Effect Of Uterine Artery Embolization Research Articles

In vivo revascularization and tissue effects of uterine artery embolization with starch microspheres in sheep.

In uterine artery embolization (UAE) for the treatment of fibroids, nondegradable particles permanently occlude the uterine artery (UA). These particles remain in the vessels and can cause secondary undesirable effects, such as severe pain after embolization and fertility issues. In this prospective experimental study, we aimed to evaluate the angiographic recanalization, local and systemic reactions, and uterine damage occurring after performing UAE with newly developed degradable starch microspheres (DSMs) in sheep. Under general anesthesia, eight nonpregnant sheep underwent bilateral UAE using DSMs to achieve stasis. Angiographic evaluation was performed on days 1, 3 and 7 after embolization to assess in vivo recanalization. In addition, the angiographic series were scored via a modified embolization score. A postmortem tissue examination was performed to determine whether DSMs and foreign body inflammatory reactions were present and to assess uterine necrosis. Complete bilateral embolization of the UA and cervicovaginal branches was achieved in all treated animals. Recanalization of the occluded arteries was evident in 25 of 27 arteries during the angiographic evaluation. In all sheep, there were multifocal areas of uterine necrosis, and some uterine vessels contained intraluminal material consistent with DSMs. The average weight of both uterine horns was significantly correlated with both the number of microspheres needed for complete embolization (r = 0.69, ρ<0.01) and the average percentage of necrosis in both uterine horns (r = 0.64, ρ<0.05). Our findings demonstrated the efficacy of vascular embolization with DSM by inducing ischemic changes in the uterus and subsequent recanalization of previously occluded arteries.

Uterine Artery Embolization for Iatrogenic Uterine Vascular Injuries

Abstract Purpose Uterine curettage or surgery can lead to uterine vascular injuries such as arteriovenous malformations (AVMs) or pseudoaneurysms (PsAs), and patients may present with life-threatening uterine bleeding. The purpose of our study is to evaluate the effectiveness of uterine artery embolization (UAE) in patients with abnormal uterine bleeding due to iatrogenic vascular injuries. Methods This is a retrospective review of 22 patients who underwent UAE at our institution between January 2019 and January 2023. Sixteen patients had a history of iatrogenic procedures. Uterine curettage was done in 12 patients, manual vacuum aspiration in 1 patient, and cesarean surgery in 3 patients. The outcomes were assessed in the form of technical feasibility, cessation of bleeding, recurrence, and pregnancy on follow-up. Results Eighteen (18/22) patients had vascular malformations and 4 (4/22) had PsA on computed tomography. Eight patients had typical AVM features with early draining vein and 10 patients had hypertrophied vessels with no early draining veins. A total of 35 uterine arteries were embolized in 22 patients. The most commonly used embolic material was polyvinyl alcohol particles (28/35 arteries). Postembolization, bleeding symptoms subsided in 19 patients (86.4%). Three patients had recurrence of bleeding symptoms for which they underwent repeat embolization. Six patients (27%) became pregnant during the follow-up period of 15 months. Conclusion UAE is a safe and effective treatment for iatrogenic uterine vascular injuries. This procedure allows for the preservation of uterine function with the possibility of future pregnancy and should be considered as a primary treatment option.

Uterine Artery Embolization Versus Hysterectomy in Postpartum Hemorrhage: A Systematic Review With Meta-Analysis.

The objective of this study is to perform a meta-analysis comparing the effectiveness of uterine artery embolization (UAE) versus peripartum hysterectomy for acute refractory postpartum hemorrhage (PPH) control. We systematically searched 6 medical databases for studies comparing UAE and hysterectomy in PPH. Outcomes examined were mortality, hospitalization duration (HD) in days, and red blood cells (RBC) units utilization. Statistical analysis used RevMan 5.1.7 and random-effects models. Odds ratios (OR) and mean differences (MDs) with 95% confidence intervals (CIs) were used for dichotomous and continuous outcomes, respectively. We included 833 patients from 4 cohort studies, with 583 (70%) undergoing UAE. The UAE population required fewer RBC units (MD: -7.39; 95% CI: -14.73 to -0.04; p=0.05) and had shorter HD (MD: -3.22; 95% CI: -5.42 to -1.02; p=0.004). Lower mortality rates were noted for UAE in the pooled analysis, but no statistical significance. Uterine artery embolization demonstrated lower procedural complications (16.45% vs. 28.8%), in which UAE had less ureter and bladder lesions (OR: 0.05; 95% CI: 0.01-0.38; p=0.004 and OR: 0.02; 95% CI: 0.00-0.15; p<0.001, respectively). Only 35 (6%) required conversion to hysterectomy, while 27 (4.6%) underwent re-embolization with 100% bleeding control. Uterine artery embolization did not hinder fertility, with normal menstruation restored in 19 patients with postoligomenorrhea. Uterine artery embolization for the control of PPH is associated with lower use of RBC units and HD, but similar rates of mortality are noted when compared to hysterectomy. These results associated with uterine preservation could support its importance for refractory PPH management. Uterine Artery Embolization is associated with a shorter hospitalization duration and reduced use of red blood cell units when compared with hysterectomy in refractory postpartum hemorrhage. Although demonstrating similar mortality rates, these findings, together with fertility preservation, support the method incorporation as a valuable option in obstetric services.

