Uterine artery embolization

The use of uterine artery embolization is a new approach in the treatment of uterine fibroids. Embolization is a technique in which blood vessels that supply nutrients and oxygen to fibroids are blocked. This blockage causes the fibroid muscle cells to degenerate and form scar tissue, thus shrinking the fibroid. Usually the fibroid no longer causes symptoms. This minimally invasive procedure involves an overnight hospital stay and results in a reduction of fibroid symptoms. Most women notice the greatest improvement in the first eight weeks. This procedure has been performed only since 1990 and, therefore, long-term results are unknown.     

Uterine fibroid tumors: diagnosis and treatment

The incidence of uterine fibroid tumors increases as women grow older, and they may occur in more than 30 percent of women 40 to 60 years of age. Risk factors include nulliparity, obesity, family history, black race, and hypertension. Many tumors are asymptomatic and may be diagnosed incidentally. Although a causal relationship has not been established, fibroid tumors are associated with menorrhagia, pelvic pain, pelvic or urinary obstructive symptoms, infertility, and pregnancy loss. Transvaginal ultrasonography, magnetic resonance imaging, sonohysterography, and hysteroscopy are available to evaluate the size and position of tumors. Ultrasonography should be used initially because it is the least invasive and most cost-effective investigation. Treatment options include hysterectomy, myomectomy, uterine artery embolization, myolysis, and medical therapy. Treatment must be individualized based on such considerations as the presence and severity of symptoms, the patient's desire for definitive treatment, the desire to preserve childbearing capacity, the importance of uterine preservation, infertility related to uterine cavity distortions, and previous pregnancy complications related to fibroid tumors.     

Ovarian reserve after fibroid embolization in premenopausal women

Objective: To investigate the effect of uterine artery embolization (UAE) for fibroids on ovarian pool of premenopausal women.

Study design: Prospective case control study.

Material and methods: One-hundred and twenty premenopausal women, aged between 40 and 50?years, who underwent UAE for symptomatic uterine fibroids and the same number of women, aged between 40 and 50?years, with symptomatic uterine fibroids, who were not offered treatment were recruited for this study. Hormonal status and ovarian reserve were evaluated by means of anti-Müllerian hormone (AMH) and follicle stimulating hormone (FSH) pre-procedural, three months, six months and 12?months after UAE.

Results: No statistically significant decrease was noted in AMH values 12?months post procedure and no statistical significant alterations in AMH values between the two groups.

Conclusions: Even though the study results may not be able to confirm the preservation of ovarian reserve and normal menstruation after UAE in premenopausal women, it should be considered as a friendly to normal menstruation treatment option of symptomatic fibroids.     

子宫肌瘤患者围手术期的心理支持及护理

报告69例子宫肌瘤患者实施手术治疗时,围手术期的心理支持和护理体会。经过术前心理需求分析,采用五步方法进行有针对性的心理护理支持,术后给予社会需求支持,针对疼痛心理支持,进行出院后指导,取得了一定经验和体会,提高了患者的手术效果及满意度。     

Uterine artery embolization for fibroids

UAE is an alternative to surgery for treatment of uterine fibroids that uses injections of small plastic or gelatin beads to thrombose fibroid vessels arising from the uterine artery. Clinical studies have reported less menorrhagia and pelvic pain in patients who have undergone the procedure. After embolization, many patients experience pain requiring an overnight hospital stay and administration of parenteral opioids. UAE is generally not recommended for women who have not completed childbearing.     

Update on uterine artery embolization for symptomatic fibroid disease (uterine artery embolization)

Transcatheter embolization of the uterine arteries for symptomatic fibroid disease has become an increasingly important alternative treatment. It is highly effective and well tolerated by most patients. Most notably, uterine artery embolization is associated with a short recovery period and is uterine sparing. To ensure the best chance for a safe and successful procedure, Interventional Radiologists should have familiarity with uterine artery anatomy, state of the art embolization techniques, and optimal patient selection and post procedure management.     

