Ultrasound-guided transvaginal thrombin injection of uterine arteries pseudoaneurysms

Objective:To evaluate the utility of transvaginal ultrasound-guided thrombin injection (UGTI) to treat uterine artery pseudoaneurysms (UAP) as an alternative to emergency arterial embolization.Methods:Two women presenting with heavy vaginal bleeding were diagnosed with UAP by pelvic CT scan. 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.Results:We describe two cases of UAP treated with transvaginal UGTI: one after intrauterine tandem and vaginal colpostat insertion for brachytherapy after diagnosis of cervical cancer (case 1), and the other after the insertion of a levonorgestrel-releasing intrauterine device (case 2).Conclusions:Transvaginal UGTI could be a minimally invasive tool to tr...