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Uterine artery embolization for fibroids  [PDF]
Thanikasalam K,,Hebbar S,,Shashikala K
Calicut Medical Journal , 2007,
Abstract: Uterine leiomyomata, commonly known as fibroids, are extremely common benign lesions of uterus, usually managed by surgical management when symptomatic. The surgical options include myomectomy or hysterectomy. However surgery is associated with significant morbidity in terms of increased blood loss, operating time, post-operative complications and longer hospital stay. Another alternative treatment is hormonal therapy using gonadotrophin-releasing hormone (GnRH) agonists which is mainly used primarily as a temporary preoperative measure to reduce tumour size and vascularity. Though this approach dramatically improves symptoms and reduces fibroid size, these tumours re-grow to their original size within a few months of discontinuing treatment and are associated with adverse effects; such as osteoporosis, menopausal symptoms and amenorrhoea. Uterine artery embolization (UAE) is one of the new treatment modality available presently in major institutions as an alternative to hysterectomy in those women wishing to preserve reproductive function. UAE is also cost-effective and is associated with a short hospital stay and may be an option in those women with major medical illness including morbid obesity, and Jehovah’s witnesses. The following treatise addresses to selection of patients, contraindications, details of the procedure and available evidence with regard to safety and benefits of the procedure.
A Case of Massive Uterine Bleeding due to Fibroid Expulsion after Uterine Artery Embolization:Control of Bleeding by Re-embolization
K. Firouznia,H. Ghanaati,M. Sanaati,A. H. Jalali
Iranian Journal of Radiology , 2004,
Abstract: A 35 year-old woman underwent uterine artery embolization (UAE) for uterine fibroid. Just the fibroid was expelled (seventy days after UAE), massive uterine bleeding occurred which was treated by super-selective uterine artery re-embolization. Three hours after the re-embolization, bleeding stopped and follow-ups showed complete elimination of menstrual, urinary and bulk-related symptoms. Massive hemorrhage after fibroid expulsion is probable and embolization of uterine arteries is a favorite alternative treatment for this condition.
Indications and Outcomes of Uterine Artery Embolization in Patients with Uterine Leiomyomas  [PDF]
Hidenori Sasa,Tatsumi Kaji,Kenichi Furuya
Obstetrics and Gynecology International , 2012, DOI: 10.1155/2012/920831
Abstract: Objective. To investigate the indication and limitations of uterine artery embolization (UAE), we retrospectively analyzed the case of patients with uterine leiomyomas who had undergone UAE. Methods. During the past 7 years, 25 patients with uterine leiomyomas had undergone UAE in our hospital. UAE was indicated in patients with menstrual disturbances such as hypermenorrhea or dysmenorrhea. The outcomes of this procedure for uterine leiomyomas were analyzed. Results. Improvement in the menstrual symptoms and/or reduction in the leiomyoma size after UAE were observed in 24 patients (96.0%). There was mean 67.9% reduction in the volume of leiomyomas at six months after UAE ( ). However, the symptoms recurred after UAE in 6 patients (24.0%), with multiple or intramural leiomyomas larger than 7?cm, which necessitated additional procedures. Conclusion. The indications and limitations of the UAE should be considered because of its noneffectiveness and/or recurrence in over 20% of patients with uterine leiomyomas. 1. Introduction Several nonsurgical techniques are used for the treatment of patients with uterine leiomyomas, such as the recently developed magnetic resonance-guided focused ultrasound therapy. Uterine artery embolization (UAE) is an outpatient nonsurgical radiologic treatment of uterine leiomyomas. It is noninvasive and useful for women who refuse hysterectomy, as well as for those with a high surgical risk, including morbid obesity [1]. We retrospectively analyzed the cases of 25 patients with symptomatic uterine leiomyomas who had undergone UAE to clarify the indications and limitations of the procedure. 2. Materials and Methods Data of 25 patients with uterine myomas who had undergone UAE between 2003 and 2009 in National Defense Medical College Hospital (Saitama, Japan) are listed in Table 1. The mean age of the patients was 41.7 years, and the standard deviation was 3.5 years. UAE was indicated in patients with menstrual disturbances such as hypermenorrhea or dysmenorrhea after obtaining their informed consent. UAE was also performed in 3 patients with severe complications and a high surgical risk. Their preexisting medical complications were as follows: diabetes mellitus and renal failure; chronic kidney disease and peritoneal dialysis; cerebral palsy and thrombosis. We detected 12 submucosal myomas and 13 intramural leiomyomas. The mean hemoglobin value before the UAE was 8.5?g/dL, and the standard deviation was 3.0?g/dL. Table 1: Patient characteristics ( ). The general indications and contraindications for UAE in patients with uterine
Uterine artery embolization for the treatment of symptomatic myomas in Brazilian women
Sena-Martins, Maurício;Roteli-Martins, Cecilia Maria;Tadini, Valdir;Souza, Gustavo Antonio de;Kisilevzky, Nestor;Lazar Junior, Felipe;
Sao Paulo Medical Journal , 2003, DOI: 10.1590/S1516-31802003000500002
