Research Article| Volume 182, P146-153, November 2014

Conservative management of uterine artery pseudoaneurysm after laparoscopic-assisted myomectomy and subsequent pregnancy outcome: case series and review of the literature

Published:September 18, 2014DOI:



      Uterine artery pseudoaneurysm is a rare potentially life-threatening complication after myomectomy. Its clinical characteristics and management, and the outcomes of subsequent pregnancy, are not well understood. The purpose of this study was to clarify these important issues.

      Study design

      Retrospective analysis of a case series of uterine artery pseudoaneurysm detected after laparoscopic-assisted myomectomy (LAM) in a single center over a 13-year period. During the early postoperative course, gray scale ultrasonographic evaluation was carried out routinely by searching for an anechoic or hypoechoic well-defined cystic structure in the post-myomectomy scar. In suspicious cases, further evaluation was performed by color Doppler flow analysis and three-dimensional computerized tomographic angiography. After finally confirming the diagnosis by digital subtraction angiography, uterine artery pseudoaneurysm was conservatively managed by angiographic intervention. In cases achieving successful conception, cesarean delivery was chosen and the uterine scar was evaluated.


      Uterine artery pseudoaneurysm was diagnosed in 9 out of 854 cases of LAM. One case was undiagnosed until massive uterine hemorrhage occurred in the late postoperative period, while the other eight cases were diagnosed in the early postoperative course without hemorrhagic complication. Eight cases were managed by uterine artery embolization, but spontaneous resolution of pseudoaneurysm was observed in one case during a difficult prolonged attempt to superselect the offending branch of the uterine artery. Postembolization course was uneventful, except in a 41-year-old woman who developed oligomenorrhea. Among five women desiring preserved fertility, three women including one after spontaneous miscarriage achieved live birth by cesarean section. One woman experienced spontaneous miscarriage and one did not become pregnant by fertility treatment. In a case with elective cesarean delivery, severe early postpartum hemorrhage occurred from the placental bed and was conservatively managed by emergency uterine artery embolization.


      The development of uterine artery pseudoaneurysm after myomectomy may be more common than previously considered, and should be carefully monitored to avoid potentially life-threatening hemorrhage and loss of fertility. Although spontaneous resolution may occur, conservative management by angiographic intervention could be a feasible management option for future fertility preservation, once a diagnosis has been made.


