Embolization with gelatin foam in the management of vascularized retained products of conception: a multicenter study by the French Society of Cardiovascular Imaging

期刊论文
发表日期：

2024年11月19日

查看全文

Julien Ghelfi,
Clément Marcelin,
Alexandre Buisson,
Eliott Mathieu,
Loic Sentilhes,
Thibault Thubert,
Antoine Boizet,
Marco Midulla,
Hélène Kovacsik,
Sébastien Caudron,
Francine Thouveny,
Maxime Barat,
Julien Frandon,
Pierre-Antoine Barral,
Aurélie Delouche,
Arthur David

摘要

Objectives

Vascularized retained products of conception (vRPOC) are the most frequent cause of delayed hemorrhage after abortion, spontaneous miscarriage, or delivery. This study evaluated the efficacy of uterine artery embolization (UAE) with gelatin foam in the management of symptomatic of vRPOC.

Materials and methods

This retrospective study included patients who underwent UAE with gelatin foam for vRPOCs with vaginal bleeding between January 2018 and December 2022 in 11 French university hospitals. Embolization was performed using either gelatin foam torpedoes or sludge. The primary endpoint was the clinical success of embolization (cessation of bleeding at approximately 1 month after UAE). The secondary objectives were the success of imaging (no persistent vRPOC at imaging follow-up), the safety of UAE, and the predictive factors of clinical and imaging failure.

Results

Two hundred twenty-four patients (median age, 30.5 years ± 5.7 [standard deviation]) were included. Clinical success was achieved in 212 patients (94.2%). One hundred sixty-five patients had imaging follow-ups, among whom 12 patients (7.3%) had persistent vascularization. According to the SIR classification, 30 patients (13.4%) had minor complications, and two patients (0.8%) had major complications (endometritis n = 1; ischemic uterine necrosis n = 1). No predictive factors of clinical success were found, but the presence of a hypertrophic uterine artery (OR = 0.6 [0.38–0.97], p = 0.045) and the use of gelatin foam torpedoes (OR = 0.57 [0.42–0.77], p = 0.0012) were associated with a greater risk of persistent vRPOC on imaging control.

Conclusion

UAE with gelatin foam is safe and effective for treating hemorrhagic vRPOC.

Key Points

Question Uterine vacuity is frequently observed on ultrasound after UAE for vRPOC.

Findings A hypertrophic uterine artery and the use of gelatin foam torpedoes are associated with an increased risk of persistent vRPOC.

Clinical relevance Embolization with gelatin foam is efficient and safe for treating bleeding in vRPOC.