Diagnosis and treatment of patients with rare uterine artery pseudoaneurysm: seven case series and review of the literature

Background: Uterine artery pseudoaneurysm (UAP) is a rare but potentially life-threatening complication of traumatic pelvic operations and non-traumatic delivery/abortion. Due to the lack of awareness, UAP is often diagnosed after the occurrence of paroxysmal massive vaginal bleeding. Methods This was a retrospective study of seven patients with UAP in the West China Second University Hospital from January 2018 to August 2022. Results In this study, the average age of seven patients was 26.71 years. Six patients presented with a history of traumatic surgery, including cesarean scar pregnancy (CSP) (two patients), curettage for abortion (one patient), laparoscopic myomectomy (one patient), cervical conization (one patient), and curettage for gestational trophoblastic disease (one patient). The seventh patient underwent second-trimester pregnancy termination without a traumatic surgical procedure. The main symptom reported in patients was vaginal bleeding: three patients had paroxysmal massive vaginal bleeding amounting to more than 2000 mL. All the patients were confirmed using magnetic resonance imaging (MRI). Five patients underwent uterine artery embolization, and two patients were managed conservatively. One patient had massive vaginal bleeding again after bilateral transarterial embolization,MRI showed that the left UAP still existed, and finally transabdominal left internal iliac artery ligation and pseudoaneurysm resection were performed. All patients had good outcomes. Conclusions Seven patients with UAP were reviewed in this study, with their characteristic clinical symptoms, previous pelvic surgery, imaging features, treatment approaches, and prognosis described in detail and analyzed, hoping to provide new insights for the diagnosis or treatment of this rare life-threatening complication.