Uterine artery embolization for symptomatic uterine myomas

OBJECTIVE: To evaluate the role of uterine artery embolization as treatment for symptomatic uterine myomas. DESIGN: Medline literature review, cross-reference of published data, and review of selected meeting abstracts. RESULT(S): Results from clinical series have shown a consistent short-term reduction in uterine size, subjective improvement in uterine bleeding, and reduced pain following treatment. Posttreatment hospitalization and recovery tend to be shorter after uterine artery embolization compared with hysterectomy. Randomized controlled trials have not been conducted, and long-term efficacy has not been studied. A limited number of deliveries have been reported following uterine artery embolization for uterine myomas. CONCLUSION(S): Uterine artery embolization is a unique new treatment for symptomatic uterine myomas. Even without controlled studies, demand for this procedure has increased rapidly. Uterine artery embolization may be considered an alternative to hysterectomy, or perhaps myomectomy, in well-selected cases. At the present time, however, uterine artery embolization should not be routinely recommended for women who desire future fertility.     

Uterine restoration after repeated expulsion of myomas after uterine artery embolization

A patient passed infarcted myomas 21, 27, and 35 days after uterine artery embolization. Transvaginal ultrasound examination did not reveal a myoma and her menstruation became normal with minimal bleeding. Uterine artery embolization and expulsion of myomas vaginally can eliminate intramural and submucous myomas.     

Ovarian failure after uterine artery embolization for treatment of myomas

Uterine artery embolization (UAE) is an effective, safe, nonsurgical treatment for uterine myomas. Although menstrual irregularities and transient amenorrhea have occurred after UAE, these reports did not provide proper hormonal documentation of ovarian failure. Our patient experienced elevated follicle-stimulating hormone (FSH) levels and vasomotor symptoms (hot flushes) within 4 weeks after the procedure. To our knowledge, this is the first report in the literature of ovarian failure after UAE confirmed by comparing preprocedure FSH levels with postprocedure levels over 12 months.     

子宫动脉栓塞术治疗子宫肌瘤

子宫动脉栓塞术治疗子宫肌瘤不但能使肌瘤坏死、缩小甚至消失,从而改善临床症状,同时可以保留子宫的生理功能,已经成为一种有效的、保留子宫的微创治疗方法。但在临床应用中也出现一些严重的并发症,甚至出现死亡病例。获得良好疗效和避免并发症的关键是处理好以下问题：选择合适的病例、使用合适的栓塞剂和栓塞颗粒、准确栓塞肌瘤的靶动脉、控制好栓塞程度、及时发现并处理并发症。     

Pregnancy after uterine artery embolization for the treatment of myomas: a case series

Purpose

Uterine artery embolization (UAE) has become an alternative therapy for the treatment of symptomatic myomas. The questions of fertility and pregnancy outcome after uterine artery embolization are still not answered. The study presents the results of pregnancies after UAE. The main goal was to evaluate the course of these pregnancies and concentrate on possible complications.

Methods

This was a prospective study from June 2009 till October 2011. Patients with symptomatic uterine myomas were included. The evaluation of the symptoms was done by quality of life questionnaire and bleeding charts. UAE was performed by superselective microcatheterization technique. Women still planning pregnancy were included in the study after signing detailed informed consent. Pregnant women after UAE were followed as high-risk pregnancies.

Results

A total of 98 patients underwent uterine artery embolization for symptomatic myomas; 21 expressed their wish to become pregnant, out of which 6 had successful spontaneous conception (23.08 %) and 1 patient was pregnant twice, and altogether there were seven pregnancies. During gestation and delivery, there was no serious complication. There was one missed abortion and one placental retention. Myomas did not show growth pattern during pregnancy.

Conclusions

Data from further prospective, randomized trials comparing fertility and pregnancies after UAE with other treatment modalities are needed. UAE, with the new techniques of superselective microcatheterization, could be, in the future, a possible approach even in women with future maternity plans.     

Uterine artery embolization for the treatment of uterine leiomyomata.

OBJECTIVES: To evaluate the results of the uterine artery embolization (UAE) for the treatment of uterine fibroids. METHODS: Twenty-six patients with ultrasonographic diagnosis of uterine leiomyomata were submitted to UAE with polyvinyl alcohol particles. Imaging and clinical follow-up was performed before the procedure, at 3 months, and 1 year after. RESULTS: All procedures but one were technically successful. Control of menorrhagia and pelvic pain were reported after UAE by 87.5% and 84.2% of patients, respectively. The initial medium uterine volume was 385 cm(3), after 3 months 255 cm(3) and after 1 year 202 cm(3). The mean uterine volume decrease was 29% after 3 months and 41% after 1 year of follow-up (P<0.001). Clinical and biochemical findings consistent with ovarian failure were observed in three patients (12% of the patients). CONCLUSIONS: UAE represents a new therapeutic approach in the treatment of uterine leiomyomata. The procedure appears effective in controlling symptoms and represents an alternative to hysterectomy.     

