Transarterial Pelvic Artery Embolization in Vaginal Bleeding Due to Advanced Gynecological Malignancy: A Comprehensive Review

Advanced gynecological cancers run a chronic course and tend to recur, and these patients have to undergo a great deal of physical, mental, and emotional anguish in the final phase of their life. Multiple distressing symptoms are associated with the advanced disease, and one of them is vaginal bleeding, which is also a common presenting symptom, but can also be life-threatening. As in developing countries like India, it is common for ailing women to seek treatment when the disease has already advanced and metastasized. The primary goals of care in the terminal stage include control of symptoms and maintaining the quality of life. If there are distant metastases with a very short life expectancy, simple conservative measures like vaginal packing, blood replacement, or hemostatic injections can be tried. But in cases of life-threatening vaginal bleed, selective pelvic vessel embolization can be a useful alternative to surgery. This review article highlights the role of the interventional radiologist in the management of vaginal bleeding in patients with advanced gynecological cancers.