Healthcare Corporation, Munich, Germany) was slowly injected into the UAPs using a 30-cm long 22-gauge needle through a needle guide attached to the vaginal probe. The same procedure was performed in both cases, and the Doppler sign disappeared immediately and the bleeding stopped. RESULTS: We describe two cases of UAPs treated with transvaginal UGTI: one after intrauterine tandem and vaginal colpostat insertion for brachytherapy after diagnosis of cervical cancer (Case 1) and the other after the insertion of a levonorgestrel-releasing intrauterine device (Case 2). CONCLUSION: Transvaginal UGTI could be a minimally invasive tool to treat selected cases of UAPs with severe vaginal bleeding. Advances in knowledge: Transvaginal UGTI could avoid the need for uterine embolization and emergency hysterectomy in selected cases of UAPs diagnosed by CT scan.
Authors: G Descargues; F Douvrin; A Gravier; J P Lemoine; L Marpeau; E Clavier Journal: Eur J Obstet Gynecol Reprod Biol Date: 2001-07 Impact factor: 2.435