Vascular complication after sacrospinous ligament fixation with uterine preservation

Sacrospinous ligament fixation (SSLF) is a minimally invasive transvaginal procedure for correcting apical prolapse. Amongst perioperative complications, life-threatening hemorrhage has a reported occurrence rate ranging from 0.2 % to 2 %. We present a case of arterial hemorrhage following SSLF and a multispecialty approach to its successful management.The video demonstrates the development of an unexpected progressive postoperative hematoma following left-side sacrospinous hysterocolpopexy via the anterior approach, despite minimal intraoperative bleeding. The mechanism of formation of the hematoma could have been laceration of an aberrant vaginal branch of the inferior vesical artery secondary to pulling the anchor which is tied off at the cervix after closure. To treat these patients effectively, it is essential for the surgeon to make a timely diagnosis, and in our patient, embolization of the inferior vesical artery provided a safe and effective treatment for the pelvic hemorrhage that eliminated the need for an invasive surgical intervention.Life-threatening bleeding is a rare complication of transvaginal SSLF. Pelvic vessel embolization can provide an effective, minimally invasive alternative to surgical re-exploration.