Uterine artery embolization for symptomatic leiomyomata.

Abstract

Technical success is an occlusion or marked reduction of blood flow in both uterine arteries. Successful embolization of only one uterine artery is considered a technical failure unless only a single uterine artery is present. Clinical success is the resolution or satisfactory improvement of the patients presenting symptoms, such as menorrhagia or bulk-related pain, bloating, urinary urge, or constipation, without additional therapy. Non-target embolization is the unintended release of an embolic agent into a vascular territory outside the targeted area. In the pelvis, the areas of concern are the ovaries, urinary bladder, intestine, muscles, and nerves, in which non-target embolization can result in symptoms of pain and/or infarction, the possibility of temporary or permanent disability and premature menopause. Post-embolization syndrome is the occurrence of pelvic pain, low-grade fever, nausea, vomiting, loss of appetite and malaise in the first few days after UAE. Endometritis is defined as inflammation of the inner lining of the uterus (endometrium) after UAE, which presents as pelvic pain, watery vaginal discharge, fever and/or leukocytosis, and can occur days to weeks after the procedure. It may be due to infectious and non-infectious causes. Leiomyoma or Fibroid infection is a bacterial infection of one or more fibroids as a result of (i) colonization of devitalised fibroid tissue by blood-borne pathogens or (ii) the ascent of vaginal organisms. Symptoms and signs include abdominal or pelvic pain, fever and/or leukocytosis. Uterine (myometrial) infection is defined as infection of the uterus, possibly as a result of necrosis of all or part of the uterus, which manifests as abdominal or pelvic pain, vaginal discharge, fever and/or leukocytosis. Transcervical leiomyoma or fibroid expulsion is defined as the detachment of leiomyoma tissue from the uterine wall and subsequent transvaginal passage, most commonly occurring with submucosal fibroids that have narrow points of attachment. This process may be associated with uterine contractions, abdominal pain, fever, nausea, vomiting and vaginal bleeding or discharge. Levels of evidence according to the Oxford Centre for Evidence-based Medicine are as follows: Level 1A systematic review (SR) of RCTs. 1B individual RCT. 2A SR of cohort studies. 2B individual cohort study. 3A SR of case–control studies. 3B individual case–control study. 4 case series. 5 expert opinions.