Abstract
Objective
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: September 18, 2014
Accepted:
September 3,
2014
Received in revised form:
August 20,
2014
Received:
July 19,
2014
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
