Collateral Uterine Arterial Supply in the Setting of Various Uterine Pathologies

Christine E. Boone; Yilun Koethe; Maureen P. Kohi; Evan D. Lehrman

doi:10.1055/s-0038-1676166

Journal of Clinical Interventional Radiology ISVIR, Table of Contents

CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2018; 02(03): 191-196
DOI: 10.1055/s-0038-1676166

Pictorial Essay

Indian Society of Vascular and Interventional Radiology

Collateral Uterine Arterial Supply in the Setting of Various Uterine Pathologies

Christine E. Boone

¹Department of Medicine, Santa Clara Valley Medical Center, San Jose, California, United States

,

Yilun Koethe

²Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States

,

Maureen P. Kohi

²Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States

,

Evan D. Lehrman

²Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States

› Author Affiliations

Abstract

In most patients, bilateral uterine arteries supply the uterus exclusively. However, collateral arterial supply to the uterus has been described, predominantly in the context of uterine artery embolization (UAE) for fibroid treatment. This may lead to incomplete embolization, which can impact clinical outcomes. Therefore, identification of potential collateral supply to the uterus is essential for achieving optimal clinical results. The authors report three cases of collateral uterine arterial supply from the ovarian and round ligament arteries in the setting of uterine arteriovenous fistula (uAVF), postpartum hemorrhage (PPH), and symptomatic fibroids. Aortography from the level of the renal arteries was performed for initial evaluation of uterine arterial supply in all patients and identified hypertrophied, tortuous ovarian artery collaterals. Selective angiography of the external iliac artery was required to identify round ligament collateral uterine supply. Three-dimensional cone beam computed tomography (CT) was also used to visualize vascular distribution of bilateral uterine arteries and an ovarian collateral feeding a uAVF. In regard to outcomes, identification of collateral uterine arterial supply allowed for single-session complete embolization in fibroid patients with collateralized round ligament or ovarian arteries and in the PPH patient in disseminated intravascular coagulation with predominantly ovarian artery supply to the uterus. Identification of collateral uterine arterial supply facilitated technical success in all patients. In the setting of various uterine pathologies, identification of collateral uterine arterial supply is essential to optimize clinical success of UAE.

Keywords

uterine artery embolization - collateral blood supply - postpartum hemorrhage - uterine arteriovenous fistula - uterine fibroids

Full Text

References

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