Uterine artery embolization in the treatment of uterine fibroids and the preservation of reproductive health in women 40 years of age and older: A retrospective study

Aim. To evaluate the effect of uterine artery embolization (UAE) on reproductive health in women 40 years and older. Materials and methods. A retrospective study was conducted at the perinatal center of the District Clinical Hospital of Khanty-Mansiysk. Patients were divided into two groups: the main group (group 1; n=57) included women with uterine fibroids after UAE, and the control group (group 2; n=42) included women without a history of uterine fibroids. Results. Women with uterine fibroids were statistically more likely to have grade 1 obesity (χ2=4.39; p=0.04) and less likely to have normal body weight (χ2=8.73; p=0.00) compared to women without fibroids. Smoking increased the risk of uterine fibroids twofold (χ2=4.49; p=0.03; odds ratio 1.97; confidence interval 0.64-6.11). More women with uterine fibroids had a history of abortions (n=42; 73.7%) than those without uterine fibroids (n=19; 45.2%; χ2=8.27; p=0.01). The most common gynecological comorbidities in women with uterine fibroids included inflammatory disease of the uterus (N71), endometrial polyp (N84), and endometriosis (N80); p0.05. The most common extragenital diseases in patients with uterine fibroids included thyroid disease, hypertension, and iron deficiency anemia (p0.05). Contour SE embolization agent with spherical particles was more often associated with pain (χ2=0.18; p=0.67) and less often with fever (χ2=4.47; p=0.03). There was a decrease in the number of short menstrual cycles (less than 24 days) from the moment before surgical treatment and after 24 months (χ2=34.580; p0.001) and an increase in the number of cycles of 24–38 days (χ2=14.887; p=0.005). At 24 months after UAE, there were more women with a menstrual period of less than 3 days (χ2=10.385; p=0.035) and fewer with a menstrual period of more than 8 days (χ2=34.573; p0.001). Ultrasound showed a decreased ovarian reserve at 6, 12 and 24 months after UAE (p0.05). Conclusion. When assessing the reproductive health of women 40 years and older after embolization of the uterine arteries, it was found that this method of treatment of symptomatic uterine fibroids leads to a decrease in the duration and heaviness of menstruation but increases the risk of an ovarian reserve decrease.

The Effect of Uterine Artery Embolization on Heavy Menstrual Bleeding in Patients with Leiomyomata

Objective: To compare the effect of uterine artery embolization and medical management on heavy menstrual bleeding in patients managed for uterine fibroids. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: The study was conducted at the Department of Gynecology and Obstetrics, Pak Emirates Military Hospital (PEMH) Rawalpindi, Pakistan fromAugust 2021 to March 2023.Methods: Women between the ages of 35 and 50 years who presented with heavy menstrual bleeding and were diagnosed with leiomyomata were included in this study. They were divided into two groups via block randomization. Group-I underwent uterine artery embolization while group-II received medical treatment (gonadotropin-releasing hormone (GnRH) antagonist). Clinical factors like shrinkage in the size of fibroids, rise in hemoglobin levels, and pelvic pain scores were compared in both groups at the end of three months. Results: Out of 160 women recruited in the study, 52 (32.5%) were pre-menopausal, while 108 (67.5%) were peri menopausal. The mean age of patients who presented with heavy menstrual bleeding due to leiomyomata was 45.23 ±12.70 years. The mean rise in hemoglobin (p-value-0.007) and mean shrinkage size (p-value&lt;0.001) were statistically significantly found more in patients who underwent uterine artery embolization as compared to those who took medical treatment. The mean pain score (p-value-0.01) was also found to be more in a group of patients who underwent uterine artery embolization.Conclusion: Uterine artery embolization emerged as an effective procedure for women managed for heavy menstrual bleeding due to uterine fibroids. Medical management via gonadotropin-releasing hormone (GnRH) antagonist was inferior in efficacy in terms of mean rise in hemoglobin and fibroid shrinkage.How to cite this: Khan S, Ahmad M, Mirza ZA, Sheraz A, Tariq M. The Effect of Uterine Artery Embolization on Heavy Menstrual Bleeding in Patients with Leiomyomata. Life and Science. 2024; 5(1): 27-32. doi: http://doi.org/10.37185/LnS.1.1.475

