Uterine artery embolisation for the management of myomata in patients without complaints of menorrhagia

Summary

Uterine artery embolisation (UAE) has been performed largely in patients complaining of menorrhagia associated with myomata Many patients also suffer from bulk-related symptoms In this series, patients were retrospectively divided into three groups based upon their initial complaints menorrhagia alone, both menorrhagia and bulk-related symptoms, and patients complaining of only bulk-related symptoms UAE had similar rates of success for control of patient symptoms in all three groups and caused similar decreases in uterine volumes in all groups A large portion of patients who initially complained only of bulk-related symptoms also reported significant improvement in bleeding after UAE A smaller, but significant portion of patients who initially complained only of menorrhagia also experienced significant improvement in symptoms associated with fibroid bulk several months after UAE UAE shows significant success in control of menorrhagia and bulk-related symptoms, regardless of patient complaints.     

Transcatheter uterine fibroid embolisation for uterine fibroids using a mobile fluoroscopy unit in an outmpatient surgical centre

Summary

Performing uterine fibroid embolisation (UFE), with or without laparoscopic myomectomy (LM), in an out-patient setting, using angiographic equipment, is much less expensive than the same procedure in hospital UFE can be performed as easily on a mobile fluoroscopy unit with angiographic equipment as with fixed equipment in a typical hospital angiographic suite The time saved by performing LM immediately after UFE makes it feasible to perform the procedure, allow the patient to recover and return home on the same day The absence of inter-operative bleeding shortens the time taken for LM and additional time is saved by performing LM on the same table immediately after UFE; there is therefore sufficient time to allow patient recovery in a day-care centre There were no groin haematoma complications, even though the hips were flexed placing patients into the lithotomy position immediately following haemostasis after femoral artery catheterisation Given that the standard period of observation following angiography is 4 h and that, typically, a combination of UFE and LM takes 2 h, there is adequate time for the procedure and recovery period and to allow the patient to return home on the same day.     

Bilateral uterine artery embolisation for myomata: Results,complications and failures

Summary

Uterine artery embolisation (UAE) was carried out on 200 patients who were followed-up by US, MRI, questionnaires and blood tests. Questionnaire data is available from 111 patients and fibroid/uterine volume reduction data from 88 followed-up for a mean of 5/12 months (range 3/12-1 year). The average fibroidhterine volume reduction at 1 year was 69%. US and MRI results were comparable. Menorrhagia improved in 79% of patients; 96% were pleased with the outcome and would recommend it to others. Two serious complications have so far occurred in the 200 patients embolised; in these two patients, infection led to hysterectomy.     

Transient buttock pain after uterine artery embolisation for the management of fibroids

Summary

Uterine artery embolisation (UAE) is becoming increasingly popular as a treatment for symptomatic fibroids We present a series of three patients out of a total of 333 cases who developed bilateral transient buttock pain after UAE. The features of this pain suggest that it IS not due to misembolisation, but to referred pain from the infarcted fibroids and the ensuing inflammatory response.     

Near fatal haemorrhage 35 years after radiation for laryngeal cancer: emergency embolisation of a vertebral artery aneurysm

The authors report a rare case of a 75 year old man who presented 35 years after radiotherapy for carcinoma of the larynx, with catastrophic bleeding through the mouth. Both the time and mode of presentation were unusual. The patient required emergency sacrifice of the left vertebral artery to stop the bleeding. The literature has been reviewed.     

Role of uterine artery Doppler flow in fibroid embolization.

