Uterine Artery Embolization for Iatrogenic Uterine Vascular Injuries

Abstract Purpose Uterine curettage or surgery can lead to uterine vascular injuries such as arteriovenous malformations (AVMs) or pseudoaneurysms (PsAs), and patients may present with life-threatening uterine bleeding. The purpose of our study is to evaluate the effectiveness of uterine artery embolization (UAE) in patients with abnormal uterine bleeding due to iatrogenic vascular injuries. Methods This is a retrospective review of 22 patients who underwent UAE at our institution between January 2019 and January 2023. Sixteen patients had a history of iatrogenic procedures. Uterine curettage was done in 12 patients, manual vacuum aspiration in 1 patient, and cesarean surgery in 3 patients. The outcomes were assessed in the form of technical feasibility, cessation of bleeding, recurrence, and pregnancy on follow-up. Results Eighteen (18/22) patients had vascular malformations and 4 (4/22) had PsA on computed tomography. Eight patients had typical AVM features with early draining vein and 10 patients had hypertrophied vessels with no early draining veins. A total of 35 uterine arteries were embolized in 22 patients. The most commonly used embolic material was polyvinyl alcohol particles (28/35 arteries). Postembolization, bleeding symptoms subsided in 19 patients (86.4%). Three patients had recurrence of bleeding symptoms for which they underwent repeat embolization. Six patients (27%) became pregnant during the follow-up period of 15 months. Conclusion UAE is a safe and effective treatment for iatrogenic uterine vascular injuries. This procedure allows for the preservation of uterine function with the possibility of future pregnancy and should be considered as a primary treatment option.