ABSTRACT
Resumen El hallazgo de hemoperitoneo en el post parto secundario a la rotura aneurismática de la arteria ovárica es una situación clínica extremadamente rara que presenta un cuadro clínico inespecífico y puede poner en riesgo la vida del paciente. El ultrasonido es una modalidad segura y rápida para la detección de líquido libre intraperitoneal. (1) . La tomografía computada es la herramienta de elección para un diagnóstico rápido y seguro (2) ; y la angiografía con embolización durante el mismo procedimiento es una alternativa útil y altamente efectiva para la resolución del cuadro. (3). Presentamos el caso de una multípara puérpera de 34 años que consulta en el servicio de urgencia por intenso dolor abdominal. La paciente se encontraba hemodinámicamente estable y afebril. La tomografía computada demostró un hematoma retroperitoneal y hemoperitoneo asociado a un aneurisma de la arteria ovárica derecha. Fue evaluada por el servicio de radiología intervencional y se trasladó de emergencia al pabellón angiográfico donde se realizó la embolización de la lesión mediante la cateterización vascular supra selectiva. La paciente evolucionó de manera favorable y fue dada de alta una semana después. Es necesario tener un alto índice de sospecha en pacientes de riesgo para lograr un diagnóstico y tratamiento oportuno.
SUMMARY Spontaneous ovarian artery aneurysm rupture is a rare postpartum life-threatening event with non-specific clinical manifestations. The present article reports the case of a 34 year old multiparous post partum women who came to the emergency department with acute onset of intense abdominal right flank pain. Patient was afebrile and hemodynamically stable. A computed tomography revealed a retroperitoneal haematoma and hemoperitoneum related to an aneurysm of the right ovarian artery. The patient was taken to the interventional radiology suite and selective embolization was performed. Following the procedure, the patient symptoms subsided and 7 days later she was discharged. A high index of suspicion in patients with risk factors can lead to a prompt diagnosis and treatment. Computed tomography is the image modality for a fast and safe evaluation, although diagnostic angiography and subsequent transcatheter embolization are thought to be effective for treatment.
Subject(s)
Humans , Female , Adult , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/diagnostic imaging , Postpartum Period , Hemoperitoneum , Ovary/blood supply , Rupture, Spontaneous , Tomography, X-Ray Computed , Uterine Artery EmbolizationABSTRACT
Background: A sound knowledge of variations of blood vessels is required during operative, diagnostic andendovascular procedures in the abdomen and pelvis. The anatomy of the gonadal vessels has assumed moreimportance with development of newer intra-abdominal operative and laparoscopic techniques. The main aimof this study is to highlight incidence of variable origin of gonadal artery and its clinical significance.Materials and Methods: Dissection of posterior abdominal wall was done in 30 cadavers in the department ofAnatomy, K.P.C. Medical College and Hospital, Kolkata to observe the origin and course of gonadal arteries.Results: Variation was found in two cases (6.67%). Both of the cases were in male (8.33%) and on the left side.Conclusion: Various morphological anomalies of gonadal arteries are reported. The possible embryologicalbasis for this variation as well as its clinical significance, are discussed. The knowledge of this variation willhelp the radiologists and surgeons in avoiding clinical complications during uroradiologic interventions andsurgical procedures such as renal and gonadal surgeries.
