Abstract
This article explores the role of uterine artery embolization in the management of bleeding secondary to cervical carcinoma. Uterine artery embolization is a safe and effective treatment for control of massive bleeding in cervical cancer. This conservative treatment not only improve the patients quality of life by reducing the risk of profound anaemia but also help them to be ready for the next phase of treatment which could be radiotherapy or surgery.
Highlights
Transcatheter uterine arterial embolization has been established in the management of pelvic haemorrhage secondary to uterine arteriovascular malformation, postpartum haemorrhage, ectopic pregnancy, gestational trophoblastic disease, uterine fibroid and gynaecological malignancies especially advanced uterine cancer and cervical cancer [1,2,3,4,5]
X-ray fluoroscopy, arteriography and embolization are performed via a percutaneous right femoral artery approach using local anaesthesia and intravenous sedation. Both internal iliac arteries are in turn selectively catheterised and limited arteriography is obtained to identify the uterine arteries
A recent case report is published in Maedica which again showed the benefit of emergency uterine artery embolization for uncontrolled haemorrhage from cervical cancer prior to planned Wertheim hysterectomy [12]
Summary
Transcatheter uterine arterial embolization has been established in the management of pelvic haemorrhage secondary to uterine arteriovascular malformation, postpartum haemorrhage, ectopic pregnancy, gestational trophoblastic disease, uterine fibroid and gynaecological malignancies especially advanced uterine cancer and cervical cancer [1,2,3,4,5]. X-ray fluoroscopy, arteriography and embolization are performed via a percutaneous right femoral artery approach using local anaesthesia and intravenous sedation. Both internal iliac arteries are in turn selectively catheterised and limited arteriography is obtained to identify the uterine arteries. Polyvinyl alcohol or gelofoam particles are used to effect embolisation of the uterine vascular bed. Mixed with contrast they are injected through the catheter and flow directed. Symptoms of advanced cervical cancer may include, anorexia, weight loss, fatigue, backache, pelvic and or leg pain, bone fractures, urinary or faecal incontinence and heavey vaginal bleeding. EUA, Chest x-ray, Cystoscopy, Intravenous pyelogram (IVP), CT scan and MRI are helpful in staging (Table 1 and 2)
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