Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Clinical and Angiographic Features of Secondary Postpartum Hemorrhage and the Outcomes of Transcatheter Arterial Embolization

속발성 분만 후 출혈의 임상 및 혈관 조영술의 특징과 경도관 동맥 색전술의 결과

  • Baek, Seung Dae (Department of Radiology, Daegu Catholic University Medical Center, Catholic University of Daegu College of Medicine) ;
  • Kang, Ung Rae (Department of Radiology, Daegu Catholic University Medical Center, Catholic University of Daegu College of Medicine) ;
  • Ji, Seung Woo (Department of Radiology, Daegu Catholic University Medical Center, Catholic University of Daegu College of Medicine) ;
  • Kim, Young Hwan (Department of Radiology, Daegu Catholic University Medical Center, Catholic University of Daegu College of Medicine) ;
  • Cha, Jung Guen (Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine)
  • 백승대 (대구가톨릭대학교 의과대학 대구가톨릭대학교병원 영상의학과) ;
  • 강웅래 (대구가톨릭대학교 의과대학 대구가톨릭대학교병원 영상의학과) ;
  • 지승우 (대구가톨릭대학교 의과대학 대구가톨릭대학교병원 영상의학과) ;
  • 김영환 (대구가톨릭대학교 의과대학 대구가톨릭대학교병원 영상의학과) ;
  • 차중근 (계명대학교 의과대학 동산병원 영상의학과)
  • Received : 2018.04.11
  • Accepted : 2018.09.20
  • Published : 2018.12.01
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Abstract

Purpose: To analyze the clinical and angiographic features with outcome of transcatheter arterial embolization in patients with secondary postpartum hemorrhage. Materials and Methods: Clinical details and angiographic features with assessment of arterial embolization were reviewed in total 38 patients underwent arterial embolization at single tertiary referral center. Results: Twenty patients (53%) had Cesarean section. The major causes of bleeding were iatrogenic vascular injury, and retained placenta (55%). The patterns of vaginal bleeding were recorded as intermittent (50%), or as persistent (50%). Seven patients (18%) were hemodynamically unstable at presentation. Positive angiographic findings appeared in eighteen patients (47.3%). The frequency of pseudoaneurysm was statistically high in the Cesarean section (p < 0.001). The used embolic agents except gelfoam were N-butyl cyanoacrylate (n = 7), and microcoil (n = 7). Unilateral selective embolization (26.3%) was shown effective in superselective embolization of bleeding focus. Technical and clinical success rate were 100% and 97.4%, respectively with no complication. Sixteen resumed regular menstruation, and one pregnancy were observed in patients with available follow-up of over 6 months. Conclusion: Considerable rate of hemodynamically unstable patients was observed with high rate of positive angiography findings. Given high successful rate and few complications, early angiographic assessment with embolization should be considered.

목적: 속발성 분만 후 출혈 환자에서 임상 양상 및 혈관 조영술의 특징과 경도관 동맥 색전술의 결과를 알아보고자 하였다. 대상과 방법: 속발성 분만 후 출혈로 인해 단일 3차 의료기관에서 동맥 색전술을 시행한 38명의 환자를 대상으로 분만 방식, 출혈 원인, 임상 증상, 혈관 조영술 소견, 색전 물질과 방법, 결과 등에 대하여 후향적으로 분석하였다. 결과: 20명(53%)의 환자가 제왕절개를 시행하였으며, 출혈 원인은 의인성 혈관 손상(n = 11), 잔류 태반(n = 10), 자궁근 무력증(n = 8), 후천성 자궁 동정맥 기형(n = 5) 등이었다. 간헐적(50%) 및 지속적(50%) 대량 질 출혈이 임상적으로 관찰되었다. 7명(18%)의 환자에서 내원 시 저혈량 쇼크를 보였다. 혈관 조영술 상 18명이 양성 소견을 보였으며, 제왕절개 후 가성동맥류 빈도가 통계학적으로 의미 있게 높았다(p < 0.001). 젤폼 이외에 N-butyl cyanoacrylate (7예), 미세 코일(7예)을 사용하였다. 출혈 부위 초선택이 가능하였던 10명의 환자(26.3%)에서는 단측 혈관 선택 색전술만으로 지혈이 성공적이었다. 기술적 성공률은 100%였으며, 임상적 성공률은 97.4%이었다. 추적 관찰이 가능했던 16명에서 정상 월경 주기를 보였으며, 1예의 정상 임신이 관찰되었다. 결론: 속발성 분만 후 출혈은 저혈량 쇼크를 보일 수 있으며, 양성 출혈 소견을 보이는 빈도가 높았다. 따라서 조기 혈관 조영술과 동맥 색전술이 필요하리라 생각된다.

Keywords

References

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