Endovascular management of acquired uterine vascular anomalies

To evaluate clinical presentation, imaging features, embolization techniques and their outcome for acquired uterine vascular anomalies (UVA) related to obstetric events.

Thirteen women (mean age = 34; range = 20-40 years) who had undergone interventional radiological treatment of UVAs between 2013 and 2024 were retrospectively analyzed. All patients had a history of an obstetric event. They presented with ongoing postpartal vaginal blood losses (n = 11) or were asymptomatic (n = 2). Fertilization had been performed by intracytoplasmic sperm injection (ICSI) in 3/13 women. 7/13 women had delivered healthy babies. 6 women had surgical, drug-induced or missed abortions. Postpartum dilatation and curettage had been performed in 4 women. The delay between the obstetric/gynecological event and the radiological intervention ranged from 19 to 193 days (median = 49 days). Long-term follow-up was available in 12/13 patients (median FU = 2.4 years). Unilateral selective transcatheter embolization was performed in 7/12 patients (n-Butyl-Cyanoacrylate-Lipiodol mixture [BCAL], n = 5; trisacryl gelatine particles, n = 2); Bilateral uterine artery embolization was performed in 5/12 women (unilateral BCAL combined with contralateral particles in 3/12, or bilateral gelatine sponge slurry in 2/12). In one patient percutaneous direct injection of BCAL into a uterine artery branch pseudoaneurysm was performed.

Primary clinical success without complications was achieved in 10/13 interventions. Re-embolization was successful in the 3 patients with ongoing bleeding despite uterine artery embolization. Follow-up information was available in 12/13 patients (median FU = 2.4 yrs). The pregnancy rate after embolization was 8/12women with a birth rate of 6/8 pregnancies.

Embolization of acquired UVAs is an effective and safe treatment. Preservation of uterine function for future pregnancy after uterine transarterial embolization seems warranted.