Endovascular management of proximal ovarian artery perforation near the ostium during uterine fibroid embolization.

Ovarian artery injury during uterine fibroid embolization is rare but can result in significant hemorrhage, especially when the injury occurs near the arterial ostium. We describe a case of iatrogenic proximal ovarian artery perforation near the ostium complicated by retroperitoneal hematoma in a patient with severe thrombocytopenia owing to underlying aplastic anemia. Definitive hemorrhage control was achieved using distal coil embolization of the injured ovarian artery combined with covered aortic stent graft deployment across the ostium. This case highlights the technical considerations, risk factors, and an effective endovascular salvage strategy for managing ovarian arterial injuries near the aorta.