OBJECTIVE: To determine whether Doppler flow measurements are useful in predicting variables associated with uterine fibroid embolization, including shrinkage of the uterus and myomas, adenomyosis, and uterine fibroid embolization failure. METHODS: A group of 227 patients with menorrhagia or postmenopausal bleeding secondary to uterine myomas were evaluated with uterine artery Doppler flow sonography before uterine fibroid embolization. Doppler flow measurements were repeated 6 months after uterine fibroid embolization for 188 of the patients. Data were analyzed for correlations between peak systolic velocity and uterine fibroid embolization patient data, including size and shrinkage of the uterus and myomas, embolization particle size, adenomyosis, and uterine fibroid embolization failure. RESULTS: Initial peak systolic velocity was positively correlated with the size and shrinkage of myomas and uterine volume. Peak systolic velocity was positively correlated with the size and load of embolization particles and was significantly lower (mean, 33.2 cm/s) in patients with adenomyosis than those without adenomyosis (mean, 39.3 cm/s). High peak systolic velocity (>64 cm/s) was a significant predictor of failure. Postembolization peak systolic velocity (mean, 21.85 cm/s) was significantly lower than preembolization peak systolic velocity (mean, 40.33 cm/s) and was not correlated with uterine fibroid embolization variables. CONCLUSIONS: Doppler flow measurements can aid in predicting adenomyosis and uterine fibroid embolization failure. Postembolization peak systolic velocity did not show value.     

Uterine artery embolization as a treatment for symptomatic uterine fibroids: a review of literature and case report

PURPOSE: To provide a case presentation and review of the literature on uterine artery embolization (UAE) as a treatment alternative for symptomatic uterine fibroids and to guide the nurse practitioner (NP) in patient selection, education, and periprocedural management of patients undergoing this procedure. DATA SOURCES: Research articles, clinical articles, and case studies pertaining to UAE. CONCLUSIONS: UAE is a safe, well tolerated, and effective nonsurgical treatment option for symptomatic uterine fibroids. This uterus-sparing procedure has low complication rates with excellent clinical outcomes and high patient satisfaction rates. The majority of women who undergo UAE report marked reduction in the severity of fibroid specific symptoms and significant improvement in their quality of life. Uterine fibroids are common in women and often produce symptoms that have a negative impact on quality of life. IMPLICATIONS FOR PRACTICE: The NP is instrumental in identifying which patients may be appropriate candidates for UAE, educating them about the risks and benefits of the procedure, and managing these patients before and after the procedure.     

Uterine artery pseudoaneurysm: unusual cause of delayed postpartum hemorrhage

We describe a case of uterine artery pseudoaneurysm in a 21-year-old woman with postpartum hemorrhage. This condition is easily diagnosed with duplex Doppler sonography and can be treated with embolization, but only if delayed postpartum hemorrhage is considered in the differential diagnosis.     

腹腔镜下子宫动脉阻断联合肌瘤剔除术治疗子宫肌瘤的临床效果观察

目的 观察腹腔镜子宫肌瘤别除术对子宫肌瘤的治疗效果.方法 2008年8月～2009年8月.对48饲子宫肌瘤要求保留子宫的患者采用腹腔镜下子宫肌瘤剔除术,其中18例配合使用腹腔镜下子宫动脉阻断术治疗.结果 所有病例腹腔镜手术均成功,无手术并发症及术后并发症.平均手术时间为(105.6±27.6)min,平均手术失血量为(87.52±18.35)mL.结论 根据不同的病例特点和要求,采用腹腔镜子宫肌瘤剔除术及子宫动脉阻断术治疗子宫肌瘤可取得满意临床效果.腹腔镜子宫肌瘤剔除术联合子宫动脉阻断术明显减少术中出血量、缩短手术时间,降低术后复发率,其术野清晰,创面电凝少,明显减少了组织坏死,术后并发症少.     