Uterine artery embolization versus myomectomy: a systematic review and meta-analysis.

Uterine fibroids are the commonest benign tumors of the reproductive tract in women of childbearing age. They are usually asymptomatic but can cause menorrhagia. Treatments include myomectomy and uterine artery embolization (UAE). The latter is a relatively new procedure, therefore of special interest. We conducted a systematic review and meta-analysis of all published studies to provide a comprehensive outlook on the effectiveness of UAE by comparing its outcomes to those of myomectomy. Electronic databases (PubMed and Cochrane Central) were systematically searched from January 2000 to March 2022 for published randomized control trials, observational studies, and meta-analyses that compared UAE to myomectomy for at least one of the pre-specified outcomes, namely re-intervention rates, length of hospital stay, and complications. We shortlisted nine studies for the final analysis. For continuous outcomes, results from random-effects meta-analysis were presented as mean differences (MDs) and corresponding 95% confidence intervals (CIs). Risk ratios (RRs) for dichotomous outcomes were pooled using a random-effects model. The final analysis consisted of nine studies. Factors like re-intervention, hospitalization, and complications, each with its unique follow-up duration were assessed. Pooled analysis demonstrated significant results for greater re-intervention rates with UAE as compared to myomectomy (RR: 2.16, 95% CI: (1.27-3.66), p-value 0.004, heterogeneity I2 = 85%). UAE holds a greater but statistically insignificant risk for major complications (RR: 0.62, 95% CI: (0.29-1.33), p-value 0.22, heterogeneity I2 = 0%) and myomectomy shows a statistically insignificant greater risk for minor complications (RR: 1.72, 95% CI: (0.92-3.22), p-value 0.09, heterogeneity I2 = 0%). UAE had a shorter but statistically insignificant duration of hospital stay (MD: -1.12, 95% CI: (-2.50 to 0.27), p-value 0.11, heterogeneity I2 = 96%) (p-value for subgroup differences = 0.005). Our meta-analysis of approximately 196,595 patients demonstrates that myomectomy results in a significant reduction in re-intervention rate compared to UAE.

Uterine artery embolization in Tanzania: a procedure with major public health implications

BackgroundThe burden of uterine fibroids is substantial in sub-Saharan Africa (SSA), with up to 80% of black women harboring them in their lifetime. While uterine artery embolization (UAE) has emerged as an effective alternative to surgery to manage this condition, the procedure is not available to the vast majority of women living in SSA due to limited access to interventional radiology (IR) in the region. One of the few countries in SSA now offering UAE in a public hospital setting is Tanzania. This study aims to assess the safety and effectiveness of UAE in this new environment.MethodsFrom June 2019 to July 2022, a single-center, retrospective cohort study was conducted at Tanzania’s first IR service on all patients who underwent UAE for the management of symptomatic fibroids or adenomyosis. Patients were selected for the procedure based on symptom severity, imaging findings, and medical management failure. Procedural technical success and adverse events were recorded for all UAEs. Self-reported symptom severity and volumetric response on imaging were compared between baseline and six-months post-procedure using paired sample t-tests.ResultsDuring the study period, 92.1% (n = 35/38) of patients underwent UAE for the management of symptomatic fibroids and 7.9% (n = 3/38) for adenomyosis. All (n = 38/38) were considered technically successful and one minor adverse event occurred (2.7%). Self-reported symptom-severity scores at six-months post-procedure decreased in all categories: abnormal uterine bleeding from 8.8 to 3.1 (-5.7), pain from 6.7 to 3.2 (-3.5), and bulk symptoms from 2.8 to 1 (-1.8) (p < 0.01). 100% of patients reported satisfaction with outcomes. Among the nine patients with follow-up imaging, there was a mean volumetric decrease of 35.5% (p = 0.109).ConclusionsUAE for fibroids and adenomyosis can be performed with high technical success and low complication rates in a low-resource setting like Tanzania, resulting in significant symptom relief for patients. Building capacity for UAE has major public health implications not only for fibroids and adenomyosis, but can help address the region’s leading cause of maternal mortality, postpartum hemorrhage.

