Postpartum Hemorrhage from Extravasation or Pseudoaneurysm: Efficacy of Transcatheter Arterial Embolization Using N-Butyl Cyanoacrylate and Comparison with Gelatin Sponge Particle

Purpose: To evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) using N-butyl cyanoacrylate (NBCA) for the treatment of active postpartum hemorrhage (PPH) and compare the efficacy of NBCA with gelatin sponge particles. Materials and Methods: From January 2004 to September 2013, 26 patients with PPH underwent TAE Using NBCA as the primary embolic material. All patients were actively bleeding, and 12 (46.2%) had coagulopathy. TAE was performed using 1:2-1:4 mixtures of NBCA and ethiodized oil with or without use of a coil or gelatin sponge. To compare the efficacy of NBCA. with conventional embolic material, 50 patients with active bleeding who underwent TAE using gelatin sponge were also analyzed. Results: Angiograms demonstrated pseudoaneurysm or extravasation or both. The technical and clinical success, rates were 100% and 92.3% (24 of 26 patients), respectively, for NBCA and 98% and 86.0% (43 of 50 patients), respectively; for gelatin sponge. In NBCA group, one patient recovered with conservative management and the other patient died because of multiorgan dysfunction, There were no major or minor procedure-related complications. Conclusions: TAE using NBCA as the primary embolic agent is, art effective method for treating PPH with extravasation or pseudoaneurysm; NBCA is comparable to gelatin sponge particles TAE using NBCA seems to fill pseudoaneurysms and Make devascularization more effective than using gelatin sponge.