Repeated pulmonary embolism with cardiac arrest after uterine artery embolization for uterine arteriovenous malformation: A case report and literature review

Balkenze Imankulova; Milan Terzic; Talshyn Ukybassova; Gauri Bapayeva; Timur Lesbekov; Gulnar Mustafinova; Nurlan Smagulov; Fariza Shauyen

doi:10.1016/j.tjog.2018.10.021

Repeated pulmonary embolism with cardiac arrest after uterine artery embolization for uterine arteriovenous malformation: A case report and literature review

Taiwan J Obstet Gynecol. 2018 Dec;57(6):890-893. doi: 10.1016/j.tjog.2018.10.021.

Authors

Balkenze Imankulova¹, Milan Terzic², Talshyn Ukybassova¹, Gauri Bapayeva¹, Timur Lesbekov³, Gulnar Mustafinova⁴, Nurlan Smagulov³, Fariza Shauyen¹

Affiliations

¹ Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, 010000, Kazakhstan.
² Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, 010000, Kazakhstan; Department of Medicine, Nazarbayev University, School of Medicine, Astana, 010000, Kazakhstan; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15213, USA. Electronic address: terzicmilan@yahoo.co.uk.
³ Cardiac Surgery Unit №1, National Research Cardiac Surgery Center, Astana, 010000, Kazakhstan.
⁴ Adults Intensive Care Unit, National Research Center of Mother and Child Health, University Medical Center, Astana, 010000, Kazakhstan.

PMID: 30545548
DOI: 10.1016/j.tjog.2018.10.021

Abstract

Objective: Uterine arteriovenous malformation (AVM) is an abnormal and nonfunctional communication between uterine arteries and veins, currently managed by uterine artery embolization (UAE). Pulmonary embolism (PE) is the most severe and life-threatening complication of this procedure.

Case report: We report a case of 27 year-old woman with heavy vaginal bleeding and abdominal pain caused by AVM. UAE was performed uneventfully, but 2 h after the procedure the first attack of pulmonary embolism occurred, treated by anticoagulation therapy. Second attack happened on the third postinterventional day. Considering vaginal bleeding, continued extracorporeal membrane oxygenation (ECMO), and suspicion of embolic particles arising from uterus, a subtotal hysterectomy was done. Patient was discharged two weeks following surgery, after complete recovery.

Conclusion: Although AVM is managed by UAE, clinicians must be aware of complications. To avoid PE, we suggest only large sized microspheres for carefully selected patients.

Keywords: Pulmonary embolism; Uterine arteriovenous malformation; Uterine artery embolization.

Publication types

Review

MeSH terms

Adult
Arteriovenous Malformations / diagnostic imaging
Arteriovenous Malformations / surgery*
Female
Heart Arrest / etiology*
Heart Arrest / therapy
Humans
Postoperative Complications / etiology
Postoperative Complications / therapy
Pregnancy
Pulmonary Embolism / etiology*
Treatment Outcome
Uterine Artery / abnormalities*
Uterine Artery / diagnostic imaging
Uterine Artery / pathology
Uterine Artery / surgery
Uterine Artery Embolization / adverse effects*