Abstract: context: uterine myomas are benign tumors that mostly occur in women of reproductive age at a frequency ranging from 20 to 25%. the symptoms are increased menstrual flow, pain and compressive signs. new treatments have been proposed and uterine artery embolization is one of them. objective: to evaluate the effects of treatment by embolization of the uterine artery, in women with symptomatic myomas. uterine and dominant myoma volumes and the major symptoms were evaluated before treatment and 12 weeks later. type of study: open clinical trial. setting: a tertiary-care women's hospital. participants: the study was conducted on 32 women with symptomatic single or multiple myomas of the uterine body, seen at the outpatient unit from may 2000 to september 2001. main measurements: the patients were submitted to gynecological examination and abdominal and endovaginal pelvic ultrasonography, and the examinations were repeated 12 weeks after the first procedure. uterine artery embolization using pva (polyvinyl alcohol) particles of 355-700 μ was performed by catheterization of the right femoral artery in 30 women and by bilateral catheterization in two. results: before embolization, the mean uterine volume of the 32 women was 455 cm3 and the mean volume of the dominant myoma was 150 cm3. twelve weeks after embolization, the mean uterine volume was 256 cm3 and the mean volume of the dominant myoma was 91 cm3, with p < 0.01 in both cases. twelve weeks after the treatment, all the women answered a questionnaire, which showed that 71% had improvement in menstrual regularity, 90% decreased menstrual volume and 81% shortened menstrual duration. the most frequent immediate post-procedure symptoms, established as complications, were pain (100%) and fatigue (34%). one woman had myoma degeneration and was submitted to myomectomy. conclusion: the significant reduction in uterine and dominant myoma volume confirms the validity of the treatment of symptomatic myomas by the technique of ut
Aberrant Right Ovarian Artery from Proximal Internal Iliac Artery in Uterine Artery Embolization Patient  [PDF]
Richard A. Reed, Bruce McLucas
Open Journal of Radiology (OJRad) , 2012, DOI: 10.4236/ojrad.2012.24021
Abstract: Some patients who undergo Uterine Artery Embolization (UAE) for symptomatic leiomyomata have collateral ovarian artery supply to the uterus. This typically occurs when the ipsilateral uterine artery is small or absent, and the ovarian artery supply to the uterus can lead to UAE failure. The authors present a case of a woman treated with UAE who had an atretic right uterine artery and an enlarged right ovarian artery supplying the fibroids. The ovarian artery arose from the proximal internal iliac artery. This rare variant vessel was embolized leading to eradication of the patient’s symptoms. The success of this case highlights the need to evaluate for possible variant ovarian artery supply and to embolize these vessels in an attempt to prevent UAE failure.
Trends in the Rates of Peripartum Hysterectomy and Uterine Artery Embolization  [PDF]
Geum Joon Cho, Log Young Kim, Hye-Ri Hong, Chang Eun Lee, Soon-Cheol Hong, Min-Jeong Oh, Hai-Joong Kim
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0060512
Abstract: The objective of this study was to determine the trends in national rates of peripartum hysterectomy (PH) and uterine arterial embolization (UAE) in Korea. We used data collected by the Health Insurance Review & Assessment Service of Korea and analyzed data from patients who gave birth during the period from 2005 to 2008. There were 1785,178 deliveries during the study period, including 2636 cases of PH (1.48 per 1000 deliveries). The PH rate in 2005 was 1.57 per 1000 deliveries and in 2008 it was 1.33 per 1000 deliveries. UAE was performed in 161 women (incidence, 0.38 per 1000 deliveries) and 447 women (incidence, 0.98 per 1000 deliveries) in 2005 and 2008, respectively. In Korea, the rate of PH decreased slightly, while the rate of UAE rate increased dramatically during the period from 2005 to 2008. Further studies are needed to evaluate the effects of UAE on the rate of PH performed.
The Role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in the Management of the Post-Embolization Symptoms after Uterine Artery Embolization  [PDF]
Tiago Bilhim,Jo?o Martins Pisco
Pharmaceuticals , 2010, DOI: 10.3390/ph3061729
Abstract: Uterine artery embolization (UAE) is usually a very painful procedure. Although pain after the procedure can occur as a single symptom, it usually is associated with other symptoms such as nausea, vomiting, pelvic pain, general malaise, fever and leukocytosis that characterize the post-embolization syndrome. Management of the post-embolization symptoms and of pain in particular, is paramount if UAE is to be performed as an outpatient procedure. Different protocols have used analgesic and/or anti-inflammatory agents to control these symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used in association with analgesic drugs to control post-embolization symptoms. In our institution the patients start oral medication with NSAIDs the day before the procedure and continue it during and after UAE. We also mix NSAIDs with the embolizing particles. This enables a reduction in the inflammation present in the uterine fibroids and helps controlling the pain. The purpose of this paper is to review the importance of NSAIDs in the management of the post-embolization symptoms. We describe the protocol that we use in our institution that enables us to perform the procedure on an outpatient basis with same day discharge and good control of the post-embolization symptoms with oral NSAIDs and analgesics.
