Transcatheter superselective arterial embolization for the treatment of massive hemorrhage due to malignant gestational trophoblastic tumors

Objective To evaluate the efficacy and safety of transcatheter superselective arterial embolization for controlling massive hemorrhage occurred in different parts of body due to malignant gestational trophoblastic tumors.Methods During the period of January 1994-December 2009 in authors' hospital transcatheter superselective arterial embolization was performed in 80 patients for massive hemorrhage caused by malignant gestational trophoblastic tumors.Pathologically,the tumors included invasive mole (n=18),choriocarcinoma (n=59) and placentalsite trophoblastic tumor (n=3).The bleeding sites included uterus (n=58),vagina (n=14),pelvic cavity (n=2),bladder (n=2),liver (n=3) and rectum (n=1).Based on the angiographic findings and the clinical judgment transcatheter arterial embolization with Gelfoam particles,coils and /or polyvinyl alcohol particles was carried out.All patients were followed up for 3 to 120 months (mean 30 months) after the procedure.Results The superselective catheterization succeeded in all patients.Angiographic signs of hemorrhage were observed in 60 cases (75%).Hemorrhage was successfully controlled in 73 cases (91.3%).One patient (1.3%) died on the third day after procedure due to multiple organ failure.Six patients (7.5%) had repeated hemorrhage and had to receive operation.Sideeffects included transient body pain (n=30,37.5%) and fever (n=45,56.3%).Conclusion For the treatment of massive hemorrhage caused by malignant gestational trophoblastic tumors,transcatheter superselective arterial embolization is an effective and safe technique,which should be regarded as the therapy of first choice.