Abstract
Article is devoted to the problem of endovascular treatment of uterine fibroids - Uterine Artery Embolization (UAE). A number of researches do not promote to use UAE technique when the uterine fibroid has submucosal position, considering the conservative transcervical myomectomy to be more accessible. In the article, based on clinical case, indication of EMA at the large submucous uterine fibroid among women that are still in their reproductive age as an alternative to a hysterectomy is discussed.
Highlights
Introduction and BackgroundUterine Artery Embolization (UAE) is a uterine-sparing procedure that is used for the treatment of uterine fibroids
The narrow-stalked, pedunculated subserous and submucosal fibroids come under the contraindications for UAE as in the former case the risk of fibroid expulsion into the abdominal cavity after endovascular intervention is high; whereas an alternative of minimally invasive hysteroscopic resection is available in the latter case1
It is sensible to carry out UAE with a subsequent myomectomy for the treatment of most uterine fibroids, when one of the tumours has a subserous or submucosal position [7]
Summary
Uterine Artery Embolization (UAE) is a uterine-sparing procedure that is used for the treatment of uterine fibroids. An ultrasound investigation was carried out after UAE It showed increased size of the body of the uterus, relatively corresponding to 15-16 weeks of pregnancy (13.5cm×9.3cm×10.9cm) and was shown as avascular on the Color Doppler scan. According to the ultrasound investigation of the organs of lesser pelvis, the submucosal fibroid was descended to the lower third of the uterus This time it was 10.5cm×6.5cm×7.9cm in size. After taking into consideration the clinical picture and ultrasound investigation of the lesser pelvis, including the Colour Doppler scan that marked well pronounced intranodular and perinodular blood flow, a decision was made to perform UAE for the second time. The patient was provided with directions regarding the further continuation of treatment of her anemia by keeping the blood hemoglobin level under control She was asked to carry out planned ultrasound investigations in the period of 1, 3, 6, and 12 months. Thickness of endometrium was 0.5cm on the upper third and 0.2cm on the lower third (Figure 3)
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