Effect of uterine artery embolization on fertility preservation in the treatment of symptomatic uterine fibroids

Introduction: Uterine fibroids are the most common benign tumors of the uterus. Most often they are asymptomatic, but in their course there may be ailments such as: abnormal bleeding, anaemia, pain, constipation, problems with urination. These tumors are also one of the many causes of infertility. They are most often detected during a standard ultrasound examination. Pharmacological, minimally invasive and surgical treatment is currently available.&#x0D; Aim: The aim of our study was to review scientific articles in order to demonstrate whether the treatment of uterine fibroids with uterine artery embolization has an impact on fertility and pregnancy outcomes.&#x0D; Materials and methods: Review of the latest PubMed literature, Google Scholar in the period 2017 - 2023 and evaluation of available randomized controlled trials using uterine artery embolization in terms of fertility preservation by assessing ovarian reserve, number of pregnancies, miscarriages and perinatal complications.&#x0D; Conclusions: Uterine artery embolization is a safe and effective method in reducing symptoms associated with uterine fibroids. This procedure shortens hospitalization and recovery time compared to myomectomy or hysterectomy. Unfortunately, for women who want children, this method is not recommended due to the risk of reduced ovarian reserve and miscarriage, premature birth, placental abnormality, and severe postpartum hemorrhage.&#x0D;

A Prospective Pilot Study of the Safety and Effectiveness of Uterine Artery Embolization for the Treatment of Endometriosis: The UAE-E Study

Abstract Purpose Uterine artery embolization (UAE) evidence is increasing in the setting of adenomyosis, which shares pathological similarities to endometriosis. Endometriosis is characterized by the presence of endometrium-like tissue outside of the uterus, and the retrograde menstruation hypothesis may account for disease development. In women where fertility is no longer desired, hysterectomy can be offered to improve pain-related symptoms. The authors hypothesize that this cohort of patients may similarly respond to UAE. The aim of this pilot study is to assess the safety and effectiveness of UAE in the management of endometriosis-related symptoms. Methods Six-patient prospective single-arm pilot study in female, premenopausal patients over 40 years with symptoms of endometriosis. Institutional review board approval was obtained.Inclusion criteria include completed family, premenopausal, pelvic endometriosis as confirmed by laparoscopy within the last 5 years, and symptoms of endometriosis impacting quality of life as evidenced by the British Society of Gynaecological Endoscopy pelvic pain and Short Form-36 questionnaires. Results The primary endpoint will be safety, as assessed by the composite number of procedural and postprocedural complications during procedure, predischarge, and at 6 weeks, 3 months, 6 months, and 12 months. Secondary endpoints will include technical success, clinical success, and durability. Discussion This study will be a novel application of UAE in the setting of endometriosis and has the potential to improve patient quality of life. This pilot study will assess safety and allow the investigators to design a prospective randomized controlled study.

Monitored Anesthesia Care in Uterine Artery Embolization for Leiomyomas and Adenomyosis

Background: Patients undergoing an interventional radiology procedure report some degree of anxiety. Therefore, procedure-related anxiety needs to be managed. The aim of our study was to investigate patient satisfaction with monitored anesthesia care (MAC) for uterine artery embolization (UAE)-related procedural anxiety in symptomatic uterine fibroids or adenomyosis. Methods: Between May 2021 and June 2022, 36 patients with symptomatic fibroids or adenomyosis underwent UAE with MAC. Follow-up evaluations consisted of clinical symptoms, degree of satisfaction with MAC in UAE, and complications. Results: MAC in UAE was successfully performed in all patients. UAE significantly reduced patients’ complaints such as bleeding and pain: the scores for bleeding and pain were significantly reduced after 3 months of UAE compared with those before UAE, indicating the effectiveness of UAE. The mean score of satisfaction with MAC in UAE was 4.3 points, meaning that 94.4% of women were satisfied or very satisfied. No major complications were observed. Conclusions: MAC in UAE for symptomatic uterine fibroids or adenomyosis can be emotionally effective and safe for patients who are anxious about the procedure.

