Transarterial Catheter Embolization Research Articles

Highly tough and elastic microspheric gel for transarterial catheter embolization in treatment of liver metastasis tumor.

Transarterial embolization is a widely recognized clinical treatment method for liver tumors. Given that the soft and easily damaged features of embolic particles may limit tumor embolization efficiency, the present study carries out an attempt of fabricating tough and elastic microspheric gel for promoting embolization efficiency. To promote the toughness of hydrogel, poly(ethylene glycol)-co-poly(ε-caprolactone)-co-poly(ethylene glycol) (PPP) and PPP with two terminal double bonds (PPPDA) are co-assembled into nano-micelles, which are connected with methacrylated chitosan (CSMA) to fabricate microspheric gels via microfluidic technology. Lowering double bond density of micelles promotes the freedom degree of micelles, significantly enhancing hydrogel toughness. To compensate for the strength loss caused by the decrease of double bond density of micelles, phytic acid (PA) are employed to interact with CS to form a physical network, further improving hydrogel strength and toughness. The CS-PPPDA&PPP-PA microspheric gels exhibit higher blocking effect in vitro. A rabbit VX2 liver metastasis tumor model is prepared to verify the embolization efficacy of CS-PPPDA&PPP-PA microspheric gels. Compared with clinical used microspheres, fewer CS-PPPDA&PPP-PA microspheric gels can achieve enough embolization efficiency. After embolization for 14 days, CS-PPPDA&PPP-PA microspheric gels exhibit improved tumor necrosis rate and promoted tumor cells apoptosis with reduced inflammation in surrounding tissues, confirming advanced embolic efficiency of tough microgels.

THE ROLE OF CHEST CT ANGIOGRAPHY AS A DIAGNOSTIC TOOL AND ROAD MAP FOR THE MANAGEMENT OF RASMUSSEN’S ANEURYSM: A CASE REPORT

Rasmussen’s aneurysm is a pulmonary artery pseudoaneurysm, secondary to the invasion of granular tissues to the pulmonary artery wall, causing massive hemoptysis. A 39-year-old male, with a history of pulmonary TB presented with massive hemoptysis, persistent cough, and dyspnea. Chest X-ray and Chest CT depicted active pulmonary tuberculosis and a co-infection with aspergillosis in the form of aspergilloma. Chest CT angiography (CTA) showed narrow-necked Rasmussen’s aneurysm with the feeding artery coming from the pulmonary artery of the apicoposterior segment and the systemic artery from the left thyrocervical trunk branch and left bronchial artery. Fluoroscopy-guided transarterial embolization with polyvinyl alcohol (PVA) and gel foam was performed from the left bronchial artery and thyrocervical trunk branch followed by transcatheter embolization with glue insertion via the pulmonary artery in the aneurysmal site. After the procedures the embolic agent completely filled the aneurysm and there were no complaints of hemoptysis during the follow-up. Appropriate chest CT angiography procedures can help diagnose Rasmussen’s aneurysm and become a road map for embolization. Transarterial catheter embolization from bronchial or non-bronchial systemic artery and pulmonary artery can be used as the treatment modality of choice for Rasmussen’s aneurysm in pulmonary tuberculosis with aspergillosis co-infection in the form of aspergilloma.

Highly Tough and Elastic Microspheric Gel for Transarterial Catheter Embolization in Treatment of Liver Metastasis

Highly Tough and Elastic Microspheric Gel for Transarterial Catheter Embolization in Treatment of Liver Metastasis

Is Urgent Diagnostic Colonoscopy still Necessary in Lower Gastrointestinal Bleeding?: A Retrospective Study from 2 Centers of Ramathibodi Hospital

Background: An urgent colonoscopy within 24 hours in acute lower gastrointestinal bleeding (LGIB) is now controversy with limited of benefit compare to elective colonoscopy. An alternative modality such as CT angiogram or CT whole abdominal has play an important role in diagnosed and localised bleeding site in emergency setting. Objective: This study is aim to report a descriptive data of incidence and prevalence of acute LGIB and therapeutic modality from 2 centers of Ramathibodi Hospital. Materials and Methods: A retrospective reviewed of adult patients who had acute LGIB in 4 years of Acute Care Surgery service of Ramathibodi Hospital and one year service of Chakri Naruebodindra Medical Institute. An exclusion criteria were patients who had associated gastrointestinal perforation or dead on arrival. A descriptive data were analysed and reported. Results: A 127 patients were enrolled, an average age is 69 year-old. Of these, there are 74.01% admitted without hemorrhagic shock. An average hospital stay is 3 days (1 to 5). Anti-coagulant and anti-platelet usage are 40.16%. Average haemoglobin on admission is 9.69±2.43 g/dL. Overall mortality rate is 4.72%. Most common cause of acute LGIB are diverticular bleeding 34.65% and colitis 17.32%. Only 9.82% underwent urgent colonoscopy. There are 95.28%, 1.57%, 0.79%, and 1.57% of successful nonoperative management, therapeutic endoscopy, transarterial catheter embolization and surgery, respectively. Only patients who had post-polypectomy bleeding underwent urgent therapeutic endoscopy intervention. Conclusion: In hemodynamic stable, urgent colonoscopy is not mandate in routine. In acute massive LGIB which hemodynamic unstable, the CT angiography follow by arterial embolisation or urgent colonoscopy are recommend for diagnosed, localised the bleeding site, and also endoscopic intervention especially in post-procedure bleeding. Keywords: Lower gastrointestinal bleeding; Urgent colonoscope; CT angiogram; Abdominal CT scan

