Arterial embolization for hemorrhage control in gynecologic malignancies: a narrative review of current evidence and unresolved questions.

Pelvic artery embolization is a minimally invasive procedure that has evolved as an option for the management of acute bleeding from gynecologic malignancies by occluding blood flow within targeted tumor-feeding vessels. Small observational studies support its efficacy and safety for managing bleeding events from a variety of gynecologic malignancies. However, to date, no comparative studies have evaluated arterial embolization against palliative radiation therapy, surgical interventions, or non-surgical interventions, such as vaginal packing and tranexamic acid, for hemorrhage control. Moreover, theoretical concerns and limited data exist about potential oncological and treatment-related adverse outcomes after obstructing tumoral blood flow and inducing local hypoxia. This narrative review examines arterial embolization within the broader spectrum of management options for acute bleeding in gynecologic malignancies. Existing retrospective studies assessing arterial embolization for hemorrhage control in gynecologic malignancies were identified and included to provide a discussion of technical considerations, complications, outcomes, potential long-term oncologic effects, and theoretical concerns surrounding its clinical use. A systematic search and meta-analysis were not performed. Although no large or prospective studies have examined this topic, existing retrospective data show that embolization can be immediately successful in managing bleeding from gynecologic malignancies, with few procedural complications and variable rates of rebleeding.