Uterine arteries embolization as a treatment of uterine leiomyoma

Uterine artery embolization is a new method of treating uterine leiomyomata, first carried out in France in the early 90s. The procedures involve placing a small catheter into an artery in the groin and directing it to the blood supply of the fibroid. Little plugs of polyvinyl alcohol are injected through the catheter to block these arteries. This cause the fibroid to shrink. Indications for uterine fibroid embolization include menorrhagia, pelvic pain or pressure, other "bulk" syndrome (low-back pain, urinary frequency and constipation. The fluoroscopic-guided procedure is performed under local anesthesia. Most patients are discharged within 72 hours. Post-embolization syndrome including severe pain is managed with morphine via patient-controlled pump. Paper reviews long term outcomes. Uterine artery embolization has several advantages: high efficacy, less invasiveness, ability to treat multifocal changes, uterine preservation, shorter hospitalisation and recovery (low cost) and disadvantages: postembolic syndrome (pain and fever), unknown relations to pregnancy and lack of long term results.     

Selective uterine artery embolization in the management of uterine myomas

OBJECTIVE: To evaluate the effectiveness of uterine artery embolization in women with uterine myomas in terms of the clinical results for the relief of related symptoms. DESIGN: A pilot study on 26 women affected by uterine single myoma. SETTING: Tertiary level care in an university hospital. PATIENT(S): Twenty-six patients, aged 32 to 54 years, suffering of menorrhagia, pelvic pain, and abdominal mass for single myoma, intramural localization. INTERVENTION(S): Selective uterine artery embolization performed under peridural anesthesia. MAIN OUTCOME MEASURE(S): We measured the x-ray dose to which patients were exposed. Color power Doppler ultrasound examinations were performed during the follow-up evaluations at 1 to 6 months and 1 year after the procedure. RESULT(S): Uterine artery embolization was successfully performed in 100% of cases. The mean fluoroscopy time was of 20 minutes during the procedure. The mean dose of x-ray absorbed by the ovary was estimated at 18.7 cGy and the mean dose of x-ray absorbed by the skin was 126.7 cGy. A reduction of myoma volume of 55% was found at 6 months' ultrasound examination and 75% at the 1-year examination. CONCLUSION(S): Patients are well satisfied and have short recovery times with this procedure. Uterine artery embolization may be a valid alternative to traditional surgery.     

Uterine artery embolization for symptomatic uterine myomas using gelfoam pledgets alone vs. embospheres plus gelfoam pledgets: a randomized comparison

The aim of the study is to evaluate the feasibility, tolerability, and clinical outcomes of uterine artery embolization (UAE) using gelfoam (G) alone versus embospheres + gelfoam (E + G) in women with symptomatic uterine fibroids. Prospective, patient blinded, randomized controlled pilot study (Level-I). University Affiliated Teaching Hospital. Fifty-nine women with symptomatic uterine fibroids; G (n = 31) vs. E + G (n = 28). Fluoroscopy-guided trans-femoral artery UAE was performed under intravenous sedation, local anesthesia, and overnight patient-controlled analgesia (PCA) pump using either gelfoam pledgets alone or gelfoam plus embospheres (500–700 μm). Baseline, 3, 6, and 12 month dominant fibroid and total uterine volume as well as menstrual blood loss and satisfaction scores were compared between the groups. The mean and standard deviation (SD) of uterine volume (cm³) for G vs G + E at baseline and at 3, 6, and 12 months were 801 (538) vs.565 (370), 535 (226) vs. 426 (322), 485 (401) vs. 401 (249), and 467 (438) vs. 343 (227), while the mean (SD) of the dominant fibroid volume (cm³) during the same time periods were 268 (291) vs. 227 (213), 190 (290) vs. 137 (168), 132 (168) vs. 93 (101), and 118 (169) vs. 81 (99), respectively, with no statistical difference (NS) between the two groups at any interval. The corresponding mean (SD) Ruta scores assessing uterine blood loss at the same time periods were 19.2 (6.8) vs. 21.6 (6.1, NS), 11.5 (7.2) vs. 8.1 (5.2, NS), 13.2 (8.3) vs. 6.4 (4.0, p < 0.001), and 10.5 (7.9) vs. 5.8 (3.6, p < 0.01) for G-alone and E + G, respectively. At 12 months, 71 vs. 79 % of patients were satisfied/very satisfied with their treatment (NS). UAE with gelfoam alone was feasible, tolerable, and equally effective to embospheres + gelfoam in reducing uterine and fibroid volume while it normalized menstrual blood loss.     

