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      Acute pulmonary embolism in a patient with cesarean scar pregnancy after receiving uterine artery embolization: a case report

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          Abstract

          Uterine artery embolization (UAE) is considered to be an effective treatment for patients with cesarean scar pregnancy, especially for those presenting uncontrollable hemorrhage. However, it can also cause some potential complications. Pulmonary embolism is a rare but fatal complication in patients treated with UAE. Here, we report a case of a woman who was diagnosed with cesarean scar pregnancy presenting with pulmonary embolism during the operation of dilation and curettage after UAE treatment. Prompt resuscitation was carried out and the patient received anticoagulant treatment immediately. During the follow-up, she recovered well without any complications. We present the clinical details and imaging findings, followed by discussions of the etiology, treatments, and prevention strategies.

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          Most cited references 11

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          Pulmonary embolism: what have we learned since Virchow? Natural history, pathophysiology, and diagnosis.

           James Dalen (2002)
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            Thrombosis associated with angiogenesis inhibitors.

            Recent advances in the understanding of the pathogenesis of cancer have led to the introduction of a variety of biological agents with novel mechanisms of action into clinical trials and even into clinical practice. In particular, tumour-associated neoangiogenesis has become a major target for this new class of antineoplastic agents. Five anti-angiogenic agents (thalidomide, lenalidomide, bevacizumab, sunitinib, sorafenib) have already obtained US Food and Drug Administration approval for clinical use, and many others have entered clinical trials. Many new biological agents with anti-angiogenic properties appear to be associated with an increased risk for thrombosis and, paradoxically, bleeding. Although the mechanisms underlying the increased thromboembolic risk remain ill defined, the main hypothesis is that perturbation of tumour-associated endothelial cells can switch the endothelium from a naturally anticoagulant surface to a prothrombotic surface, thus mediating the activation of systemic coagulation in cancer patients, who are already more susceptible to thromboembolism due to their underlying disease. The toxicity profile differs between the anti-angiogenic agents. Thalidomide, lenalidomide, semaxibin (SU5416) and prinomastat have produced more venous thromboembolic complications, whereas bevacizumab, sunitinib, sorafenib and ZD6126 have been associated with a higher risk of arterial thromboembolism and, in particular, myocardial ischaemia. The observation of these vascular toxicities suggests the need to establish, in randomized clinical trials, the usefulness of thrombosis prophylaxis when anti-angiogenic agents are used in cancer patients, especially when associated with chemotherapy. In addition, careful reporting of haemostatic complications during treatment with new anti-angiogenic drugs is warranted.
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              Imaging manifestations of complications associated with uterine artery embolization.

              Uterine artery embolization (UAE) is an increasingly performed, minimally invasive alternative to hysterectomy or myomectomy for women with symptomatic uterine fibroids. A growing body of literature documents symptomatic improvement in the majority of women who undergo UAE. Although UAE is usually safe and effective, there are a number of known complications associated with the procedure. Major complications include fibroid passage, infectious disease (endometritis, pelvic inflammatory disease-tubo-ovarian abscess, pyomyoma), deep venous thrombosis, pulmonary embolism, inadvertent embolization of a malignant leiomyosarcoma, ovarian dysfunction, fibroid regrowth, uterine necrosis, and even death. Minor complications include hematoma, urinary tract infection, retention of urine, transient pain, and vessel or nerve injury at the puncture site. As UAE takes its place in the treatment arsenal for women with symptomatic fibroids, radiologists need to be familiar with UAE-associated complications, which may require further treatment and may even be life threatening in some cases. Knowledge of these complications and their imaging features should lead to prompt diagnosis and appropriate treatment.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2018
                10 January 2018
                : 14
                : 117-120
                Affiliations
                [1 ]Department of Obstetrics and Gynecology, Huzhou Central Hospital, Huzhou, Zhejiang
                [2 ]Department of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang
                [3 ]Department of General Surgery, Huzhou Central Hospital, Huzhou, Zhejiang
                [4 ]Women’s Reproductive Health Laboratory of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China
                Author notes
                Correspondence: Weiguo Lu, Department of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University, Xueshi Road #2, Hangzhou, Zhejiang 310006, People’s Republic of China, Tel +86 571 8706 1501, Fax +86 571 8706 1878, Email lbwg@ 123456zju.edu.cn
                Article
                tcrm-14-117
                10.2147/TCRM.S147754
                5768181
                © 2018 Qiu et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Case Report

                Medicine

                pulmonary embolism, cesarean scar pregnancy, uterine artery embolization

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