Comparison of hysterectomy and uterine artery embolization in the treatment of symptomatic uterine fibroids: A protocol for systematic review and meta-analysis

Uterine fibroids are common benign tumors in premenopausal women. Surgery is the preferred treatment for symptomatic uterine fibroids. An alternative of hysterectomy to manage symptomatic uterine fibroids is selective uterine artery embolization. We performed a protocol for systematic review and meta-analysis to assess the effectiveness of uterine artery embolization for treating symptomatic uterine fibroids compared with hysterectomy. The current systematic review and meta-analysis will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. This review protocol has been registered in the International Prospective Register of systematic reviews. Its registration number is CRD42022371866. Only randomized controlled trials (RCTs) are included in our study.Two independent reviewers will search for databases including PubMed, Embase, Cochrane Library website, ClinicalTrials.gov databases, Chinese National Knowledge Infrastructure Database, Wanfang database, and VIP database. The risk of bias in each included study will be assessed utilizing the Cochrane Collaboration's risk of bias tool. The RevMan 5.3 software (Cochrane Collaboration, Oxford, UK) will be used to conduct the meta-analyses. The results of this systematic review will be published in a peer-reviewed journal. This systematic review will provide high quality evidence to judge whether uterine artery embolization is an effective surgical method for patients with symptomatic uterine fibroids.

Uterine artery embolization

Uterine fibroids (UF) is an extremely common benign tumor of the female reproductive system. This pathology is often associated with symptoms that significantly impair the quality of life of a woman and her working capacity, and can also affect the ability to conceive and gestation. Today, we have in the arsenal of operational, drug and minimally invasive methods of UF treatment. One of the most researched and at the same time rather controversial methods of UF treatment is uterine artery embolization (UAE).Literary sources were reviewed using the MEDLINE, PubMed and Web of Science databases for the period 2011–2021. The data related to the history of the technique development, its implementation, indications and contraindications for UAE, its effect on the UF symptoms and on fertility were systematized and presented in this review.UAE as an independent method for the treatment of benign uterine tumors has 20 years of experience in the world and in Ukraine. The indications for UAE are symptomatic UF: profuse and/or prolonged menstruation, dysmenorrhea, compression of the pelvic organs, dyspareunia, frequent urination or urinary retention. Absolute contraindications for UAE are genital tract infections, pregnancy, doubts about the diagnosis, as well as contraindications to the use of X-ray contrast agents.The effectiveness of UAE is assessed by the manifestations of UF symptoms and by the degree of fibroids size reduction. The average node reduction in the diameter is 2.2 cm. The clinical efficacy index is 81–96, 70–100 and 46–100% respectively in the treatment of abnormal uterine bleeding, pelvic pain and symptoms of compression of adjacent organs. There is a decrease in the node volume by 25–60% within 3–6 months.Conclusions. UAE today is an effective and safe minimally invasive operation, which is a worthy alternative to hysterectomy and expands the possibilities of organ-preserving technologies if there is UF.

Utilization and Comparative Effectiveness of Uterine Artery Embolization versus Hysterectomy for Severe Postpartum Hemorrhage: A National Inpatient Sample Study

PurposeTo identify differences in mortality or length of hospital stay for mothers treated with uterine artery embolization (UAE) or hysterectomy for severe postpartum hemorrhage (PPH), as well as to analyze whether geographic or clinical determinants affected the type of therapy received. Materials and MethodsThis National Inpatient Sample study from 2005 to 2017 included all patients with live-birth deliveries. Severe PPH was defined as PPH that required transfusion, hysterectomy, or UAE. Propensity score weighting–adjusted demographic, maternal, and delivery risk factors were used to assess mortality and prolonged hospital stay. ResultsOf 9.8 million identified live births, PPH occurred in 31.0 per 1,000 cases. The most common intervention for PPH was transfusion (116.4 per 1,000 cases of PPH). Hysterectomy was used more frequently than UAE (20.4 vs 12.9 per 1,000 cases). The following factors predicted that hysterectomy would be used more commonly than UAE: previous cesarean delivery, breech fetal position, placenta previa, transient hypertension during pregnancy without pre-eclampsia, pre-existing hypertension without pre-eclampsia, pre-existing hypertension with pre-eclampsia, unspecified maternal hypertension, and gestational diabetes (all P < .001). Delivery risk factors associated with greater utilization of hysterectomy over UAE included postterm pregnancy, premature rupture of membranes, cervical laceration, forceps vaginal delivery, and shock (all P < .001). There was no difference in mortality between hysterectomy and UAE. After balancing demographic, maternal, and delivery risk factors, the odds of prolonged hospital stay were 0.38 times lower with UAE than hysterectomy (P < .001). ConclusionsDespite similar mortality and shorter hospital stays, UAE is used far less than hysterectomy in the management of severe PPH.