Uterine artery embolization for the treatment of uterine fibroids: An outpatient procedure

OBJECTIVE: Our objectives were to establish an outpatient program for uterine artery embolization of fibroids and to monitor the following: percentage of patients who required immediate hospitalization or admission within 2 weeks, outcomes in terms of the degree of ultrasound regression of the fibroids, patient satisfaction, reduction of pressure symptoms, and reduction of bleeding. STUDY DESIGN: Patients were screened by a gynecologist with the use of a designed care algorithm; they then underwent uterine embolization, performed by an interventional radiologist. Patients were evaluated at 6 weeks and 6 months after the procedure, and ultrasound studies were performed both before and at 2 to 6 months after the procedure. RESULTS: Of 35 patients, 29 (83%) went home on the day of the procedure, whereas 6 were observed overnight. Three (9%) patients required admission within 1 week. Of 26 patients, 24 (92%) were satisfied with the reduction of bleeding, and 14 of 18 (78%) were satisfied with the reduction in pressure symptoms. The mean decrease in uterine volume was 36%, and the mean decrease in the size of the dominant fibroid was 49%. CONCLUSIONS: Uterine artery embolization for the treatment of uterine fibroids might be done on an outpatient basis with a low rate of same-day admissions and delayed admissions. Patient satisfaction was high, and uterine artery embolization might become an accepted option for the treatment of uterine fibroids.     

Uterine artery embolization in an undiagnosed uterine sarcoma

Background: Uterine sarcomas are rare malignancies that resemble benign uterine leiomyomata. Uterine artery embolization is offered increasingly for treatment of uterine leiomyomata, which might lead to embolization of undiagnosed uterine sarcoma.Case: A 52-year-old woman, gravida 7, para 6, with perimenopausal menometrorrhagia was diagnosed with uterine leiomyomata after physical examination and transvaginal ultrasound. An endometrial biopsy was negative for malignancy. After medical treatment was unsuccessful, she had uterine artery embolization. She then passed a piece of tissue from her vagina, the pathology report of which was necrotic high-grade sarcoma. During surgery we confirmed that the tumor was confined to the uterus.Conclusion: Uterine sarcoma cannot be diagnosed except by pathologic examination of a resected specimen. Women considering uterine artery embolization for treatment of apparent leiomyomata should be counseled on the risk of decreased survival by delaying diagnosis and treatment of uterine sarcoma.     

Uterine artery embolization for symptomatic uterine leiomyoma and adenomyosis.

BACKGROUND AND PURPOSE: Uterine artery embolization (UAE) is increasingly accepted as an alternative treatment for symptomatic uterine leiomyoma and adenomyosis. The purpose of this study was to compare the outcomes of UAE in 3 diagnostic categories--submucosal leiomyoma, intramural leiomyoma, and adenomyosis--to assist in patient selection for this relative new form of therapy. METHODS: The medical records of 43 patients (aged 22 to 54 years) who underwent UAE for symptomatic uterine leiomyoma or adenomyosis were retrospectively reviewed. Magnetic resonance imaging (MRI) was used for categorization of the patients into the 3 diagnostic categories, and also for objective measurement of the uterine and leiomyoma size, and subsequent imaging follow-up. UAE was performed using polyvinyl alcohol particles. Symptom improvement and complications after treatment were evaluated at gynecologist clinics using monthly questionnaires. The group differences in complete symptom resolution, uterine and leiomyoma size reduction, incidence of complications, and subsequent surgeries were analyzed. RESULTS: The mean duration of follow-up was 10.9 months. Complete resolution of symptoms was achieved in 13 out of 16 patients with submucosal leiomyoma (81%), 3 out of 15 patients (20%) with intramural leiomyoma (p = 0.002) and 3 out of 12 patients (25%) with adenomyosis (p = 0.01). The average reduction of leiomyoma size in the submucosal and intramural groups was 56% and 29%, respectively (p = 0.02). None of the patients died. Severe complications occurred in 3 of 43 patients (7%), including permanent amenorrhea in 2 and pelvic actinomycosis in 1 patient. The incidence of complications (p = 0.17) and subsequent surgery (p = 0.67) did not differ significantly among the 3 groups. CONCLUSIONS: UAE is an effective treatment for patients with symptomatic leiomyoma or adenomyosis. In this study, patients with submucosal leiomyoma had the best treatment outcome.