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Uterine Artery Anatomy Relevant to Uterine Leiomyomata Embolization 总被引:12,自引:0,他引:12
Gomez-Jorge J Keyoung A Levy EB Spies JB 《Cardiovascular and interventional radiology》2003,26(6):522-527
To categorize the anatomic variants of uterine arteries, and determine the incidence of menopausal symptoms where the tubo-ovarian branches were seen prior to embolization.
Between July 1997 and June 2000, 257 (n = 257) uterine fibroid embolizations were performed at our institution. Arteriograms were retrospectively evaluated. Uterine arteries were classified into groups: type I (the uterine artery as first branch of the inferior gluteal artery), type II (the uterine artery as second or third branch of the inferior gluteal artery), type III (the uterine artery, the inferior gluteal and the superior gluteal arteries arising as a trifurcation), type IV (the uterine artery as first branch of the hypogastric artery), inconclusive, or not studied. Tubo-ovarian branches were recorded if visualized prior to and/or after embolization. Menopausal symptoms were recorded (n = 175 at 3 months, n = 139 at 6 months, n = 98 at 1 year, n = 22 at 2 years) using written questionnaires.
Five hundred and fourteen uterine arteries (n = 514) were evaluated. There were 38% classifiable types, 23% inconclusive, and 39% not studied. Classification was as follows: type I, 45%; type II, 6%; type III, 43%; type IV, 6%. Among 256 patients, tubo-ovarian arteries were seen in 36 prior to embolization, but not afterwards. In this group, 25 patients reported transient menopausal symptoms (hot flashes, amenorrhea). Five patients did not report any menopausal symptoms. Six patients did not answer the questionnaires.
Type I is the most common type of anatomy, followed by type III. The tubo-ovarian arteries may be visualized prior to and/or after embolization. The embolization was monitored to avoid embolization of the tubo-ovarian branches. Menopausal symptoms were transient all patients when the tubo-ovarian branches were seen prior to embolization. 相似文献
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Quality Improvement Guidelines for Uterine Artery Embolization for Symptomatic Leiomyomata 总被引:1,自引:0,他引:1
Hovsepian DM Siskin GP Bonn J Cardella JF Clark TW Lampmann LE Miller DL Omary RA Pelage JP Rajan D Schwartzberg MS Towbin RB Walker WJ Sacks D;CIRSE Standards of Practice Committee;SIR Standards of Practice Committee 《Cardiovascular and interventional radiology》2004,27(4):307-313
Uterine artery embolization (UAE) is assuming an important role in the treatment of women with symptomatic uterine leiomyomata worldwide. The following guidelines, which have been jointly published with the Society of Interventional Radiology in the Journal of Vascular and Interventional Radiology, are intended to ensure the safe practice of UAE by identifying the elements of appropriate patient selection, anticipated outcomes, and recognition of possible complications and their timely address. 相似文献
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Ovarian Artery: Angiographic Appearance,Embolization and
Relevance to Uterine Fibroid Embolization 总被引:7,自引:0,他引:7
Pelage JP Walker WJ Le Dref O Rymer R 《Cardiovascular and interventional radiology》2003,26(3):227-233
Purpose: To describe the angiographic
appearance of the ovarian artery and its main variations that may be
relevant to uterine fibroid embolization.
Methods: The
flush aortograms of 294 women who had been treated by uterine artery
embolization for fibroids were reviewed. Significant arterial supply to
the fibroid, and the origin and diameter of identified ovarian arteries
were recorded. In patients with additional embolization of the ovarian
artery, the follow-up evaluation also included hormonal levels and
Doppler imaging of the ovaries.
Results: A total of 75
ovarian arteries were identified in 59 women (bilaterally in 16 women
and unilaterally in 43 women). All ovarian arteries originated from the
aorta below the level of the renal arteries with a characteristic
tortuous course. Fifteen women had at least one enlarged ovarian artery
supplying the fibroids. Fourteen women (14/15, 93%) presented at least
one of the following factors: prior pelvic surgery, tubo-ovarian
pathology or large fundal fibroids.
Conclusion: We
advocate the use of flush aortography in women with prior tubo-ovarian
pathology or surgery or in cases of large fundal fibroids. In the case
of an ovarian artery supply to the fibroids, superselective
catheterization and embolization of the ovarian artery should be
considered. 相似文献
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Scheurig-Muenkler C Poellinger A Wagner M Hamm B Kroencke TJ 《Cardiovascular and interventional radiology》2011,34(6):1199-1207
Purpose
To evaluate the safety and outcome of ovarian artery embolization (OAE) in patients with collateral supply to symptomatic uterine leiomyomata. 相似文献9.
