Aberrant Ovarian Artery Arising from the Common Iliac Artery: Case Report
A 46-year-old pregnant woman at 31 weeks gestation was referred to the gynecology department of our hospital for premature membrane rupture with uterine atony and placenta accreta. She had no significant past medical history, except a previous caesarean section. After an emergency caesarean section, the patient presented severe postpartum hemorrhage secondary to uterine atony and was referred to our department (interventional radiology).\nEmbolization was performed using the single femoral artery approach with insertion of a 5-Fr introducer sheath (Terumo, Tokyo, Japan). At the beginning of the procedure, flush aortography () with a 5-Fr pigtail catheter (Cook, Bloomington, IN) positioned at the level of the celiac trunk showed a single aberrant artery arising from the right common iliac artery. Selective angiography of the aberrant artery using a 5-Fr Yashiro catheter (Terumo, Tokyo, Japan) revealed that it had a sinuous course and was tortuous (). This artery showed the typical ovarian blush and abundant collateral perfusion to the markedly enlarged uterine fundus ().\nBoth ovarian arteries could not be observed on pelvic aortography, and anastomosis with the uterine artery was not clearly defined. The diameter of the aberrant artery was larger than the diameters of both uterine arteries. Selective angiography of both the internal iliac arteries and both uterine arteries showed markedly increased uterus vascularity. The aberrant ovarian artery () and both uterine arteries () were embolized with 1 × 1 mm gelfoam pledgets (Johnson & Johnson, Skipton, UK) by using a 2.7-Fr microcatheter (Progreat®, Terumo, Tokyo, Japan). Vaginal bleeding ceased after this successful embolization procedure.\nThree days after embolization, the patient underwent a contrast-enhanced abdominal-pelvic computed tomography (CT) scan, and no associated unusual findings such as anomalies of the kidney or renal arteries were noted.\nThe patient's condition rapidly stabilized after the embolization procedure, and she was discharged in a good condition.