ABSTRACT

Between 1991-2004, 9 patients with vaginal bleeding ranging in age from 28 to 53 years (mean; 45.3 years) were treated with endovascular embolization therapy. The causes of massive vaginal bleeding were; gynecological malignancy in 8 cases, and arterial pseudoaneurysm formation following postpartum subtotal hysterectomy in 1 case. We used polivynil alcohol (PVA) particles in cases of gynecological malignancies, and Gelfoam in the postpartum case as embolizing agents. The results were retrospectively analysed.

Diagnostic angiograms demonstrated tumoral blush in all cases with pelvic malignancies fed by the branches of both internal iliac artery. In obstetric case, a pseudoaneurysm at lateral wall of the cervix and the vaginal cuff, which was the source of bleeding. The embolization procedures were technically successful and vaginal bleeding was controlled after embolization in all cases. In two cases, with gynecological malignancy, 20% and 30% residual tumoral blush were seen, respectively. The latter case rebleeded after 4 months, and re-embolization was performed successfully. In all other cases, there were no recurrent vaginal bleeding.

The endovascular embolization is a safe and effective treatment in massive or intractable vaginal bleeding. Because of various factors (lower mortality and morbidity rates, preservation of surgical options even after unsuccesful embolization), the endovascular embolization should be kept in mind as a first treatment modality.

Keywords: vaginal bleeding, endovascular embolization