P14.13: Ultrasound-guided transvaginal thrombin injection to treat uterine arteries pseudoaneurysms

We describe two cases of uterine artery pseudoaneurysm (UAP) treated with ultrasound-guided transvaginal thrombin injection (UGTI), as an alternative to emergency arterial embolisation. Two women presenting with heavy vaginal bleeding were diagnosed with UAP by CT-angiography: one after colpostat insertion for brachytherapy after diagnosis of cervical cancer; and the other after the insertion of a levonorgestrel releasing intrauterine device. After UAP identification by transvaginal ultrasound (TVUS), 2 cc of thrombin (Tissucol®, Baxter Healthcare Corporation. Munich, Germany) were slowly injected into the UAP using a 30 cm long 22-gauge needle through a needle-guide attached to the vaginal probe. The same procedure was performed in both cases, the Doppler sign disappeared immediately and bleeding stopped. This preliminary study with two cases of UAP treated by UGTI does not provide enough evidence to replace the implemented option of uterine embolisation. Nonetheless, transvaginal UGTI may be used in selected patients with uterine bleeding and a UAP identified in the CT-angiography. The application of this biological glue is a minimally invasive and a selective treatment which could avoid uterine embolisation and emergency hysterectomy. More research is needed to confirm the safety and feasibility of this procedure.