Uterine necrosis following uterine artery embolization: case report and literature review

Background: A cesarean scar pregnancy (CSP) is a high -risk pregnancy that can result in uncontrollable bleeding, hysterorrhexis, peripheral visceral injury, and hysterectomy during or after curettage. Uterine artery embolization (UAE) is an important adjuvant therapy that can be performed for CSP types II and III to decrease the risk of bleeding; however, it may be associated with severe complications, such as uterine necrosis. Uterine necrosis is a major complication of embolization; however, it is extremely rare today. We conducted a search of English articles on PubMed and found 21 reports of uterine necrosis following uterine artery embolization. Our literature search did not identify any reports of uterine necrosis following uterine artery embolization for a cesarean scar pregnancy. Case Description: We present the case of a 43 -year -old woman diagnosed with type III cesarean scar pregnancy and adenomyosis, who underwent uterine artery embolization (prior to curettage) that resulted in a large area of uterine necrosis. We performed a hysterectomy and bilateral salpingectomy. Conclusions: In conclusion, although uterine necrosis is a major complication of embolization, it is extremely rare today. Uterine artery embolization must be practiced with caution, using large polyvinyl alcohol particles (>500 mu m) and/or gelatin sponges >500 mu m. Physicians should strictly control the indications for UAE and master the technique explicitly.