Abstract No. 459 Technical success and safety of transradial approach for embolization in the setting of obstetrical and gynecological hemorrhage: a single-center experience

Abstract

To retrospectively evaluate the efficacy and safety of using a transradial approach (TRA) for embolization in the setting of emergent obstetrical (OB) and gynecological (GYN) hemorrhage. TRA for management of pelvic hemorrhage may minimize patient discomfort and enhance ease of access relative to traditional femoral access in the presence of lithotomy positioning and recent pelvic surgery. All patients who underwent TRA embolization of refractory postpartum OB or GYN hemorrhage with significant hemodynamic compromise between 1/2013 and 12/2018 were retrospectively reviewed. Patient demographics, procedural details, technical success (defined as absence of extravasation on post-embolization angiography), adverse events (AEs) and clinical success (defined as hemodynamic stabilization) were reviewed. A total of 20 women (mean age 32, range 23-65) with acute uterine or vaginal hemorrhage were embolized using TRA. Indications for embolization included: post-partum hemorrhage (n=18), post gynecological surgery hemorrhage (1) and spontaneous bleeding from malignancy (1). A 4F 125cm VERT catheter was used in all cases to cannulate the internal iliac artery. Technical success was achieved in all patients. Clinical success was achieved in 95% of patients; 1 patient required repeat embolization for continued hemorrhage at 1 day. All patients received 3000 U intra-arterial heparin, 200ug nitroglycerin and 2.5 mg verapamil via radial sheath as per standard TRA technique. Patients were embolized with n-BCA liquid embolic (8), particles (8) or Gelfoam slurry (4). Embolized vessels included: unilateral uterine (4), bilateral uterine (13), hypogastric (4), internal pudendal (2) and vaginal (1). AEs included: minor radial arteritis (1) which resolved with conservative management. No major access site bleeding or ischemic AEs were noted. TRA for embolization of acute OBGYN hemorrhage, particularly in the setting of recent pelvic intervention is safe and effective.