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Philippe Soyer - One of the best experts on this subject based on the ideXlab platform.
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Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications
CardioVascular and Interventional Radiology, 2015Co-Authors: Philippe Soyer, Anthony Dohan, Etienne Gayat, Raphael Dautry, Youcef Guerrache, Aude Ricbourg, Mourad Boudiaf, Marc Sirol, Olivier LedrefAbstract:Postpartum hemorrhage (PPH) is a potentially life-threatening condition, which needs multidisciplinary management. Uterine atony represents up to 80 % of all causes of PPH. Transcatheter Arterial Embolization (TAE) has now a well-established role in the management of severe PPH. TAE allows stopping the bleeding in 90 % of women with severe PHH, obviating surgery. Pledgets of gelatin sponge as torpedoes are commonly used for safe TAE, and coils, glue, and microspheres have been primarily used in specific situations such as Arterial rupture, pseudoaneurysm, and arteriovenous fistula. TAE is a minimally invasive procedure with a low rate of complications, which preserves future fertility. Knowledge of causes of PPH, potential risks, and limitations of TAE is essential for a timely decision, optimizing TAE, preventing irreversible complications, avoiding hysterectomy, and ultimately preserving fertility.
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postpartum hemorrhage resulting from pelvic pseudoaneurysm a retrospective analysis of 588 consecutive cases treated by Arterial Embolization
CardioVascular and Interventional Radiology, 2013Co-Authors: Anthony Dohan, Philippe Soyer, Y Fargeaudou, O Morel, M Boudiaf, Aqeel Subhani, Delphine Hequet, Etienne Gayat, E Barranger, Olivier Le DrefAbstract:Objective This study was designed to determine the incidence of Arterial pseudoaneurysm in patients presenting with postpartum hemorrhage (PPH), to analyze the angiographic characteristics of pseudoaneurysms that cause PPH, and to evaluate the effectiveness of pelvic Arterial Embolization for the treatment of this condition.
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severe postpartum haemorrhage from ruptured pseudoaneurysm successful treatment with transcatheter Arterial Embolization
European Radiology, 2008Co-Authors: Philippe Soyer, Y Fargeaudou, O Morel, M Boudiaf, Olivier Le Dref, R RymerAbstract:The purpose of this retrospective study was to evaluate the role of transcatheter Arterial Embolization in the management of severe postpartum haemorrhage due to a ruptured pseudoaneurysm and to analyse the clinical symptoms that may suggest a pseudoaneurysm as a cause of postpartum haemorrhage. A retrospective search of our database disclosed seven women with severe postpartum haemorrhage in whom angiography revealed the presence of a uterine or vaginal artery pseudoaneurysm and who were treated using transcatheter Arterial Embolization. Clinical files were reviewed for possible clinical findings that could suggest pseudoaneurysm as a cause of bleeding. Angiography revealed extravasation of contrast material in five out of seven patients. Transcatheter Arterial Embolization allowed to control the bleeding in all patients and subsequently achieve vaginal suture in four patients with vaginal laceration. No complications related to transcatheter Arterial Embolization were noted. Only two patients had uterine atony, and inefficiency of sulprostone was observed in all patients. Transcatheter Arterial Embolization is an effective and secure technique for the treatment of severe postpartum haemorrhage due to uterine or vaginal artery pseudoaneurysm. Ineffectiveness of suprostone and absence of uterine atony should raise the possibility of a ruptured pseudoaneurysm.
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secondary postpartum hemorrhage treatment with selective Arterial Embolization
Radiology, 1999Co-Authors: Jean-pierre Pelage, D Jacob, M Kardache, D Repiquet, Le O Dref, Philippe Soyer, D Herbreteau, E Houdart, Patrick Schurando, J B TrucAbstract:PURPOSE: To evaluate the efficacy and safety of selective Arterial Embolization of the uterine arteries in the management of intractable delayed postpartum hemorrhage. MATERIALS AND METHODS: Fourteen consecutive women with secondary postpartum hemorrhage were treated with selective Embolization of the uterine arteries. In all cases, hemostatic Embolization was performed because of intractable hemorrhage that could not be controlled with the administration of uterotonic drugs or with uterine curettage. RESULTS: The causes of bleeding included genital tract tears in four women and endometritis in eight women; the endometritis was associated with proved, retained portions of placenta in four women. In two women, no evident cause of bleeding was found before angiography. Angiography revealed extravasation in three women. A false aneurysm of the uterine artery was found in two women. In one patient, an arteriovenous fistula was observed. Immediate resolution of external bleeding was observed in all women. No c...