ABSTRACT
Objective To investigate the influence of ovarian arterial blood flow index on pregnancy outcomes in patients undergoing in vitro fertilization and embryo transfer (IVF-ET).Methods Totally 136 infertile patients undergoing IVF-ET from February 2014 to April 2016 were divided into pregnant group and non-pregnant group.The monitoring through transvaginal B of two groups for chorionic gonadotropin (HCG) day and ovarian artery resistance index (RI),pulsatility index (PI) and umbilical artery diastolic flow velocity height ratio (S/D) on 2nd day of menstruation (M2) was conducted.The difference of blood flow indexes in two groups was analyzed.Results Compared with those in non-pregnant group,RI,PI and S/D in pregnant group were decreased on M2,and the difference was statistically significant (P ＜ 0.05).RI and PI were also decreased significantly on HCG day,and the difference was statistically significant (P ＜ 0.05),but S/D showed no significant changes (P ＞ 0.05).RI and PI decreased significantly on HCG day in two groups (P ＜ 0.05) when compared with those on M2,but in non-pregnant group,the comparison of S/D on HCG day showed no statistical significance (P ＞ 0.05).Conclusions There is close relationship among RI and PI of ovarian artery and ovarian reserve function.RI and PI are effective indexes to predict outcomes in IVF-ET,and provide scientific basis for the preparation and treatment for IVF-ET.
ABSTRACT
Objective To retrospectively analyze the correlation between uterine fibroid and ovarian blood supply, and to discuss the visualization of ovarian artery and uterine ovarian branch in uterine arterial embolization. Methods A total of 363 patients with clinically-confirmed uterine fibroid were enrolled in this study. Uterine arterial embolization was carried out in all patients. The visualization of ovarian artery and uterine ovarian branch during angiography was recorded. After the procedure the changes of uterine fibroid and ovarian functions were followed up. The results were statistically analyzed. Results The blood supply of uterine fibroid could be divided into three types: unilateral artery as the main source of blood supply (34.16%), bilateral balanced blood supply (43.80%) and unilateral uterine artery (22.04%). The visualization rate of uterine ovarian branch in bilateral balanced blood supply type was significantly higher than that of other two types (P<0.05). The visualization rate of ovarian artery at the side which was lack of blood vessels was higher than that at the opposite side (P< 0.05). Transient ovary functional impairment was observed in patients with visualization of uterine ovarian branch, which restored to normal in three months. No significant difference in the reduction of the tumor mass existed between each other among the different blood supply types. Conclusion The blood supply types of uterine fibroids have a parallel relationship with the ovarian blood supply from ovarian artery and/or uterine ovarian branch. Special attention should be paid to the uterine arterial embolization of the side that is lack of blood vessels, and it is needed to carefully observe the embolization extent, the flow velocity, etc. during the performance of embolization so as to avoid ovarian function impairment.
ABSTRACT
Although many studies have confirmed that uterine arterial embolization has good short-term and long- term effects for the treatment of uterine fibroids, certain failure rate does exist. Many researches have indicated that the surgical failure is mainly related to the collateral arterial supplies, among which the ovarian artery supply is the commonest cause. This review aims to make a further understanding of the influence of ovarian artery on the outcomes of uterine fibroid embolization.
ABSTRACT
Objective To quantitatively analyze the changes of ovarian artery blood flow volume during whole pulsation cycle in patients with polycystic ovary syndrome (PCOS) by pulsed Doppler. Methods The ovarian arteries of 80 PCOS patients were examined by transvaginal color Doppler flow image (TV-CDFI). After examination of the parameters of pulsed Doppler, the ovarian artery blood flow volume in whole pulsation cycle was calculated with velocity-time integral while considering the internal diameter ofthe blood vessels. The results were compared with those of 80 healthy women of childbearing age in the control group. Results The typical spectrum of ovarian artery blood flow in PCOS patients was highspeed low-resistance waveform. The changes ofblood flow volumeand resistance index (RI) value were not significantly different at different times of the menstrual cycle (P>0.05). However, the changes of blood flow volume and RI value in the control group were significanly different at different times of the menstrual cycle (P 0.05). Conclusion Quantitative determination of ovarian blood flow volume using blood flow whole pulsation period method can provide a relatively accurate and reliable quantitative assessment of the ovarian perfusion in PCOS patients.
ABSTRACT
A 46-year-old Vietnamese woman received embolization therapy in order to control postpartum hemorrhage. Angiography revealed an aberrant ovarian artery arising from the right common iliac artery. Superselective catheterization and subsequent embolization of the aberrant ovarian artery and bilateral uterine arteries were performed. Precise knowledge of the anatomic variations of the ovarian artery is important for successful embolization.