子宫动脉栓塞术治疗剖宫产后切口妊娠26例临床分析

目的 探讨子宫动脉栓塞术治疗剖宫产后切口妊娠(CSP)的疗效及价值.方法 回顾性分析2006年5月～2010年12月浙江萧山医院收治的26例CSP患者,均行子宫动脉插管灌注甲氨蝶呤加双侧子宫动脉栓塞,然后行B超监护下清宫术.结果 所有病例均治疗有效,阴道流血患者有效止血,血HCG下降明显,而后清宫术中无1例出现大出血.26例均送病理检查示:子宫瘢痕部位绒毛、蜕膜或胎盘组织,有变性、坏死.1例于介入治疗后发生卵巢早衰.结论 子宫动脉栓塞术能有效控制切口妊娠大出血,有效杀死妊娠物,减少清宫出血量,针对清宫术中大出血、保守治疗后疗效欠佳、B超提示子宫肌层薄、孕囊及包块血流丰富、直径大于3 cm等高危CSP,介入治疗有明显的效果.     

子宫动脉栓塞联合宫腔镜专用取物钳治疗 剖宫产瘢痕妊娠：附28例分析

目的 探讨子宫动脉栓塞联合宫腔镜专用取物钳在剖宫产瘢痕妊娠治疗中的作用。方法 回顾性分析2009年1月~2013年1月在该院行子宫动脉栓塞术后,于宫腔镜或宫腹腔镜联合监视下,以宫腔镜专用取物钳行病灶清除术的剖宫产瘢痕妊娠患者28例,观察分析其临床资料。结果 28例患者均接受双侧子宫动脉栓塞术,次日均采用宫腔镜专用取物钳行病灶清除术,其中17例患者行宫腹腔镜联合监视下手术,11例患者行宫腔镜监视下手术。所有患者平均年龄（30.90±3.28）岁,停经时间（51.47±6.42）d,剖宫产次数（1.20±0.41）次,距离前次剖宫产的时间（4.27±2.84）年,术前子宫前峡部肌层的厚度（3.75±1.70）mm,B超提示前峡部包块大小（28.71±13.25）mm,术前HCG值（22 822.66±19 664.71）mIU/mL,手术时间（41.85±9.91）min,术后24 h血红蛋白下降值（13.12±5.15）g/L、总住院时间（8.32±4.79）d,术后HCG下降至正常的时间（25.81±8.15）d。所有患者均一次手术获得成功,术后1周复查B超均未提示妊娠物残留,术中、术后无并发症。结论 子宫动脉栓塞联合宫腔镜专用取物钳治疗剖宫产瘢痕妊娠安全有效。     

Direct percutaneous transorbital puncture under fluoroscopic guidance with a 3D skull reconstruction overlay for embolisation of intraorbital and cavernous sinus dural arteriovenous fistulas

Objective

To describe the direct percutaneous transorbital puncture technique for embolisation of the selected intraorbital and cavernous sinus dural arteriovenous fistula, which failed to be treated by conventional endovascular techniques.

Methods

One case of intraorbital and five cases of cavernous sinus dural arteriovenous fistula were embolised through direct percutaneous transorbital puncture in 2012, and the clinical data were reviewed. Under fluoroscopic guidance with a three-dimensional (3D) skull reconstruction overlay, the cavernous sinus or ophthalmic vein was punctured via the superior orbital fissure. Then a microcatheter was inserted via the needle, and Onyx was injected to embolise the fistula with or without a combination of coils.

Results

Complete obliteration of the fistula was achieved in all six patients. After operation all the patients experienced transient swelling of the punctured orbit persisting for three to five days. No other complications occurred. Follow-up of six patients at three to six months showed resolution of their initial neuro-ophthalmological symptoms in five and left visual loss in one did not recover. Six months follow-up angiogram showed no recurrence of these fistulas.

Conclusion

Direct percutaneous transorbital puncture provides an option for the intraorbital and cavernous sinus dural arteriovenous fistulas, particularly when the conventional transvenous routes are inaccessible. Overlay of the 3D skull reconstruction can facilitate the precise puncture of the superior orbital fissure.     