Uterine artery embolization, surgery and high intensity focused ultrasound in the treatment of uterine fibroids: a network meta-analysis.

To systematic review the safety and effectiveness between uterine artery embolization (UAE), surgery and high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids. The PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang Data, and CNKI were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE, surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019. After two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, network meta-analysis was performed by ADDIS 1.16.8 and Stata 14 software. A total of 11 studies (22 articles) involving 3,646 patients were included. Compared with surgery, UAE and HIFU patients had higher quality of life (1-year follow-up) improvement, and UAE was higher than HIFU. Network meta-analysis show that patients treated with HIFU had the lowest incidence of major complications within 1 year, followed by UAE, and the highest surgery. Patients treated with HIFU and UAE have shorter hospital stays and quicker recovery time than surgery. The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU. UAE has the highest quality of life improvement (1-year follow-up) for uterine fibroids. HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery. However, both UAE and HIFU have the risks of re-treatment. However, limited by the number and quality of included studies, the above conclusions need to be verified through more high-quality studies.

Evaluation of the diagnosis and treatment of cesarean scar pregnancy induced in the second trimester: a national multicenter retrospective study

Objective: To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester. Methods: A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared. Results: Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta (P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95%CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness (OR=0.033, 95%CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions: (1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.

Long-term effects of uterine artery embolization caused by the embolic material

Background and objectives. Uterine artery embolization (UAE), or uterine fibroid embolization (EFM), a technique introduced in the conservative treatment of uterine fibroids in the 1990s, has been increasingly used in the last decades. The data accumulated in time revealed also, besides the expected benefits, some undesirable complications, initially unanticipated. The study aims at analyzing the histological changes of myometrium occurred after uterine artery embolization for fibroids. Materials and method. Presentation of a series of three cases that have undergone gynecologic surgery in the Bucur Maternity of the “Sf. Ioan” Emergency Clinical Hospital, Bucharest, after the embolization of the uterine arteries performed (in the past) for fibroids. Results. In two of the three cases presented, it was practiced hysterectomy with bilateral anexectomy and in one case myometrectomy. At the histopathological examination, what was proven to be specific for the long-term effects of UAE was the thickening of vascular structures containing intraluminal amorphous material, with vascular and perivascular infiltration with giant multinucleated histiocytes around the foreign body. This histological aspect corresponds to a nonspecific granulomatous inflammation with giant cells. Conclusions. Embolization of the uterine arteries may cause a giant-cell type inflammation at the level of the myometrium and fibrosis, and this type of changes could be the cause of a poor prognosis for women who want a future pregnancy.

Uterine artery embolization using gelatin sponge particles for symptomatic focal and diffuse adenomyosis

Objective: To evaluate the effectiveness of uterine artery embolization (UAE) with gelatin sponge particles for symptomatic focal and diffuse adenomyosis. Materials and Methods: This was a retrospective study conducted between January 2014 and December 2019. All women underwent UAE for symptomatic adenomyosis without leiomyomas. Gelatin sponge particles were used in all cases. Patients were assessed for effectiveness of symptom control, changes in uterine volume, and degree of tumor necrosis on magnetic resonance (MR) imaging. Results: One hundred and sixty-three patients underwent UAE. There were statistically significant differences in bleeding score, pain score, and uterine volume at three months after UAE (P &lt; 0.001, P &lt; 0.001, and P &lt; 0.001, respectively). Complete tumor necrosis occurred in 66.9% of cases after UAE. Proportion of complete necrosis were significantly different in cases with focal adenomyosis compared with diffuse adenomyosis (P = 0.023). Symptom recurrence occurred in 20.6% of cases at 12-month follow-up. Focal adenomyosis patients with complete necrosis had no recurrent menorrhagia and dysmenorrhea. No major complications were observed. Conclusions: UAE using gelatin sponge particles is an effective and safe treatment for symptomatic adenomyosis. Patients with focal adenomyosis with complete necrosis after UAE had no symptom recurrence at midterm follow-up.