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life threatening primary postpartum hemorrhage treatment with emergency selective Arterial Embolization
Radiology, 1998Co-Authors: Jean-pierre Pelage, D Jacob, M Kardache, D Repiquet, J. Mateo, Le O Dref, Didier Payen, H. Dahan, Philippe Soyer, J B TrucAbstract:PURPOSE: To prospectively evaluate the efficacy and safety of emergency selective Arterial Embolization in the management of intractable primary postpartum hemorrhage. MATERIALS AND METHODS: Twenty-seven consecutively seen women with life-threatening primary postpartum hemorrhage underwent uterine Embolization. In all cases, hemostatic Embolization was performed because of intractable hemorrhage that could not be controlled with vaginal packing and administration of uterotonic drugs. The mean hemoglobin level before Embolization was 7.48 g/dL +/- 2.39 (74.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in two patients before Embolization failed to stop the bleeding. RESULTS: Angiography revealed extravasation in nine patients and spasm of the branches of the internal iliac artery in five. The procedure consisted of Embolization of uterine (n = 46), vaginal (n = 5), or ovarian (n = 2) arteries or anterior division of internal iliac arteries (n = 8). Immediate disappearance or dramatic diminu...
D Herbreteau - One of the best experts on this subject based on the ideXlab platform.
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uterine necrosis after Arterial Embolization for postpartum hemorrhage
Obstetrics & Gynecology, 2002Co-Authors: J P Cottier, A Fignon, F Tranquart, D HerbreteauAbstract:Abstract BACKGROUND: Selective Embolization is an effective and reputedly safe method of managing pregnancy-related bleeding. However, we report an ischemic uterine necrosis after Arterial Embolization. CASE: The patient had heavy postpartum bleeding treated by Embolization of the uterine arteries using polyvinyl alcohol particles (diameter 150–250 and 300–600 μm) and gelatin sponge pledgets. Her postoperative recovery was complicated by menorrhagia and pelvic pain. Because of the persistent menorrhagia and risk of infection, a hysterectomy was performed. Histopathology of the hysterectomy specimen revealed massive ischemic myometrial necrosis. CONCLUSION: This complication is most likely related to the small size of the particles used. In the management of postpartum bleeding by Arterial Embolization, the material of choice is gelatin sponge pledgets, and the use of small particles should be avoided.
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uterine necrosis after Arterial Embolization for postpartum hemorrhage
Obstetrics & Gynecology, 2002Co-Authors: J P Cottier, A Fignon, F Tranquart, D HerbreteauAbstract:Abstract BACKGROUND: Selective Embolization is an effective and reputedly safe method of managing pregnancy-related bleeding. However, we report an ischemic uterine necrosis after Arterial Embolization. CASE: The patient had heavy postpartum bleeding treated by Embolization of the uterine arteries using polyvinyl alcohol particles (diameter 150–250 and 300–600 μm) and gelatin sponge pledgets. Her postoperative recovery was complicated by menorrhagia and pelvic pain. Because of the persistent menorrhagia and risk of infection, a hysterectomy was performed. Histopathology of the hysterectomy specimen revealed massive ischemic myometrial necrosis. CONCLUSION: This complication is most likely related to the small size of the particles used. In the management of postpartum bleeding by Arterial Embolization, the material of choice is gelatin sponge pledgets, and the use of small particles should be avoided.
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secondary postpartum hemorrhage treatment with selective Arterial Embolization
Radiology, 1999Co-Authors: Jean-pierre Pelage, D Jacob, M Kardache, D Repiquet, Le O Dref, Philippe Soyer, D Herbreteau, E Houdart, Patrick Schurando, J B TrucAbstract:PURPOSE: To evaluate the efficacy and safety of selective Arterial Embolization of the uterine arteries in the management of intractable delayed postpartum hemorrhage. MATERIALS AND METHODS: Fourteen consecutive women with secondary postpartum hemorrhage were treated with selective Embolization of the uterine arteries. In all cases, hemostatic Embolization was performed because of intractable hemorrhage that could not be controlled with the administration of uterotonic drugs or with uterine curettage. RESULTS: The causes of bleeding included genital tract tears in four women and endometritis in eight women; the endometritis was associated with proved, retained portions of placenta in four women. In two women, no evident cause of bleeding was found before angiography. Angiography revealed extravasation in three women. A false aneurysm of the uterine artery was found in two women. In one patient, an arteriovenous fistula was observed. Immediate resolution of external bleeding was observed in all women. No c...
L Marpeau - One of the best experts on this subject based on the ideXlab platform.