Uterine artery embolization for symptomatic myomata

Fibroid disease is common and causes significant health problems in women of childbearing age. Over the past several years, uterine artery embolization (UAE) has emerged as a minimally invasive treatment for symptomatic uterine myomata. Embolotherapy is effective in relieving myoma-related symptoms in 80% to 90% of patients. It requires shorter hospitalizations than traditional surgical therapies for myoma disease and is associated with faster recovery and lower complication risks than surgery. Patient selection, the UAE procedure, and post-UAE management are reviewed.     

Three-dimensional color Doppler sonography before and after fibroid embolization.

Three-dimensional color Doppler sonography was performed within 1 hour, 1 day, 3 months, and 6 months of fibroid embolization in 20 patients who had a total of 31 fibroids greater than 2 cm in average dimension. The greatest decrease in vascularity occurred 1 day after the procedure, whereas the greatest volume change was found at the 3 month follow-up examination. In about one half of the patients scanned, depiction of fibroid vascularity by color Doppler sonography was found to improve the delineation of the size, location, and extent of myometrial involvement. Hypervascular fibroids (12 of 31) tended to decrease in size after treatment more than isovascular (10 of 31) or hypovascular ones (9 of 31). Additional investigations that are similar to this one will be needed to determine if three-dimensional color Doppler sonography can be used to predict those who will be responders, partial responders, or nonresponders to embolotherapy.     

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.     

选择性子宫动脉栓塞术治疗子宫肌瘤的探讨

目的评价选择性子宫动脉栓塞术治疗子宫肌瘤的临床疗效及应用价值。方法19例子宫肌瘤患者均采用经右侧股动脉穿刺双侧子宫动脉超选择性插管,使用聚乙醇＋明胶海绵颗粒栓塞双侧子宫动脉,阻塞肌瘤血供。结果全部病例随访3～24个月,8例肌瘤体积缩小大于50％,9例肌瘤体积缩小20％-50％,月经量和月经周期恢复正常,1例缩小〈20％,临床症状明显改善,1例无明显变化。治疗后3个月18例患者血红蛋白升至105g/L以上。无1例严重并发症发生。结论选择性子宫动脉栓塞术治疗子宫肌瘤是一种安全、简便、创伤小、疗效高的治疗方法,具有较高的临床应用价值。     

Uterine artery embolization: sonographic imaging findings.

OBJECTIVE: To examine the sonographic and angiographic imaging findings before and after uterine fibroid embolization for symptomatic leiomyoma. METHODS: This prospective study involved 14 premenopausal women who underwent uterine fibroid embolization for symptomatic leiomyoma. Preprocedure sonography with color Doppler imaging was performed. Bilateral uterine artery embolization was successfully performed with the use of polyvinyl alcohol. Follow-up sonographic examinations were performed between 1 and 3 months after the procedure. The correlation between the sonographic appearance before and after embolization and the degree of decrease in uterine size was evaluated by using the Jonckheere-Terpstra 2-sided P test. RESULTS: Preprocedure sonographic imaging showed a varied appearance to the fibroids. Color Doppler imaging primarily showed the fibroids to be vascular with marked peripheral blood flow. Postprocedure sonographic imaging showed decreased uterine size and echogenicity. Color Doppler imaging showed a marked decrease in the blood flow to the leiomyoma. There was no statistical significance in the relationship between echogenicity and vascularity shown before the procedure and the percent decrease in the size of the uterus. CONCLUSIONS: Although sonography is an efficient method for identifying leiomyomata and determining the reduction in size after uterine artery embolization, we were unable to identify any predictive characteristics of success for aiding the preprocedural assessment.     

Uterine artery embolisation for fibroid disease: Results of a 6 year study

Summary

Uterine myomata are very common Failed treatment frequently leads to major surgery Therefore, non-invasive techniques, such as uterine artery embolisation (UAE) are of great interest and were first reported by Ravina et a1 to treat symptomatic myomata initially scheduled for surgery The objectives of this 6 year study were to evaluate UAE as the only treatment of myomata.