de Bruijn Annefleur M. Adriaansens Sven-Ole J. H. Smink Marieke Venmans Alexander Hehenkamp Wouter J. K. Smeets Albert J. Lopez Anthony Huirne Judith A. F. Lohle Paul N. M. 《Cardiovascular and interventional radiology》2019,42(3):371-380
CardioVascular and Interventional Radiology - To perform an evaluation on safety and efficacy of uterine artery embolization (UAE) in the patients with symptomatic cervical leiomyomata. Patients... 相似文献
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Atul Gupta Thijs Grünhagen 《Journal of vascular and interventional radiology : JVIR》2013,24(11):1690-1697
PurposeTo assess the feasibility of live magnetic resonance (MR) angiography roadmapping guidance for uterine artery (UA) embolization (UAE) for fibroid tumors.Materials and MethodsTwenty patients underwent UAE with live MR angiographic roadmapping. The pre-acquired MR angiography scan was coregistered with the live intraprocedural fluoroscopy stream to create a visual roadmap to direct the microcatheter during UAE. Patient radiation dose, as measured by dose–area product (DAP), procedure time, contrast medium volume, and fluoroscopy time, was recorded. For the first 10 patients, an additional parameter of contrast medium volume needed to catheterize each UA was recorded.ResultsIn all 20 patients (40 UAs), the MR angiography overlay on live fluoroscopy was accurate and allowed for successful catheterization of the UA, resulting in a technical success rate of 100%. In the subset of the initial 20 UAs (ie, the first 10 patients) in which this data point was recorded, 17 (85%) were successfully catheterized with no iodinated contrast medium at all, by purely relying on the MR angiography roadmap. Mean procedure time was 45 minutes (range, 30–99 min), mean contrast agent dose was 75 mL (range, 46–199 mL), and mean DAP was 155 Gy·cm2 (range, 37–501 Gy·cm2).ConclusionsLive MR angiographic roadmapping is feasible and accurate for catheter guidance during UAE. 相似文献
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Ryan Kohlbrenner K. Pallav Kolli Andrew G. Taylor Maureen P. Kohi Evan D. Lehrman Nicholas Fidelman Miles Conrad Jeanne M. LaBerge Robert K. Kerlan Robert Gould 《Journal of vascular and interventional radiology : JVIR》2017,28(8):1129-1135.e1
Purpose
To assess radiation dose reduction during uterine fibroid embolization (UFE) using an optimized angiographic processing and acquisition platform.Materials and Methods
Radiation dose data for 70 women (mean age, 46 y; range, 34–67 y) who underwent UFE were retrospectively analyzed. Twenty-one patients underwent UFE using the baseline fluoroscopic and angiographic image acquisition platform, and 49 underwent UFE after implementing an optimized imaging platform in otherwise identical angiography suites. Cumulative kerma-area product (CKAP), cumulative air kerma (CAK), total fluoroscopy time, and image exposure number were collected for each procedure. Image quality was assessed by 3 interventional radiologists blinded to the platform used for image acquisition and processing.Results
Patients undergoing UFE using the new x-ray fluoroscopy platform had significantly lower CKAP and CAK indicators than patients for whom baseline settings were used. Mean CKAP decreased by 60% from 438.5 Gy · cm2 (range, 180.3–1,081.1 Gy · cm2) to 175.2 Gy · cm2 (range, 47.1–757.0 Gy · cm2; P < .0001). Mean CAK decreased by 45% from 2,034.2 mGy (range, 699.3–5,056.0 mGy) to 1,109.8 mGy (range, 256.6–4,513.6 mGy; P = .001). No degradation of image quality was identified through qualitative evaluation.Conclusions
Significant reduction in patient radiation dose indicators can be achieved with use of an optimized image acquisition and processing platform. 相似文献12.
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Panick Catherine Wunderle Kevin Sands Mark Martin Charles 《Cardiovascular and interventional radiology》2018,41(12):1925-1934
CardioVascular and Interventional Radiology - We sought to evaluate patient radiation exposure during complex liver interventional procedures performed with newer angiography equipment. We... 相似文献
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Pratik Shukla Saurin P. Sanghvi Valdis M. Lelkes Abhishek Kumar Sohail Contractor 《Journal of vascular and interventional radiology : JVIR》2013,24(4):469-474
PurposeTo determine the readability of Internet-based patient education materials (IPEMs) created by United States hospitals and universities and clinical practices and miscellaneous health care–associated Web sites regarding uterine artery embolization (UAE) as a marker for IPEMs in general.Methods and MethodsTwo hundred unique Web sites were evaluated for patient-related articles on UAE. Web sites produced by US hospitals and universities and clinical practices, as well as miscellaneous health care–associated Web sites meeting the Health on the Net Foundation Code of Conduct criteria were included in the database. By using mathematical regression algorithms based on word and sentence length to quantitatively analyze reading materials for language intricacy, readability of 40 UAE-related IPEMs was assessed with four indices: Flesch–Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (GFOG). Scores were evaluated against national recommendations, and intergroup analysis was performed.ResultsNone of the IPEMs were written at or below the sixth-grade reading level, based on FKGL. The mean readability scores were as follows: FRES, 43.98; FKGL, 10.76; SMOG, 13.63; and GFOG, 14.55. These scores indicate that the readability of UAE IPEMs is written at an advanced level, significantly above the recommended 6th grade reading level (P<.05) determined by the United States Department of Health and Human Services.ConclusionsIPEMs related to UAE generated by hospitals, clinical practices, and miscellaneous health care–associated Web sites are written above the recommended sixth grade level. IPEMs for other disease entities may also reflect similar results. 相似文献
