European Journal of Radiology 136 (2021) 109511
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European Journal of Radiology
journal homepage: www.elsevier.com/locate/ejrad
Uterine artery pseudoaneurysm due to obstetric/gynaecologic manoeuvres: Endovascular or
percutaneous interventional radiology approach?
Dear Sirs,
we read with interest and appreciated the paper by U Gorsi, et al.,
entitled: Interventional radiology in the management of uncommon
causes of obstetric haemorrhage, recently published in European Jour­
nal of Radiology [1]. Authors clearly highlighted the role of interven­
tional radiology procedures to treat uncommon causes of obstetric
haemorrhage. Among the various cause of obstetric haemorrhage, we
would like to focus on the most common pathology in their study that
was uterine artery pseudoaneurysm [1]. In literature there are only case
reports and limited case series on uterine artery pseudoaneurysm as
complication of post obstetric/gynaecologic manoeuvres and all of them
were managed by endovascular approach [2–5]. Endovascular emboli­
zation of uterine artery pseudoaneurysms is an effective and safe pro­
cedure. This endovascular manoeuvre can be performed in unstable
patients and has reduced the need of emergency hysterectomy [1–4].
We emphasize the concept introduced by U Gorsi, et al. on totally
percutaneous embolization manoeuvre of uterine artery pseudoaneur­
ysms, who were the first to describe it [1]. This manoeuvre is indicated
for uterine artery pseudoaneurysm sufficiently large in size to be eval­
uated by ultrasound, with a favourable anatomical percutaneous needle
placement and with a relatively narrow neck [1]. One of the main ad­
vantages of this totally percutaneous embolization manoeuvre can be a
significant shorter execution time in expert hand compared to the
endovascular one. In addition, this manoeuvre is mainly done under
ultrasound guidance and only with few seconds of fluoroscopy controls.
Another consideration concerns the use of glue as embolic agent despite
of thrombin. The use of thrombin is associated with higher recanalisa­
tion rates, thromboembolic complications and allergic reactions [6], so
glue mixture is usually preferred by skilled operators. Advantages of
glue over thrombin are its minimal tissue inflammation, low toxicity and
good radioopacity when mixed with oil-based contrast agent, leading to
visualisation of glue cast in post-procedure images, including the opa­
cification of the feeding arteries [6].
This technique must be taken into consideration given that are
treated a young women of childbearing age.
https://doi.org/10.1016/j.ejrad.2020.109511
Received 15 December 2020
Available online 30 December 2020
0720-048X/© 2020 Elsevier B.V. All rights reserved.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
References
[1] U. Gorsi, A. Bansal, S.B. Chaluvashetty, A. Lal, N. Kalra, M. Kang, et al., Interven­
tional radiology in the management of uncommon causes of obstetric haemorrhage,
Eur. J. Radiol. 17 (134) (2020 Nov) 109415.
[2] P. Kodey, G. Koneru, L. Kota, Pseudoaneurysm of uterine artery: as a cause of sec­
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(2015) 1821–1824.
[3] J.P. Pelage, P. Soyer, D. Repiquet, D. Herbreteau, O. Le Dref, E. Houdart, et al.,
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[4] S. Ferrero, S. Bogliolo, U.G. Rossi, C. Baldi, M. Valenzano Menada, N. Ragni, et al.,
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[5] R. Das, R. Champaneria, J.P. Daniels, A.M. Belli, Comparison of embolic agents used
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[6] U. Gorsi, S. Chaluvashetty, N. Kalra, M. Kang, V. Bhatia, A. Lal, et al., Percutaneous
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Umberto G. Rossi*
Department of Radiological Area - Interventional Radiology Unit, E.O.
Galliera Hospital, Mura Delle Cappuccine, 14 - 16128, Genova, Italy
Anna Maria Ierardi
Department of Diagnostic Imaging - Radiology Unit, I.R.C.C.S. Cà Granda
Fondation, Maggiore Policlinico Hospital, Via Francesco Sforza, 28 - 20122
Milano, Italy
*
Corresponding author.
E-mail address: umberto.rossi@galliera.it (U.G. Rossi).