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predictors of failed pelvic Arterial Embolization for severe postpartum hemorrhage
Obstetrics & Gynecology, 2009Co-Authors: Loic Sentilhes, A Gromez, Benoit Resch, E Verspyck, Eric Clavier, L MarpeauAbstract:OBJECTIVES: To estimate what factors are associated with a failed pelvic Arterial Embolization for postpartum hemorrhage and to attempt to estimate efficacy of pelvic Arterial Embolization in rare conditions. METHODS: This was a retrospective cohort study including all consecutive women who underwent pelvic Arterial Embolization trial for postpartum hemorrhage between 1994 and 2007 at a tertiary care center. Pelvic Arterial Embolization failure was defined as the requirement for subsequent surgical procedure to control postpartum hemorrhage. RESULTS: Pelvic Arterial Embolization was attempted in 0.3% of deliveries by the same radiologist in 87% of cases. Failures occurred in 11 of 100 cases (11%) and in 4 of 17 cases (24%) of placenta accreta or percreta. The major complication rate after pelvic Arterial Embolization was low (3%). Fifty patients (50%) were transferred from nine other institutions. Pelvic Arterial Embolization was performed in 11 cases (11%) after a failed conservative surgical procedure and in eight cases (8%) for secondary postpartum hemorrhage, with success rates of 91% and 88%, respectively. Pelvic Arterial Embolization demonstrated a patency throughout one ligated pedicle in 9 of the 11 cases of failed conservative surgical procedure (82%). Twin pregnancy, chorioamnionitis, operative vaginal delivery, hospital-to-hospital transfer, nature of embolizing agent and arteries embolized, failed surgical procedure, secondary postpartum hemorrhage, cause of postpartum hemorrhage, and more than one pelvic Arterial Embolization were not found to be significantly associated with failed pelvic Arterial Embolization. CONCLUSION: The only factors significantly associated with failed pelvic Arterial Embolization were a higher rate of estimated blood loss (more than 1,500 mL) and more than 5 transfused red blood cell units. Attempted pelvic Arterial Embolization after a failed vessel ligation procedure and for a secondary postpartum hemorrhage is a good option with high success rates.
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predictors of failed pelvic Arterial Embolization for severe postpartum hemorrhage
Obstetrics & Gynecology, 2009Co-Authors: Loic Sentilhes, A Gromez, Benoit Resch, E Verspyck, Erick Clavier, L MarpeauAbstract:OBJECTIVES:To estimate what factors are associated with a failed pelvic Arterial Embolization for postpartum hemorrhage and to attempt to estimate efficacy of pelvic Arterial Embolization in rare conditions.METHODS:This was a retrospective cohort study including all consecutive women who underwent p
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menses fertility and pregnancy after Arterial Embolization for the control of postpartum haemorrhage
Human Reproduction, 2004Co-Authors: G Descargues, Mauger F Tinlot, F Douvrin, E Clavier, J P Lemoine, L MarpeauAbstract:BACKGROUND: The long-term effects of uterine artery Embolization for the control of postpartum haemorrhage on menses, fertility and future pregnancy evolution have not been assessed. METHODS: Between November 1993 and July 1999, 31 women with obstetric haemorrhage underwent Arterial Embolization. Four patients underwent a hysterectomy. Gynaecological information on 25 of the 27 patients who did not undergo hysterectomy was obtained by interview. RESULTS: All women had a return of normal menses. Nine of the 25 patients desired subsequent pregnancy and five patients became pregnant with normal delay of conception. Moreover, two other patients who did not plan another pregnancy became pregnant. A total of 10 pregnancies was studied, four ended during the first trimester. For the six others, the maternal evolution of the pregnancy was uneventful until term. No case of pre-eclampsia was observed. The ultrasonographic examinations revealed normal fetal growth and umbilical and uterine Doppler studies showed no anomaly. No repetition of obstetric haemorrhage was observed. All full-term, new-borns were healthy, weighing from 3220 to 4100 g. CONCLUSION: Our results suggest that women who undergo Arterial Embolization for obstetric haemorrhage should expect to have a return of normal menses with preservation of future fertility and successful uneventful pregnancies.
J B Truc - One of the best experts on this subject based on the ideXlab platform.