Intractable bleeding: the role of embolization in a resource-limited country

Transarterial catheter embolization is novel in Ghana, even though it has been practiced over three decades in certain parts of the world. The procedure is safer with the advent of new catheter techniques and embolic agents which place interventional radiology at the forefront of the treatment of bleeding due to myriad of indications. It is fast, safe, and minimally invasive relative to open surgery, especially when other conventional minimally invasive procedures such as endoscopic banding and sclerotherapy fail. This paper presents two cases involving pre-and post-embolization digital subtraction angiogram (DSA) of gastroduodenal artery and bilateral iliac arteries. Findings of DSA of the gastroduodenal artery and bilateral iliac arteries showed florid extravasation and extensive neovascularity. Post embolization DSA showed absent extravasation and near total devascularization. The inclusion of embolization to the management protocols of upper gastrointestinal bleeding and intractable haematuria is recommended

Abstract No. 487 Expanding the diagnostic toolbox: introduction of core needle liver biopsies in Tanzania

Hepatocellular carcinoma (HCC) is the fourth most common cancer in Africa and tends to present earlier with worse outcomes in Africa than in Europe and North America. Although risk factor management plays a key role in reducing the burden of HCC, early and accurate detection are equally as important. Additionally, for cultural reasons, patients wish to have pathologic confirmation of diagnosis even when there is no treatment available. In Tanzania, no core needle biopsies (CNBs) were routinely performed at the nation’s largest public hospital until the introduction of an interventional radiology (IR) service in 2018. All patients who underwent liver CNB by the IR service at Muhimbili National Hospital (MNH) from October 2018 to September 2020 were included in the study. All procedures were performed by Tanzanian IR trainees as primary operators. Patient and procedural data, including demographic information, complications, and pathology results were collected and analyzed. Data was stored in REDCap, a HIPAA-compliant data management platform. A total of 51 core needle biopsies of the liver were performed on 49 patients. While 22 were done under direct supervision by US visiting faculty (43.1%), 29 were done independently by Tanzanian IR fellows (56.9%). All 51 were technically successful. No minor complications occurred. One major complication (Society of Interventional Radiology Class C) occurred (patient developed abdominal pain and rigors 30 minutes post-procedure). Of the 38 samples returned, 37 were diagnostic (97.4%); 33 confirmed malignancy, the most common types of which were hepatocellular carcinoma (14/33, 42.4%) and metastatic disease (14/33, 42.4%). Previously at MNH, fine-needle aspiration was used to assess hepatic lesions. While cheaper, it is not as reliable as CNB, with a lower sensitivity, specificity, and diagnostic accuracy. The introduction of a superior method of diagnosing hepatic lesions has provided surgeons and oncologists with a tool for earlier diagnosis. Furthermore, with the introduction of new IR procedures like transarterial catheter embolization and radiofrequency ablation to the region, patients can expect better treatment and prolonged survival.

Abstract 17500: A Crisis of the Heart

A 59 year old female with past medical history of metastatic neuroendocrine tumor without cardiac involvement was admitted for transarterial catheter embolization (TACE) procedure of liver lesions. During the TACE procedure, she developed hypertensive urgency treated with intravenous beta blocker therapy and continuous octreotide for carcinoid reaction. The following day she developed acute pulmonary edema and labile blood pressures requiring low dose norepinephrine. Octreotide infusion was up-titrated to 500 mcg/hour with concern for carcinoid crisis. On physical exam, she was tachycardic and regular without notable murmurs or extra cardiac sounds, no elevated jugular venous distension, and no lower extremity edema. She had bilateral crackles on pulmonary exam and was diaphoretic and delirious. There were sub-millimeter lateral ST- segment elevations on her electrocardiogram but her troponin levels were elevated to 14 ng/dL. Point of care cardiac ultrasound demonstrated severely impaired left ventricular systolic function without regional wall motion abnormalities. Coronary angiogram revealed diffuse coronary vasospasm and elevated left ventricular end-diastolic pressure. On right heart catheterization, she had elevated filling pressures, pulmonary arterial oxygen saturation of 25%, and cardiac index of 1.42 L/min/m2. Our patient was diagnosed with cardiogenic shock secondary to octreotide mediated coronary vasospasm causing diffuse myocardial injury. Continued multidisciplinary discussions were needed to determine appropriate vasopressor and inotropic agent use to support cardiac function without triggering further hormonal dysregulation during carcinoid crisis. Her cardiac function eventually improved with left ventricular Impella support and gradual down-titration of octreotide dose. Norepinephrine, epinephrine, and phenylephrine were avoided in favor of vasopressin, and dobutamine was switched to milrinone to prevent further sympathetic activation. She was able to wean off Impella and pressor support and had improvement of her left ventricular function on repeat echocardiography one month later. She has not had recurrence of heart failure symptoms and continues to follow up with oncology via tele-visits.