Subject(s)
Female , Humans , Middle Aged , Pregnancy , Angiography , Embolization, Therapeutic/methods , Iliac Artery/diagnostic imaging , Ovary/blood supply , Postpartum Hemorrhage/diagnostic imaging , Vascular Malformations/diagnostic imagingABSTRACT
Objective To observe the relationship between morphological and hemodynamic changes of female internal genital organs in the patients with hypomenorrhea with transvaginal color Doppler ultrasound (TVCDS). Methods Thirty female patients with hypomenorrhea of unknown origin were studied, and 30 healthy women of eumenorrhea aged 20 to 40 years were selected as control group. The size and shape of uterus, ovaries, and the thickness of endometria of uterus were observed with TVCDS in follicular phase, ovulation phase, luteal phase and luteal atrophy phase, respectively. Hemodynamic parameters of ovarian artery, uterus artery and their branches were measured. At the same time, hormones of female were examined in 30 patients in follicular phase, ovulation phase and luteal atrophy phase, respectively. Results ①No difference of the size of uterus and ovaries, the thickness of endometria and the amount of egg follicles was found between two groups (P＞0.05). ②Compared with that in the control group, type C of endometria increased in hypomenorrhea group (P＜0.05). ③RI, PI and S/D of spiral arteries in hypomenorrhea group were higher than those in control group, but no significance in these parameters of uterine arteries, arcuate arteries and radiate arteries was found. RI of uterine arteries, arcuate arteries and radiate arteries decreased successively. ④RI, PI and S/D of ovarian arteries in hypomenorrhea group was higher than those in control group in ovulation phase (P＜0.05). Conclusion Reduction in blood supply of ovary and endometria may be the causes of hypomenorrhea with unknown origin. TVCDS can be used as a conventional examination method for these patients.
ABSTRACT
Spontaneous ovarian artery rupture is exceedingly rare case that occur in the postpartum period. There were the cases that occurred aneurysmal rupture of ovarian artery and the coronary artery rupture in the women postpartum period without preeclampsia. There were the cases that occurred the cerebral artery rupture or retinal artery rupture in preeclampsia, but ovarian artery rupture is unreported. The cause of ovarian artery rupture in the postpartum period is unknown, but we thought that thinned arterial wall may be the cause during this period. The women in preeclampsia have high risk factors such as hypertension and pathologic disorder of the vessel. The retroperitoneal hemorrhage due to ovarian artery rupture cause hypovolemic shock, eventually death, therefore, it is necessary to immediate diagnosis and treatment. We described a case of spontaneous right ovarian artery rupture that occurred 2 days after vaginal delivery in preeclampsia including a review of the literature.
Subject(s)
Female , Humans , Aneurysm , Arteries , Cerebral Arteries , Coronary Vessels , Glycosaminoglycans , Hemorrhage , Hypertension , Postpartum Period , Pre-Eclampsia , Retinal Artery , Risk Factors , Rupture , ShockABSTRACT
The relationship of the flow velocity of ovarian artery to the follicular growth and genital endocrine hormone was observed in 36 normal and 32 infertile women by transvaginal color Doppler imaging(TVCD). The result showed that before and after ovulation, the peak flow velocity occurred in 87 % normal women i the diestolic flow waveforms had high amplitude with low impedance, the diameters of the follicles were large, the blood E2 and LH increased and attained the peak values. However, during the time of early follicular development and late stage of luteum, the diastolic flow waveforms had low amplitude with high impedance and the blood levels of E2 and LH were low. This suggests that a close relationship exists in the flow velocity and waveform of ovarian artery to the follicular development and genital endocrine hormone. In most cases of the infertile group, the diastolic flow of ovarian arteries showed with low amplilude with high impedance > there were no mature follicle with irregular change of ovarian steriods. The study indicats that this technique may forecast the time of ovulation and investigate the causes of infertility.