Between 1991 and 1997, 184 women with symptomatic myomata were prospectively enrolled in the study Bilateral, particular UAE was performed with polyvinyl alcohol (PVA, halon) under local anaesthesia and analgesia during a 24 h hospitalisation Women's ages ranged from 21 to 54 years (mean 41) Menorrhagia was present in 93% of cases, pain in 22%, enlarged uterus in 25% Myomata were interstitial (77%), subserous (16%) or submucous (7%) Multiple myomata were common (in 80%, ≥3 myomata) mean myomata diameter 58 mm 157 cases could be evaluated (19 were lost during follow-up and there were eight catheterisation failures) The mean duration of follow-up was 29 months Success with menorrhagia and uterine volume reduction, without subsequent surgery, was observed in 90% of cases Most of the incidents (10%) were benign and observed before 1996, including catheterisation failure and five definitive amenorrhea In seven patients, eight pregnancies were observed These data confirm our previous reports and other studies on the safety and efficacy of UAE as the only treatment of uterine myomata.     

子宫肌瘤的动脉栓塞治疗

子宫肌瘤是女性生殖系统最常见的良性肿瘤,病因不明,一般认为与雌激素有关。肌瘤的大小与发病率随着年龄的增长而增长,在４０岁以上的白人妇女中发病率约２０％,在５０岁以上仍有月经的女性中发病率达４０％１;在未产妇中更常见;黑人女性发病率更高、发病时间更早;非洲－加勒比地区女性的发病率是白人的３～９倍。停经后肿瘤缩小。临床症状通常有月经不调、月经过多,而出血是粘膜下及肌壁间肌瘤的最常见症状,并常导致缺铁性贫血;肌瘤的肿瘤效应及增大的子宫可产生泌尿道及神经症状如腹胀及疼痛、下坠不适感。另外子宫肌瘤还可…     

Uterine artery embolization using progressively larger calibrated gelatin sponge particles

Purpose To assess the effectiveness and safety of uterine artery embolization (UAE) using progressively larger calibrated gelatin sponge particles for symptomatic uterine fibroids. Material and methods Thirty patients with symptomatic uterine fibroids underwent UAE. Calibrated gelatin sponge particles were used in all patients, beginning with 355-500?μm particles, progressively increasing to 500-710?μm and finally to 710-1000?μm particles. Changes in tumor, uterine volume, and tumor infarction rate were assessed using pelvic magnetic resonance imaging (MRI). The level of complication, improvement of clinical symptoms, and Uterine Fibroid Symptom and Quality of Life (UFS-QOL) score were assessed. Results MR imaging revealed the mean largest tumor volume reduction was 56.23?±?16.25% at three months and 72.61?±?14.47% at 12 months after the procedure. 100% infarction of the dominant fibroids was 91.27?±?5.02% at three months and 96?±?5.20% at 12 months after the procedure. Menorrhagia improved markedly in all 23 patients. Bulk-related symptoms improved in 12 (92.30%) of 13 patients. The baseline UFS-QOL score was 43.13 and improved to 11.88 (p?<?0.001). No major complications were observed. Conclusion UAE using progressively larger calibrated gelatin sponge particles is an effective and safe treatment for symptomatic uterine fibroids.     

Uterine fibroids: targeted embolization,an update on technique

Uterine fibroid embolization has become an attractive alternative therapy for symptomatic uterine fibroids. Since its introduction, the applied embolization technique has undergone several refinements. Complete fibroid devascularization to block uterine arteries was the initial goal. Thereafter, more sophisticated techniques for targeted embolization of the fibroid to preserve cervical and vaginal branches and ovarian anastomosis were being performed by more and more interventionists. In addition, the use of calibrated embolic agents has become more and more popular. In this article we provide an update on the modern uterine fibroid, targeted embolization technique, including a summary of catheterization-related problems, flaws, and tricks.