Visualization of utero-ovarian anastomoses: Comparison between patients with and without uterine fibroid

Purpose: To retrospectively review uteroovarian anastomosis (UOA) visualization during uterine artery embolization (UAE) in patients with or without uterine fibroids (UFs). Material and Methods: 43 patients underwent UAE for uterine fibroids (n = 23) and gynecological hemorrhage (n = 20). The frequency of angiographic visualization of UOAs was compared between the two groups and analyzed by the Fisher’s exact test. Results: Except for one patient with no right uterine artery, 85 uterine arteries were evaluated. Of these 85 uterine arteries, 23 UOA were recognized: 14 UOAs (58%) (right: 5 [21.7%], left: 9 [37.5%]) were visualized in 23 patients with UFs, and 9 UOAs (47.4%) (right: 4 [21%], left: 5 [26.3%]) were visualized in 20 patients with gynecological hemorrhage. In both groups, UOA was observed after UAE in one patient. Statistically significant difference was not observed for UOAs visualized between patients with or without UFs except a group of left UAE in patients with UFs (P = 0.036). Conclusion: The frequency of UOAs visualized during angiography was similar between patients with or without UFs. Therefore, UOA should be visualized carefully during UAE in patients with gynecological hemorrhage.

Efficacy of Uterine Artery Embolization for Patients with Postpartum Hemorrhage

Purpose: To investigate the efficacy of uterine arterial embolization (UAE) in patients with post-partum hemorrhage (PPH). Materials and Methods: The subjects were 40 women (mean age, 33 years;age range, 21 - 42 years) who underwent UAE for PPH at two institutes from June 2001 to May 2011. The rates of clinical success (avoidance of hysterectomy) and complications were calculated. Differences in related factors between primary PPH and secondary PPH and between caesarean section and vaginal delivery were examined. The risk factors associated with hysterectomy were also examined. Results: The overall clinical success rate was 90% (93% of primary PPH, 77% of secondary PPH, and 87.5% of PPH with cesarean section), and the overall complication rate was 10%. There were significant differences in time to PPH (P < 0.0001) and in blood infusion after UAE (P = 0.0158) between subtypes of primary and secondary PPH and in blood infusion before UAE (P = 0.0052) between delivery methods. The significant factors associated with hysterectomy were cesarean section (P = 0.02), severe PPH (>1000 mL bleeding, P = 0.03), and embolization of non-uterine arteries (P = 0.02).

Endovascular Treatment of Brachiocephalic and Subclavian Arterial Disease

Objectives: To review our experience of stentgraft deployment for vascular aneurysm or pseudoaneurysm of the brachiocephalic or subclavian artery. Methods: Participants comprised 7 patients (4 men, 3 women;mean age, 61 years;range, 47 - 76 years) who underwent endovascular repair of brachiocephalic or subclavian arterial vascular lesions between July 2001 and November 2008. Causes of vascular lesions were: traffic accident, n = 4;infection, n = 2;and post-irradiation state of esophageal cancer, n = 1. Safety, technical success, and clinical follow-up were evaluated. Results: Stentgraft deployment was successful in all cases. No complications related to stent fracture were encountered during follow-up (up to 2308 days). One male patient with esophageal cancer died of rebleeding from the tracheostomy hole 13 days after treatment with size mismatch between the stentgraft and brachiocephalic artery. Conclusion: Stentgraft deployment represents acceptable treatment for the injured brachiocephalic artery or proximal side of the subclavian artery.