Abstract No. 629 - Endovascular management of gonadal artery hemorrhage

Abstract

1) Discuss the epidemiology and mechanism of gonadal artery hemorrhage. 2) Review pertinent anatomical and imaging considerations. 3) Highlight techniques and principles for endovascular management of gonadal artery hemorrhage. 4) Discuss follow up care, postembolization imaging, and potential complications. Gonadal artery injury is rarely encountered in clinical practice. Gonadal artery hemorrhage is most frequently seen in the setting of iatrogenic injury, blunt or penetrating trauma. In addition, ovarian artery hemorrhage has been reported due to spontaneous rupture of aneurysms during the puerperal period. Historically, these patients were managed surgically; however recent case reports have demonstrated the feasibility of endovascular treatment. Endovascular management of the gonadal artery hemorrhage is technically challenging due to anatomical considerations, particularly in postoperative patients. This exhibit includes four cases of gonadal artery hemorrhage of differing etiologies. The discussion includes evaluation of the preprocedure imaging as well as a discussion of the technique involved in each case. In particular, we will discuss different strategies for successful and stable access to tortuous gonadal arteries. We will also discuss various embolic materials (including cyanoacrylate, coils, and particles) along with considerations for choice of embolic agent. We also demonstrate management of gonadal arteriovenous fistulae as well as tumor related hemorrhage. Gonadal artery hemorrhage is a rare but potentially life-threatening clinical entity. Proper evaluation by preprocedure imaging, technical considerations, and embolic agent choice are key for successful and safe endovascular management of gonadal artery hemorrhage.