Chinese Herbal Medicine for Dysfunctional Uterine Bleeding: a Meta-analysis

We conducted a systematic review to evaluate the efficacy and safety of Chinese herbal medicine (CHM) for dysfunctional uterine bleeding (DUB) by performing a meta-analysis. Randomized controlled trials (RCTs) or quasi-RCTs comparing CHM vs no treatment, placebo, conventional western medicine (CWM), or general non-specific surgical treatment for DUB were identified by electronic and manual searches. Trials of CHM treatments with CWM treatments were compared with CWM treatments alone. Jadad scale and allocation concealment were used to assess the quality of included studies. Four RCTs or quasi-RCTs involving 525 patients were included. The methodological quality was poor in all trials except one trial. No serious adverse events were reported in the included studies. With the lack of trials comparing CHM with no treatment or placebo, it is impossible to accurately evaluate the efficacy of CHM. However, CHM in these studies seem to show an encouraging comparative effectiveness with CWM. More RCTs with a higher quality are required.     

子宫动脉化疗栓塞在前置胎盘中期妊娠引产中的应用

目的探讨子宫动脉化疗栓塞术(UACE)在前置胎盘中期妊娠并阴道出血引产术中的价值。方法对10例前置胎盘中期妊娠并阴道出血需终止妊娠患者,先行双侧子宫动脉化疗栓塞术,再行依沙吖啶羊膜腔内注射术引产,观察引产前、引产中、术后出血及产后恢复情况。结果 10例患者栓塞术后阴道出血停止,羊膜腔穿刺注入依沙吖啶后6~24 h娩出死胎,分娩后阴道流血量80~150m1,平均100m1,7~10 d子宫复旧,42~96 d月经复潮,月经周期和月经量与孕前相仿。结论子宫动脉化疗栓塞术为前置胎盘中期妊娠并阴道出血需终止妊娠患者提供了一种控制引产前出血、预防产后大出血的安全有效措施,介入治疗序贯药物引产术可作为前置胎盘引产的新策略。     

子宫肌瘤动脉栓塞治疗中长期观察

目的:探讨子宫肌瘤动脉栓塞治疗的中长期疗效。方法:共治疗83例症状性子宫肌瘤,在治疗后3、6个月及1年、2年、3年和4年随访复查,了解月经增多等症状的改善,按随访期观察肌瘤的缩小。结果:治疗后月经增多完全或明显改善的病人,3个月复查时占83.1%,6个月92.6%,1年93.9%,2年95.2%,3年和4年100.0%。对疼痛和压迫症状的有效率:3个月88.5%,6个月95.2%,1年100.0%。肌瘤平均缩小率:3个月31.2%,6个月46.1%,1年56.4%,2年61.3%,3年65.7%,4年70.6%。结论:子宫肌瘤动脉栓塞治疗中长期疗效好,肌瘤呈进行性缩小。     

Patients' experiences of living with peripheral arterial disease awaiting intervention: a qualitative study

The aim of this study was to investigate patients’ experiences of living with peripheral arterial disease (PAD) and the influence on activities of daily living. Twenty-four patients with various degrees of PAD were interviewed. The transcribed texts were analysed using manifest and latent content analysis. Living with PAD meant carrying a hard-to-bear physical, social and emotional burden, and struggling for relief. The experience of burden was interpreted in the following themes representing consequences and strategies for gaining control in daily life: (I) “being limited by the burden” (II) “striving to relieve the burden” (III) “accepting and adapting to the feeling of burden”. The use of different coping strategies was crucial to achieve some relief. Pain and sleep disturbance emerged as a major feature of living with PAD, and by combining both analgesics and non-pharmacological methods some pain relief was received. To provide optimal alleviation of pain for these patients, education about pain and pain management is of great importance followed by regular evaluations of the pain and pain management. Furthermore, the study underlines the importance of preventing the progression of the vascular disease and from the individual power and knowledge support and preserve as independent life as possible.     

