Angiographic arterial embolization in the management of postoperative vaginal hemorrhage

Recently great success was achieved at the Toronto General Hospital in treating patients with postoperative vaginal hemorrhage by angiographic methods. A retrospective review was performed from 1975 to 1984 on eight patients treated by this technique for nine separate episodes of hemorrhage with a mean estimated blood loss in excess of 5000 ml. Success was achieved in seven episodes despite failure of various vaginal and abdominal approaches. One of the failures was due to previous bilateral hypogastric artery ligation that made the bleeding branch inaccessible to the angiography catheter. The other patient developed bleeding following cesarean section which did not respond to angiographic embolization due to faulty technique. Both of these patients were eventually cured by abdominal surgery. We feel that angiographic embolization is the procedure of choice in the management of postoperative vaginal hemorrhage when conservative management has failed or is inappropriate; it can be lifesaving when all other attempts to stop the hemorrhage have failed.