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secondary postpartum hemorrhage treatment with selective Arterial Embolization
Radiology, 1999Co-Authors: Jean-pierre Pelage, D Jacob, M Kardache, D Repiquet, Le O Dref, Philippe Soyer, D Herbreteau, E Houdart, Patrick Schurando, J B TrucAbstract:PURPOSE: To evaluate the efficacy and safety of selective Arterial Embolization of the uterine arteries in the management of intractable delayed postpartum hemorrhage. MATERIALS AND METHODS: Fourteen consecutive women with secondary postpartum hemorrhage were treated with selective Embolization of the uterine arteries. In all cases, hemostatic Embolization was performed because of intractable hemorrhage that could not be controlled with the administration of uterotonic drugs or with uterine curettage. RESULTS: The causes of bleeding included genital tract tears in four women and endometritis in eight women; the endometritis was associated with proved, retained portions of placenta in four women. In two women, no evident cause of bleeding was found before angiography. Angiography revealed extravasation in three women. A false aneurysm of the uterine artery was found in two women. In one patient, an arteriovenous fistula was observed. Immediate resolution of external bleeding was observed in all women. No c...
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life threatening primary postpartum hemorrhage treatment with emergency selective Arterial Embolization
Radiology, 1998Co-Authors: Jean-pierre Pelage, D Jacob, M Kardache, D Repiquet, J. Mateo, Le O Dref, Didier Payen, H. Dahan, Philippe Soyer, J B TrucAbstract:PURPOSE: To prospectively evaluate the efficacy and safety of emergency selective Arterial Embolization in the management of intractable primary postpartum hemorrhage. MATERIALS AND METHODS: Twenty-seven consecutively seen women with life-threatening primary postpartum hemorrhage underwent uterine Embolization. In all cases, hemostatic Embolization was performed because of intractable hemorrhage that could not be controlled with vaginal packing and administration of uterotonic drugs. The mean hemoglobin level before Embolization was 7.48 g/dL +/- 2.39 (74.8 g/L +/- 23.9) (1 standard deviation). Hysterectomy performed in two patients before Embolization failed to stop the bleeding. RESULTS: Angiography revealed extravasation in nine patients and spasm of the branches of the internal iliac artery in five. The procedure consisted of Embolization of uterine (n = 46), vaginal (n = 5), or ovarian (n = 2) arteries or anterior division of internal iliac arteries (n = 8). Immediate disappearance or dramatic diminu...
Nadia Berkane - One of the best experts on this subject based on the ideXlab platform.
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impact of pelvic Arterial Embolization for intractable postpartum hemorrhage on fertility
American Journal of Obstetrics and Gynecology, 2009Co-Authors: Olivia Fiori, Jean-françois Deux, Jeanclaude Kambale, Franck Bougdhene, Serge Uzan, Nadia BerkaneAbstract:Objective This study was to determine the long-term outcomes of Arterial pelvic Embolization for intractable postpartum hemorrhage and particularly its effect on menses, fertility, and outcomes of subsequent pregnancies. Study Design Fifty-six consecutive patients who underwent emergency pelvic Arterial Embolization for severe postpartum hemorrhage between April 1995 and July 2005 were included in the study. Patients were contacted to obtain information about menses and fertility after pelvic Arterial Embolization. Results Thirty-four women (61.8%) were successfully contacted. One patient had a hysterectomy. Thirty women (91%) reported regular menses. Thirteen women (38.3%) had a total of 20 spontaneous pregnancies. Eight pregnancies ended during the first trimester. The 12 other pregnancies (60%) were all normal and all patients delivered vaginally healthy babies with normal weight for gestational age. Conclusion The current study suggests that fertility is not adversely affected by Arterial pelvic Embolization for intractable postpartum hemorrhage and that women can conceive after the procedure with normal pregnancy outcomes.
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impact of pelvic Arterial Embolization for intractable postpartum hemorrhage on fertility
American Journal of Obstetrics and Gynecology, 2009Co-Authors: Olivia Fiori, Jean-françois Deux, Jeanclaude Kambale, Franck Bougdhene, Serge Uzan, Nadia BerkaneAbstract:Objective This study was to determine the long-term outcomes of Arterial pelvic Embolization for intractable postpartum hemorrhage and particularly its effect on menses, fertility, and outcomes of subsequent pregnancies. Study Design Fifty-six consecutive patients who underwent emergency pelvic Arterial Embolization for severe postpartum hemorrhage between April 1995 and July 2005 were included in the study. Patients were contacted to obtain information about menses and fertility after pelvic Arterial Embolization. Results Thirty-four women (61.8%) were successfully contacted. One patient had a hysterectomy. Thirty women (91%) reported regular menses. Thirteen women (38.3%) had a total of 20 spontaneous pregnancies. Eight pregnancies ended during the first trimester. The 12 other pregnancies (60%) were all normal and all patients delivered vaginally healthy babies with normal weight for gestational age. Conclusion The current study suggests that fertility is not adversely affected by Arterial pelvic Embolization for intractable postpartum hemorrhage and that women can conceive after the procedure with normal pregnancy outcomes.