Severe Vaginal Bleeding Treated with a Stent Graft

Abstract

Introduction tumour in the upper part of the vagina. The bleeding suddenly increased and became life threatening with Pelvic and genital haemorrhage is a major cause of hypovolaemic shock within hours after admission. Partially haemostasis was achieved by immediate morbidity and mortality in many gynaecological and obstetrical disorders and is often a major therapeutic transvaginal and aortic compression. Blood replacement was administered. Surgery was not conchallenge, especially in patients with malignant disease. In recent years, several case reports have demsidered as a possibility due to the patient’s unstable condition. It was decided to achieve haemostasis onstrated the effectiveness of percutaneous transluminal arterial embolisation in controlling through a percutaneous transluminal endovascular procedure. Haemostasis was initially achieved by plagynaecological haemorrhage when branches of the internal iliac artery are involved. However, incing a balloon (14 mm in diameter, Olbert balloon, Boston Scientific/Medi-tech, MA, U.S.A.) in the abvolvement of the external iliac artery seems much more uncommon and a different endovascular therapeutic dominal aorta below the renal arteries introduced through the left common femoral artery (Fig. 1). Angioapproach seems necessary. We describe an endovascular stent graft placement over an erosion of graphy, obtained from the right common femoral artery, revealed an erosion of the right external iliac the external iliac artery in a patient with recurrent endometrial carcinoma presenting with life-threatartery 3 cm from its origin which was haemorrhaging directly into the vagina (Fig. 2). ening vaginal bleeding. Through a 9 Fr. introducer sheath in the right common femoral artery a self-expanding nitinol stent graft (Passager stent graft, Boston Scientific, MA, U.S.A.) Case Report with a diameter of 8 mm and length of 6 cm was placed over the guide wire covering the erosion. Control A 64-year-old woman underwent radical hysterectomy angiography demonstrated a patent external iliac arand bilateral salpingo-oophectomy for endometrial tery without any leak (Fig. 3). The balloon in the distal adenocarcinoma in January 1996. No adjuvant therapy part of the aorta was deflated and there was no sign was given. Local recurrence was diagnosed 10 months of recurrent bleeding. The patient received 11 units of later and treated with external radiation therapy blood from the time of presentation to haemostasis. (46 Gy). Metastases in two vertebral bodies were disShe died 3 days later due to general deterioration, covered in May 1999, and the patient received local there was no evidence of recurrent vaginal bleeding radiation therapy (28 Gy) supplemented with horat this time. monal therapy. In November 1999, the patient was hospitalised with lower abdominal pain and acute vaginal bleeding. Gynaecological examination revealed an ulcerating Discussion