Kye Jin Park MD, Presenter: Nothing to Disclose

Ji Hoon Shin MD, Abstract Co-Author: Nothing to Disclose

To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) using N-butyl-2-cyanoacrylate (NBCA) for the treatment of active postpartum hemorrhage (PPH).

From January 2004 to August 2013, 26 patients underwent TAE using NBCA for PPH. All of these patients were in an active bleeding state and seven patients (26.9%) were in a coagulopathic condition. Two patients underwent a second session of TAE due to the failed first TAE using a gelatin sponge. Their angiograms and medical records were retrospectively reviewed in order to obtain the patients’ baseline characteristics, technical/clinical success information, and follow-up data regarding menstruation and fertility.

Angiograms demonstrated pseudoaneurysm, extravasation or artery cut-off, and NBCA was used as the primary (n=24) or a complimentary (n=2) embolic material. The technical and clinical success rates were 100% and 92.3% (24/26), respectively. Two patients with persistent bleeding after TAE with NBCA (clinical failure) were among the three patients with an overt DIC condition. One of them recovered through conservative management, while another patient died due to multi-organ dysfunction. Two patients who underwent two sessions of TAE failed to regain their normal menstruation, while three patients experienced successful deliveries after TAE.

TAE using NBCA as the primary or a complimentary embolic agent is an effective method for treating PPH with extravasation and/or a pseudoaneurysm. Overt DIC and its corresponding clinical situations could not be compensated for with the use of NBCA. Repeated TAE with NBCA could result in uterine dysfunction and amenorrhea.

Transarterial embolization using NBCA can be an effective method for treating postpartum hemorrhage and be recommended when a pseudoaneurysm or active extravasation is uncontrolled despite using conventional embolic material.

Park, K, Shin, J, Postpartum Hemorrhage from Extravasation or Pseudoaneurysm: Efficacy of Transcatheter Arterial Embolization Using N-butyl-2-cyanoacrylate.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010726.html