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Specific Management of PPH
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
The arteriovenous malformation can be managed conservatively with antibiotics and component therapy if the bleeding is not excessive. Blood and component transfusion is necessary to build up the haemoglobin. These women are likely to have episodic bleeding. Uterine artery or internal iliac artery embolisation through the femoral artery can be electively planned. Ultimately, if the bleeding becomes torrential and does not respond to or if the procedure of embolisation fails, then hysterectomy may be resorted to for stopping torrential bleed for cases of acquired AVM. Rarely direct injection to embolise the AVM has been tried to conserve the uterus.
Embryology, Anatomy, and Physiology of the Bladder
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Allan Johnston, Tarik Amer, Omar Aboumarzouk, Hashim Hashim
Branches of the anterior trunk of the internal iliac artery (Figure 10.5):Superior and inferior vesical arteriesObturator arteryInferior gluteal artery
Normal Anatomy of the Female Pelvis and Sonographic Demonstration of Pelvic Abnormalities
Published in Asim Kurjak, Ultrasound and Infertility, 2020
Pelvic vessels are much more clearly defined on an ultrasound scan. They are sonographically demonstrated as tubular structures characterized by an anechoic lumen and hyperechoic walls. The internal iliac artery is seen by performing an oblique scan posteriorly and laterally to the ovaries. It can be easily distinguished from the internal iliac vein, which is typically located posterior to the artery. If a real-time machine is used, pulsations of the artery are easily seen while the diameter of the vein is constant. The external iliac artery and vein are also routinely imaged on an oblique scan directed through the bladder to the contralateral pelvic wall. The external iliac vein sometimes can be compressed by an overfull urinary bladder, so that only the artery is visualized. The ovarian artery approaches the ovary from its lateral and posterior aspect, and being relatively thin, is not regularly seen. However, meticulous scanning of the lateral periovarian space will demonstrate in 60 to 70% of examined women the ovarian artery and vein which reach the ovaries via the mesovarium. Because of their small diameter and variable ovarian position, it is difficult to distinguish between the artery and vein. Although there were several reports describing marked dilatation of the ovarian vessels at the periovulatory phase of the cycle,25 we were not able to confirm this in spite of systematic scanning of patients during the late follicular phase of the cycle until ovulation (Figures 16 to 20).28
Uterine artery pseudoaneurysm haemorrhage requiring semi-urgent caesarean section: a multidisciplinary approach
Published in Journal of Obstetrics and Gynaecology, 2019
Aaron Rohr, Hasnain Hasham, Aaron Frenette, Ryan Ash, Philip Johnson, Thomas Fahrbach
A right common femoral artery approach was used with a 5F vascular sheath (Merit Medical, South Jordan, UT) over a wire into the infrarenal abdominal aorta. A 0.035 Glidewire (Terumo, Somerset, NJ) was used to select the left external iliac artery. A 5 French JB 1 catheter (Cook, Bloomington, IN) was utilised to confirm the catheter placement within the left internal iliac artery. A left uterine artery pseudoaneurysm was identified arising from the anterior division of the left internal iliac artery, which is the most common anatomical origin. A Fogarty balloon (Edwards Lifesciences, Irvine, CA) was positioned within the mid aspect of the left internal iliac artery. The balloon was inflated with approximately 0.5 mL contrast/saline solution. A contrast injection then demonstrated complete the occlusion of the left internal iliac artery without extravasation from the pseudoaneurysm. The occlusion balloon remained inflated for the emergency caesarean section. The foetal monitoring post-balloon inflation demonstrated that there were no significant cardiotocography (CTG) abnormalities.
Balloon occlusion technique for embolization of unselectable hemorrhaging pelvic arteries in the setting of traumatic pelvic fractures
Published in Baylor University Medical Center Proceedings, 2018
Sean Gipson, Mathew Weissenborn, Chip Bell, Chet Rees
Access was obtained with a 25-cm-long 5 French sheath in the left common femoral artery. A Cobra catheter was passed into the contralateral right internal iliac artery, where digital subtraction angiography (DSA) demonstrated two areas of active contrast extravasation from the presumed internal pudendal and obturator arteries, compatible with hemorrhage secondary to traumatic lacerations (Figure 1b). From here, a microcatheter (Pro-Great, Terumo, Somerset, NJ) was advanced coaxially through the base catheter with initial selection of the internal pudendal artery. Position was confirmed within the pudendal artery with injected contrast. A gelatin embolization (Gelfoam, Pfizer, New York, NY) slurry was injected until slowed flow and pruning of the distal vessels was observed. The following DSA confirmed satisfactory embolization.
MRI to investigate iliac artery wall thickness in triathletes
Published in The Physician and Sportsmedicine, 2018
Susanne Regus, Veronika Almási-Sperling, Rolf Janka, Ulrich Rother, Michael Lell, Alexander Meyer, Werner Lang
All datasets were sent to a 3D workstation (Leonardo VD10B, Siemens). Patient identification tags were removed. At the beginning of each measuring, an intensive screening for abnormities as arterial stenosis, aneurysms, or occlusion was performed for all aortic and iliac vessels. Afterward further investigations followed. Measurement parameters were diameter and wall thickness of the CIA and EIA nearby the iliac bifurcation. The examinations were all scored retrospectively by two investigators who were blinded to the complaints of the subjects and each other’s results. Each investigator performed 3 measurements with an interval of at least 2 weeks between the sessions to reduce bias introduced by recall of cases. Measurements were performed on image planes oriented perpendicular to the vessel and were taken 5 mm above and below the origin of the internal iliac artery.