Uterine Arteries Embolization—A Rescue Tool for Acute Vaginal Bleeding in Late Stages of Gynecologic Malignancies

Abstract

Uterine Arteries Embolization—A Rescue Tool for Acute Vaginal Bleeding in Late Stages of Gynecologic Malignancies Roxana Elena Bohîlțea1,2,*, Bogdan Dorobaț3 , Maria Mădalina Doldur4 , Ana-Maria Cioca4 , Ionița Ducu5,*, Bianca Margareta Mihai2 , Corina-Aurelia Zugravu1,6 , Corina Grigoriu1,7,*, Valentin Varlas1,2 1Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania 2Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania 3Department of Interventional Radiology, Bucharest University Emergency Hospital, 050098 Bucharest, Romania 4 “Carol Davila” University of Medicine and Pharmacy, Faculty of Medicine, 020021 Bucharest, Romania 5Department of Obstetrics and Gynecology, Life Memorial Hospital, 010719 Bucharest, Romania 6Fundamental Sciences Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania 7Department of Obstetrics and Gynecology, Bucharest University Emergency Hospital, 050098 Bucharest, Romania *Correspondence: dr.bohiltea@gmail.com (Roxana Elena Bohîlțea); ionitaducu@gmail.com (Ionița Ducu); corigri@gmail.com (Corina Grigoriu) Academic Editor: Michael H. Dahan Submitted: 26 January 2022 Revised: 18 March 2022 Accepted: 28 March 2022 Published: 15 June 2022 Abstract Background: Uterine arteries embolization (UAE) is a minimally invasive procedure with good results when it is used as interventional treatment for patients diagnosed with benign or malignant uterine tumors. The main gynecological malignancies that are complicated by hemorrhages and would benefit from UAE are cervical cancer and endometrial cancer in late inoperable stages or following surgery. Methods: During five years, in the Bucharest University Emergency Hospital’s Obstetrics and Gynecology Department, from 605 patients to whom trans-catheter embolization of the uterine arteries was performed, 33 (5.45%) were diagnosed with cervical cancer (n = 31) and endometrial cancer (n = 2) in the advanced stage addressed for heavy acute vaginal bleeding and secondary anemia. Results: For those patients, UAE was used as palliative treatment. The average age of the patients in the evaluated group was 48.7 ± 8.3 years, and the average number of days of hospitalization was 4.72 ± 2.97 (range 1–11). The benefits of UAE include cessation of bleeding in up to 100% of cases and expanding the window of opportunity for secondary anemia correction. The most common side effects (pain, nausea) could be managed with mild analgesics and easily-accessible antiemetics. Conclusions: Considering these patients’ fragile advanced oncological status, surgical ligation should be adopted only in centers where UAE is not available. The article strengthens the need for interventional radiology departments in all regional emergency centers. Keywords: uterine artery embolization; cervical cancer; endometrial cancer; acute uterine bleeding; palliation; heavy vaginal bleeding; secondary anemia; mesh