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        • Saad N.E.
        • Saad W.E.
        • Davies M.G.
        • Waldman D.L.
        • Fultz P.J.
        • Rubens D.J.
        Pseudoaneurysms and the role of minimally invasive techniques in their management.
        Radiographics. 2005; 25: S173-S189
        • Kwon H.S.
        • Cho Y.K.
        • Sohn I.S.
        • et al.
        Rupture of a pseudoaneurysm as a rare cause of severe postpartum hemorrhage: analysis of 11 cases and a review of the literature.
        Eur J Obstet Gynecol Reprod Biol. 2013; 170: 56-61
        • Higón M.A.
        • Domingo S.
        • Bauset C.
        • Martínez J.
        • Pellicer A.
        Hemorrhage after myomectomy resulting from pseudoaneurysm of the uterine artery.
        Fertil Steril. 2007; 87: 417.e5-417.e8
        • Zorlu C.G.
        • Akar M.E.
        • Seker-Ari E.
        • Yilmaz S.
        • Sindel T.
        Uterine artery embolization to control bleeding after myomectomy.
        Acta Obstet Gynecol Scand. 2005; 84: 606-607
        • Takeda A.
        • Kato K.
        • Mori M.
        • Sakai K.
        • Mitsui T.
        • Nakamura H.
        Late massive uterine hemorrhage caused by ruptured uterine artery pseudoaneurysm after laparoscopic-assisted myomectomy.
        J Minim Invasive Gynecol. 2008; 15: 212-216
        • Takeda A.
        • Koyama K.
        • Imoto S.
        • Mori M.
        • Sakai K.
        • Nakamura H.
        Early diagnosis and endovascular management of uterine artery pseudoaneurysm after laparoscopic-assisted myomectomy.
        Fertil Steril. 2009; 92: 1487-1491
        • Asai S.
        • Asada H.
        • Furuya M.
        • Ishimoto H.
        • Tanaka M.
        • Yoshimura Y.
        Pseudoaneurysm of the uterine artery after laparoscopic myomectomy.
        Fertil Steril. 2009; 91: 929.e1-929.e3
        • Kvashin A.I.
        • Melnik A.V.
        • Sharifulin M.A.
        Endovascular correction of the right uterine artery pseudoaneurysm. A clinical case.
        Int J Interv Cardioangiol. 2010; 22: 37-39
        • Oishi H.
        • Wada-Hiraike O.
        • Osuga Y.
        • Yano T.
        • Kozuma S.
        • Taketani Y.
        Spontaneous cessation and recurrence of massive uterine bleeding can occur in uterine artery pseudoaneurysm after laparoscopically assisted myomectomy.
        J Obstet Gynaecol Res. 2013; 39: 598-602
        • Ito N.
        • Natimatsu Y.
        • Tsukada J.
        • Sato A.
        • Hasegawa I.
        • Lin B.L.
        Two cases of post-myomectomy pseudoaneurysm treated by transarterial embolization.
        Cardiovasc Intervent Radiol. 2013; 36: 1681-1685
        • Sauerbrun-Cutler M.
        • Kanos J.
        • Friedman A.
        • Bernstein S.
        Pseudoaneurysm after abdominal myomectomy: a rare but catastrophic complication.
        Open J Obstet Gynecol. 2013; 3: 123-125
        • Wan A.Y.H.
        • Shin J.H.
        • Yoon H.K.
        • et al.
        Post-operative hemorrhage after myomectomy: safety and efficacy of transcatheter uterine artery embolization.
        Korean J Radiol. 2014; 15: 356-363
        • Takeda A.
        • Sakai K.
        • Mitsui T.
        • Nakamura H.
        Wound retraction system for gasless laparoscopic-assisted myomectomy with a subcutaneous abdominal wall-lift method.
        J Minim Invasive Gynecol. 2007; 14: 240-246
        • Takeda A.
        • Imoto S.
        • Mori M.
        • Yamada J.
        • Nakamura H.
        Isobaric two-port laparoscopic-assisted myomectomy by combined approach through umbilical and suprapubic mini-incisions with hidden scar: a technique and initial experience.
        Eur J Obstet Gynecol Reprod Biol. 2012; 160: 88-92
        • Takeda A.
        • Koyama K.
        • Mori M.
        • Sakai K.
        • Mitsui T.
        • Nakamura H.
        Diagnostic computed tomographic angiography and therapeutic emergency transcatheter arterial embolization for management of postoperative hemorrhage after gynecologic laparoscopic surgery.
        J Minim Invasive Gynecol. 2008; 15: 332-341
        • Takeda A.
        • Koike W.
        • Imoto S.
        • Nakamura H.
        Three-dimensional computerized tomographic angiography for diagnosis and management of intractable postpartum hemorrhage.
        Eur J Obstet Gynecol Reprod Biol. 2014; 176: 104-111
        • Miller C.E.
        Unmet therapeutic needs for uterine myomas.
        J Minim Invasive Gynecol. 2009; 16: 11-21
        • Olufowobi O.
        • Sharif K.
        • Papaionnou S.
        • Neelakantan D.
        • Mohammed H.
        • Afnan M.
        Are the anticipated benefits of myomectomy achieved in women of reproductive age? A 5-year review of the results at a UK tertiary hospital.
        J Obstet Gynaecol. 2004; 24: 434-440
        • Sizzi O1
        • Rossetti A.
        • Malzoni M.
        • et al.
        Italian multicenter study on complications of laparoscopic myomectomy.
        J Minim Invasive Gynecol. 2007; 14: 453-462
        • Lee W.K.
        • Roche C.J.
        • Duddalwar V.A.
        • Buckley A.R.
        • Morris D.C.
        Pseudoaneurysm of the uterine artery after abdominal hysterectomy: radiologic diagnosis and management.
        Am J Obstet Gynecol. 2001; 185: 1269-1272
        • Webber G.W.
        • Jang J.
        • Gustavson S.
        • Olin J.W.
        Contemporary management of postcatheterization pseudoaneurysms.
        Circulation. 2007; 115: 2666-2674
        • Baba Y.
        • Matsubara S.
        • Kuwata T.
        • et al.
        Uterine artery pseudoaneurysm: not a rare condition occurring after non-traumatic delivery or non-traumatic abortion.
        Arch Gynecol Obstet. 2014; 290: 435-440
        • Hebrang A.
        • Grga A.
        • Brkljacic B.
        • Drinkovic I.
        Successful closure of large pseudoaneurysm of peroneal artery using transluminal temporary occlusion of the neck with the catheter.
        Eur Radiol. 2001; 11: 1206-1209