RESUMEN
PURPOSE: AVMs are rare tumorous vascular lesions derived from placental tissue that may present with massive post-partum hemorrhage (PPH) causing potentially life-threatening anemic shock. Current treatment options include the embolization of uterine arteries and emergency postpartum hysterectomy. We present a new form of minimally invasive, highly specific sonographically guided treatment in the form of the application of a human fibrin sealant leading to the instant cease of blood loss. MATERIALS AND METHODS: A management protocol was established and a case series of 14 patients is presented. Diagnosis by endovaginal color Doppler sonography is followed by the sonographically guided application of biological glue (TISSEEL®), thus allowing for super-selective occlusion of the feeding vessels. RESULTS: The procedure was technically successful in all 14 patients, 3 of whom (21â%) had a repeated procedure after 4â-â7 days. The mean age (yrs.) of the patients was 31 (25â-â40), the gravity was median 2 (1â-â5) and the parity was median 1 (0â-â4), the lowest Hb value was on average 9.35â±â2.25 (5.2â-â14.2) g/dl, the lowest Ht was on average 30.82â±â6.02 (18â-â41â%). Spectral Doppler analysis revealed an average of 80.71â±â11.2 (66â-â115) cm/sec for the maximal detectable PSV. In the period of 4â-â55 months after treatment, 7 patients (50â%) had 8 successful pregnancies and 2 miscarriages. CONCLUSION: In PPH there is vital interest in timely diagnosis of the underlying cause, thus allowing fertility-sparing, minimally invasive and super-selective emergency treatment. In AVMs causing PPH, a positive impact on perinatal morbidity and mortality may be achieved by sonographically guided application of this biological glue.