Postpartum hemorrhage with uterine artery embolization: the risk of complications of uterine artery embolization

Introduction The purpose of this study was to evaluate the efficacy and adverse effects of uterine artery embolization (UAE) to treat postpartum hemorrhage (PPH) and determine the factors associated with clinical outcomes. Material and methods This study included 117 patients who underwent UAE for PPH between January 2010 and November 2018. Their medical records were retrospectively reviewed to assess the mode of delivery, causes of bleeding, detailed laboratory results, clinical outcomes, time from delivery to UAE, and embolizing material used. Results The clinical UAE success rate was 99.1%. Late complications were found in 11 patients. Two total hysterectomies were performed. Most PPH cases treated with UAE had early-onset PPH caused by uterine atony. Late-onset PPH was caused by placenta-related problems (remnant placenta, placenta accreta). Body mass index, cesarean section, the use of mixed embolizing materials, placenta abruption as the cause of PPH, and transferred patients were associated with uterine necrosis. Age, re-embolization, and the use of mixed embolizing materials were associated with adverse complications. Conclusions Although UAE is a safe and effective way to manage PPH, a long-term follow-up is needed to determine the complications of UAE. When uterine necrosis is suspected, prompt and adequate treatment should be performed due to the effects of necrosis on menstrual cycles, fertility, and subsequent pregnancies.

Clinical effect of uterine artery embolization in the treatment of refractory postpartum hemorrhage

sThis study is to investigate the clinical effect of uterine artery embolism in the treatment of refractory postpartum hemorrhage. Retrospective analysis of 50 patients with refractory postpartum hemorrhage admitted to PLA Group 83 Military Hospital from July 2014 to July 2018, using uterine artery embolization (observation group) and hysterectomy (control group), compared the effective rate of hemostasis, total bleeding volume, operation time and postoperative complications (fever, pain, infection) between the two groups. The effective rate of hemostasis was 96% in the observation group and 92% in the control group. There was no significant difference between the two groups (P > 0.05). The total blood loss was 2237.34 ±548.33 ml and 39.02 ±12.14 min in the observation group and 3427.55 ±667.42 ml in the control group, and 74.21 ±16.16 min in the control group. There was significant difference between the two groups (P < 0.05).The postoperative complications of the observation group were lower than that of the control group (P <0.05). The two methods are effective in the treatment of refractory postpartum hemorrhage, but uterine artery embolism has the advantages of less bleeding, short operation time and rapid recovery after operation, which is worthy of clinical application.

Role of Uterine Artery Embolization using Embolic Microspheres in Treatment of Uterine Fibroid

Abstract Background Uterine Artery Embolization (UAE) is a well-established treatment of symptomatic fibroids with clinical efficacy comparable with traditional surgical treatment. UAE is now commonly proposed as an organ preserving treatment to the population of younger women willing to conceive. It has been proven, in a large cohort of women wishing to conceive before embolization, that complete pregnancies can occur after UAE Objectives The study aims to assess the effect of uterine artery embolization using the different types of embolic microspheres in treatment of patients with uterine fibroid. Patients and Methods Type of Study: prospective study. Study Setting: At the radiology department of Ain Shams University hospitals and Ain Shams University Specialized Hospitals. Study Period: 6-12 months. Results High symptom severity score indicates severe symptoms and a high HRQOL score indicates a good quality of life. The mean UFS questionnaire baseline score was 70± 11.51 prior to embolization and became 45± 9.34 three months following embolization which indicates a good symptomatic response to the microspheres embolization. The mean QOL baseline score was 65± 8.58 prior to embolization and 81± 6.48 three months following embolization. Conclusion UAE using embolic microsphere is , an effective, minimally invasive procedure and easily one day procedure which showed competitive promising and well proved results when compared to other modalities outcomes in treating uterine fibroids such as conventional surgery. It deserves our attention to it's value and efficacy for the sake of the patient as a minimally invasive procedure providing better quality of life , using Embosphere and Embozene microspheres have the same symptomatic effect and volume reduction after three months follow up in compare with using Embosphere alone or with spherical polyvinyl alcohol particles.