Clinical Study Of Ovarian Artery Embolization In Interventional Therapy Of Uterine Bleeding

Background and objectivePregnancy and childbirth diseases and rupture of uterine tumor cause massive uterine bleeding(the amount of bleeding within 24 hours is more than 1000ml),which endangers the life of patients.Intermittent bleeding caused by uterine fibroids affects the physical and mental health of patients.Since the first application of uterine arterial embolization(UAE)for postpartum hemorrhage in 1979,it has achieved good results in the treatment of maternal hemorrhage.It is a minimally invasive,safe and effective interventional procedure with few complications and can retain the uterus.With the progress and development of transcatheter embolization technology,as well as the deeper understanding of the effectiveness and safety of UAE,it has been widely used in the interventional treatment of uterine bleeding.In recent years,the incidence of refractory maternal bleeding has increased with the release of the second child policy.More attention should be paid to the advantages of interventional therapy in the treatment of refractory maternal bleeding,which is safe and effective,rapid and reliable hemostasis,and uterine retention.Pelvic arterial embolization(PAE),including internal iliac arterial embolization(IIAE)and uterine arterial embolization,has proven to be a first-line solution to save patients with severe obstetric and gynecological bleeding.However,some patients still have no effective control of uterine bleeding after PAE,because the blood vessels responsible for uterine bleeding may not be limited to the uterine artery or internal iliac artery.After PAE,the ovarian artery becomes the main blood supply vessel,which can cause uterine bleeding to be not effectively controlled.The purpose of this article is to retrospectively analyze the clinical data of 82 patients with ovarian arteries participating in uterine bleeding disorders,and to explore the effectiveness,safety,and application process and timing of ovarian arterial embolization(OAE)in interventional treatment of uterine bleeding disorders.Materials and methodsWe collected clinical data of 82 patients with ovarian artery participating in the blood supply of uterine bleeding disease from January 2010 to June 2019 in the First Affiliated Hospital of Zhengzhou University.70 patients received OAE,and 12 patients did not receive OAE.All patients underwent uterine pelvic artery embolization by DSA.5F catheter was inserted into the contralateral uterine artery and then embolization was performed.After the embolization,the catheter became a loop and entered the uterine artery at the puncture side for embolization.The anterior trunk and uterine artery of internal iliac artery could be simultaneously embolized in patients with severe bleeding.After pelvic artery embolization,we press the uterus or remove the uterine cavity to pack gauze to observe the hemostasis.27 cases of bleeding were not controlled and the ovarian artery was found to be involved in the blood supply,so OAE was supplemented.After uterine bleeding is controlled by UAE,abdominal aorta and OA angiography were performed in 45 patients with high risk factors that ovarian artery is the blood supply.The patients and their families were fully informed of the significance and risk of ovarian artery embolization.Among them,19 patients underwent ovarian artery embolization and 26 patients did not receive OAE.10 patients stopped bleeding after UAE,and no obvious ovarian arterial blood supply was seen on the angiography.During the hospital stay,they rebleeded again.OA became the main blood supply artery during re-intervention,and ovarian artery embolization was performed.When embolizing the ovarian artery,the 4?5F catheter and microcatheter are selected to release the embolizer to the distal end of the OA and close to the abnormal blood vessel.The embolization is performed with gelatin sponge particles.Results1 Ovarian arteriography and embolismThe diameter of the ovarian artery participating in the blood supply was thickened,ranging from 1.2 to 4.7 mm(average 3.0 ±0.9 mm).The peripheral branches were significantly increased and disordered.Contrast overflow was seen in 45 cases and vascular staining of uterine leiomyoma were seen in 24 cases.There were 48 cases of unilateral embolization(35 cases of distal embolism,13 cases of proximal embolism),22 cases of bilateral embolism,and 12 cases without embolization.2 Control of uterine bleeding after OAE56 patients with OA participating in the blood supply of the disease and received OAE,54 of them did not rebleed,2 had recurrent bleeding and hysterectomy.Of the 26 patients with OA participating in the blood supply of the lesion who did not receive OAE,14 of them relapsed into hemorrhage,controling bleeding after OAE.supplementing with OAE can control bleeding The risk of recurrent major bleeding without OAE was low(P<0.001).The postoperative average hemoglobin content is(101.3±15.6)g/L,which is higher than the preoperative average hemoglobin content(63.6±11.8)g/L(P<0.001).3 Ovarian function after OAE19 cases(10 cases with bilateral embolism,5 cases with unilateral proximal embolism,3 cases with unilateral distal embolism,and 1 case without OAE)had symptoms of ovarian failure after operation,but all of them were reversible,lasting for 2?6 months.Compared with the incidence of ovarian dysfunction,bilateral embolism was higher than those with unilateral embolism(P=0.011),and proximal embolism was more likely than those with distal embolism(P=0.042).Compared with UAE alone,unilateral embolism is not Increasing the incidence of ovarian failure(P=0.786)and bilateral embolism can the incidence of ovarian failure(P=0.030).The levels of follicle stimulating hormone(FSH)and luteinizing hormone(LH)in 15 patients were higher than those before operation at 1 week,1 month and 3 months after operation,and estradiol(E2)was lower than that before operation,and the hormone values were restored to normal at 6 months after operation.4 Follow-up after OAEPlacenta implants were excreted from the body within 1 to 2 weeks after surgery,and patients with ectopic pregnancy,scar pregnancy and placenta previa had bleeding less than 400mL;The menstrual volume of patients with uterine fibroids significantly reduce,and hemoglobin increase to normal levels and there is no recurrence of myoma;some patients had post-embolization syndrome,and symptomatic treatment could be relieved.No pelvic organ necrosis occurred,such as uterus and ovary.Conclusion1.In the interventional treatment of patients with uterine bleeding,it is significant and safe to supplement OAE when OA is involved in the blood supply of uterine bleeding patients.We can quickly and effectively control bleeding and reduce the risk of recurrent massive bleeding by OAE,and it is valuable for the treatment of primary uterine bleeding.2.When performing ovarian arterial embolization,we can reduce the incidence of ovarian dysfunction through distal embolization and unilateral embolization.The use of short and medium-term embolic agents is helpful to the recovery of ovarian function and reduce complications.