Efficacy of median sacral artery embolization for treating severe pelvic fractures: a retrospective study

ObjectiveTranscatheter arterial embolization (TAE) of bilateral internal iliac arteries (IIAs) in patients with a hemodynamically unstable pelvic fracture is associated with a low mortality rate. The persistence of unstable hemodynamics after IIA embolization indicates the involvement of other arteries, such as the median sacral artery (MSA). This study aimed to evaluate the efficacy of MSA embolization.MethodsIn this single-center, retrospective, observational study, medical records of patients who underwent MSA angiography or embolization for pelvic fractures (n = 21) between January 2007 and August 2019 were reviewed. The percentage of patients achieving hemodynamic stabilization by MSA embolization was calculated.ResultsFifteen patients underwent MSA embolization, and the remaining six underwent MSA angiography. The shock index value was significantly higher after MSA embolization than that before MSA embolization in hemodynamically unstable patients who underwent this procedure. The success rate of MSA selection was 100%. One patient presented with urinary retention because of bladder and rectal disorders after MSA embolization. The 30-day survival rate was 85.7%.ConclusionsSevere pelvic fractures, such as a Dennis Zone III fracture and suicidal jumper’s fracture due to trauma from a fall, may require MSA embolization.     

A plantar flexion device exercise programme for patients with peripheral arterial disease: a randomised prospective feasibility study

Objectives

To determine if the use of a plantar flexion device (Step It pedal) in a newly developed exercise programme is of benefit to patients with peripheral arterial disease.

Design

Prospective feasibility trial with patients randomised to either standard care or the Step It exercise programme plus standard care.

Setting

Physiotherapy Department at Cumberland Infirmary, Carlisle, UK.

Participants

Patients were identified from the vascular team's referral list. In total, 42 patients agreed to take part; 18 in the control group and 24 in the intervention group.

Interventions

Eligible participants were randomised and received either standard care or took part in a plantar flexion resistance exercise programme, involving the Step It pedal, for a period of 12 weeks.

Main outcome measures

Maximum walking distance, claudication distance and ankle brachial pressure index.

Results

Eighty-three percent of patients completed the study. Improvements in median distance to claudication symptoms and maximum walking distance were observed in the intervention group but not in the control group. Nine out of 15 (60%) participants in the control group and 14 out of 20 (70%) participants in the intervention group improved their walking distance. Ankle brachial pressure index remained virtually unchanged in both groups.

Conclusions

Due to the variability of patients’ fitness in the sample, it cannot be concluded whether use of the Step It pedal has additional benefits to patients over standard care. However, the study completion rate implies that patients with peripheral arterial disease are receptive to undertaking exercise programmes.     

The use of echocardiography for the non-invasive evaluation of coronary artery disease

In the Western world, there are now millions of patients who undergo clinical procedures that evaluate coronary artery status each year. Methods span from direct imaging using angiography, computerized tomography, to nuclear magnetic imaging as well as to functional studies, such as positron emission tomography. These techniques have provided significant information to physicians, but there is still need for an improved accessibility. Angiographic methods are expensive and expose the patient to significant amounts of radiation, undesirable in younger patients. Among the novel technologies for coronary diagnostics, transthoracic echocardiography (TTE) of coronary arteries has provided an important alternative, particularly in everyday practice. Diagnostic arterial TTE can allow determination of the coronary wall lumen in at least three major coronary segments (left main [LM], left arterial descending [LAD] and right coronary artery [RCA]). Coronary wall thickness using the LAD has been preliminarily shown to be related to the risk of coronary events. Since it is well ascertained that coronary lesions found in any location indicate that at least 80% of the coronary tree is affected, this is very important clinical information. Evaluation of coronary status by TTE is a novel technology providing important information in ischemic syndromes, in cases of coronary malformations and other coronary diseases.

• KEY MESSAGES

• Coronary evaluation can be carried out by a variety of both invasive and non-invasive methods, many requiring radiation exposure or patient immobility.

• Transthoracic echocardiography (TTE) of the coronaries can, in particular, evaluate the coronary wall thickness, and this may be directly related to the coronary disease risk.

• TTE is a useful method for the monitoring of coronary flow reserve and can allow the detection of coronary malformations.