Efficacy of Uterine Artery Embolization for Patients with Postpartum Hemorrhage  [PDF]
Young Ho Choi, Yasutaka Baba, Shunichiro Ikeda, Young Ho So, Sadao Hayashi, Masayuki Nakajo
Open Journal of Radiology (OJRad) , 2013, DOI: 10.4236/ojrad.2013.32008
Abstract:

Purpose: To investigate the efficacy of uterine arterial embolization (UAE) in patients with post-partum hemorrhage (PPH). Materials and Methods: The subjects were 40 women (mean age, 33 years; age range, 21 - 42 years) who underwent UAE for PPH at two institutes from June 2001 to May 2011. The rates of clinical success (avoidance of hysterectomy) and complications were calculated. Differences in related factors between primary PPH and secondary PPH and between caesarean section and vaginal delivery were examined. The risk factors associated with hysterectomy were also examined. Results: The overall clinical success rate was 90% (93% of primary PPH, 77% of secondary PPH, and 87.5% of PPH with cesarean section), and the overall complication rate was 10%. There were significant differences in time to PPH (P < 0.0001) and in blood infusion after UAE (P = 0.0158) between subtypes of primary and secondary PPH and in blood infusion before UAE (P = 0.0052) between delivery methods. The significant factors associated with hysterectomy were cesarean section (P = 0.02), severe PPH (>1000 mL bleeding, P = 0.03), and embolization of non-uterine arteries (P = 0.02).

Conservative management of cervical pregnancy: The utility of methotrexate treatment and uterine artery embolization  [PDF]
Hisashi Masuyama, Seiji Inoue, Etsuko Nobumoto, Kei Hayata, Tomonori Segawa, Yuji Hiramatsu
Open Journal of Obstetrics and Gynecology (OJOG) , 2013, DOI: 10.4236/ojog.2013.310131
Abstract:

The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined clinical presentations, treatments, and therapeutic outcomes in fifteen patients with a cervical pregnancy who wished for preservation of fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve patients received systemic methotrexate including five treated with UAE. One was treated with UAE alone. Two patients received neither UAE nor methotrexate because of a low human chorionic gonadotropin (hCG) level and poor blood flow around the gestational sac (GS). An increased GS size and the elevated hCG level during methotrexate therapy might be risk factors for emergent UAE. Two of six patients treated with UAE had subsequent confirmed viable pregnancies. In patients with a cervical pregnancy, methotrexate therapy in combination with UAE can be considered as an option before performing a hysterectomy with suitable counseling about the risk of loss of fertility. Careful observation of the GS size and hCG level during methotrexate therapy might be important for management.

Uterine Artery Embolization for Symptomatic Uterine Fibroids: a Prospective Study on 102 Patients in Iran
K. Firouznia,H. Ghanaati,M. Sanaati,A. H. Jalali
Iranian Journal of Radiology , 2005,
Abstract: Background/Objectives : To evaluate the safety, efficacy an d complication rate of uterine artery embolization in symptomatic fibroid patients in Iran. Patients and Methods: A hundred and two patients aged 20-48 years (mean age: 35.7 ±6.4 years) with symptomatic fibroids entered th e study from September 2001 to November 2004. The most common presenting symptom was increased menstrual bleeding, which occurred in 74.5% of all patients. Urinary symptoms occurred in 43%, and bulk-related symptoms were seen in 63.7 % of our patients. We performed bilateral UAE (uterine artery em bolization) using PVA (pol yvinyl alcohol) particles (500-710 micron) and assessed the patients before UAE and at regular follow- ups at 1, 3, 6 and 12-month intervals by questionnaires / interviews and ultrasound. MRI without gadolinium (Gd-DTPA) injection was done before emboliz ation and at 6 and 12 months after the procedure. Results: By Friedman test, sequential follow-up (up to 12 months) showed that the vaginal bleeding severity significantly decreased (p <0.0001), with menorrhagia resolving in 59.4% of patients at 1 month, and in 69% at 12 months. The mean uterus volume decreased 38.5 ±30% after 12 months .The paired t-test showed that dominant fibroid volume changed from 273.7±439.2 cm3 to 112.1±141.6 cm3 at month 6 (n=58, p=0.001 ) and from 246.1±314.5 cm3 to 70.1±73.5 cm3 at month 12 (n=41, p<0.0001 ). The initial size of the fibroids did not affect the success rate. Conclusion: The study showed the high efficacy of UAE in controlling fibroid related symptoms, with only few complications.
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