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Froeling V Scheurig-Muenkler C Hamm B Kroencke TJ 《Cardiovascular and interventional radiology》2012,35(3):523-529
Purpose
To evaluate the clinical outcome for uterine adenomyosis with or without uterine leiomyomata 40?months after uterine artery embolization (UAE).Methods
Forty women aged 39?C56?years (median 46?years) with symptomatic uterine adenomyosis and magnetic resonance imaging findings of uterine adenomyosis with or without combined uterine leiomyomata underwent UAE. Self-perceived changes in clinical symptoms were assessed, and residual symptom severity and health-related quality of life (HRQOL) after UAE were evaluated. Clinical failure was defined as no symptomatic improvement or second invasive therapy after UAE. Results were stratified by the extent of uterine adenomyosis at baseline magnetic resonance imaging.Results
Patients were followed for a median of 40?months (range 5?C102?months). UAE led to symptomatic control after UAE in 29 (72.5%) of 40 patients while 11 women underwent hysterectomy (n?=?10) or dilatation and curettage (n?=?1) for therapy failure. No significant difference between women with pure uterine adenoymosis and women with uterine adenomyosis combined with uterine leiomyomata was observed. Best results were shown for UAE in uterine adenomyosis with uterine leiomyomata predominance as opposed to predominant uterine adenomyosis with minor fibroid disease (clinical failure 0% vs. 31.5%, P?=?0.058). Throughout the study group, HRQOL score values increased and symptom severity scores decreased after UAE. Least improvement was noted for women with pure adenomyosis.Conclusions
UAE is clinically effective in the long term in most women with uterine adenomyosis. Symptomatic control and HRQOL were highest in patients with combined disease of uterine adenomyosis but leiomyomata predominance. 相似文献17.
《Journal of vascular and interventional radiology : JVIR》2014,25(3):443-447
This study investigates the feasibility of performing uterine artery embolization (UAE) via transradial access (TRA). Growing evidence demonstrates significant benefits of TRA versus standard transfemoral access during percutaneous coronary intervention, now making it the preferred approach at many centers worldwide. At a single institution from March 2013 to October 2013, 29 consecutive patients were treated by transradial UAE. Technical success rate was 100%, with no immediate major or minor complications. The radial artery was patent at 1-month follow-up evaluation in all cases. These preliminary data suggest that transradial UAE is feasible and safe. 相似文献
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《Journal of vascular and interventional radiology : JVIR》2019,30(9):1452-1458
PurposeTo evaluate the radiation dose in patients undergoing prostatic artery embolization (PAE) using cone-beam CT and 3-dimensional (3D) guidance software.Materials and MethodsIn this single-center retrospective study, 100 patients with benign prostatic hyperplasia (mean prostate volume, 83.6 mL ± 44.2; 69.4 ± 9.6 years of age; body mass index, 26.5 ± 4.2) were treated using PAE between October 2016 and April 2018. Informed consent was obtained from all participants included in the study. All patients received at least 1 intraprocedural cone-beam CT per side for evaluation of the vessel anatomy and software rendering of 3D guidance for catheter guidance. Digital subtraction angiography (DSA) was performed in the distal branches only. The total dose area product (DAP), along with the DAP attributed to fluoroscopy, DSA, and cone-beam CT, were assessed.ResultsBilateral embolization was achieved in 83 patients (83%). The average total DAP was 134.4 Gy ⋅ cm2 ± 69.5 (range, 44.7–410.9 Gy ⋅ cm2). Fluoroscopy, DSA, and cone-beam CT accounted for 35.5 Gy ⋅ cm2 ± 21.3 (range, 8.6–148.6 Gy ⋅ cm2) or 26.4% (percentage of total DAP), 58.2 Gy ⋅ cm2 ± 48.3 (range, 10.3–309.3 Gy ⋅ cm2) or 43.3%, and 40.7 Gy ⋅ cm2 ± 14.5 (range, 15.9–86.3 Gy ⋅ cm2) or 30.3%, respectively. Average procedure time was 89.4 ± 27.0 minutes, and the average fluoroscopy time was 30.9 ± 12.2 minutes.ConclusionsIntraprocedural cone-beam CT in combination with 3D guidance software allows for identification and catheterization of the prostatic artery in PAE. Furthermore, the results of this trial indicate that this study protocol may lead to a low overall radiation dose. 相似文献
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Gonsalves C Franciosa SV Shah S Bonn J Wu C 《Cardiovascular and interventional radiology》2007,30(6):1263-1266
Uterine artery embolization is a safe and effective procedure for the treatment of symptomatic uterine fibroids. Nontarget
embolization of adjacent internal iliac artery branches is a reported complication of uterine artery embolization. The following
report describes the presentation and management of ulcerations of the labium minora due to nontarget embolization of the
internal pudendal artery. 相似文献