Not Always a Gastrointestinal Bleed in a Cirrhotic Patient: A Case of Spontaneous Retroperitoneal Hematoma

Introduction: Cirrhosis is associated with wide variety of bleeding manifestations. We describe a rare presentation of spontaneous psoas muscle hematoma with retroperitoneal hemorrhage associated with cirrhosis. Case: 59-year-old male with hypertension, gout, and alcoholic cirrhosis presented with worsening abdominal distension for a few months. Vitals were within physiological limits. Physical exam was significant for signs of chronic liver disease and abdominal distension with shifting dullness. Labs were remarkable for platelets of 61,000 and INR 1.60. A non-contrast CT scan of the abdomen revealed a 6 cm polypoid mass on the inferior aspect of right liver lobe along with evidence of cirrhosis. A triple phase CT confirmed the diagnosis of hepatocellular carcinoma. On the day of planned discharge 3 days after admission, patient showed signs of hemodynamic instability associated with a drop in hemoglobin from 12.9 to 9.1 gm, prompting ICU admission. An emergent EGD was done for concern of brownish aspirate via NG tube. It revealed small non-bleeding esophageal varices. He required aggressive resuscitation, multiple blood transfusions and three vasopressor agents. A repeat CT scan showed acute hemorrhage in right psoas, extending into the right retroperitoneum and measuring 8 cm x 6 cm. Interventional radiology was consulted for embolization, but it was deferred due to poor localization of bleeding vessel in spontaneous psoas hematoma. He was managed conservatively with FFP, platelets and blood transfusions. After three days, hemoglobin stabilized, blood pressure improved and he was weaned off from vasopressors.Figure 1Figure 2Discussion: Spontaneous retroperitoneal hematoma is potentially life threatening and usually associated with anticoagulation or defect in coagulation pathway. There are rare case reports of association with cirrhosis. The most common location is iliopsoas muscle or rectus sheath. Patients can present with back pain, groin pain or symptoms of neuropathy. Diagnosis is suspected with an unexplained drop in hemoglobin. CT scan is the initial imaging of choice. Conservative management entails supportive care with blood transfusions and correction of coagulopathy. Transarterial catheter embolization (TAE) has shown some promise in literature, however the increased vascular fragility in cirrhosis and difficulty in isolating a single bleeding vessel pose problems. The prognosis is poor with mortality up to 70%.

Transarterial Catheter Embolization to Control Massive Intra-Abdominal Bleeding in a Case of Large Ruptured Hepatocellular Carcinoma

Transarterial Catheter Embolization to Control Massive Intra-Abdominal Bleeding in a Case of Large Ruptured Hepatocellular Carcinoma

Spinal metastasis from malignant meningeal intracranial hemangiopericytoma: one-staged percutaneous Onyx™ embolization and resection - a technical innovation

BackgroundWe are the first to report one-staged resection of a spinal metastasis from malignant cranial hemangiopericytoma after preoperative Onyx™-20 embolization by direct percutaneous puncture.Spinal metastases from cranial hemangiopericytoma are extremely rare. Surgical morbidity of these highly vascularized tumours results mainly from excessive blood loss. Preoperative embolization of hyper vascular tumours has been used to reduce intraoperative blood loss for a long time. To avoid complications from arterial catheter intervention, direct percutaneous puncture has been advocated as a safe and effective alternative.MethodsA 46-year-old man with a history of malignant cranial hemangiopericytoma deriving from the left frontal skull base presented with a short history of lower back pain. A magnetic resonance imaging scan revealed an intra- and extra spinal mass lesion of the thoracic spine at Th 12. Indication for tumour resection was made and the patient’s written consent was obtained. Preoperatively, arterial catheter angiography was performed to reveal the tumour’s angioarchitecture, revealing high-flow arteriovenous shunts. In order to impede the expected perioperative blood loss, tumour embolization by direct percutaneous puncture and application of Onyx™-20 was performed prior to surgery.ResultsAfter percutaneous Onyx™-20 embolization, complete and safe resection of the lesion could be achieved. There was only minimal blood loss perioperatively. A pathohistological report confirmed malignant, anaplastic hemangiopericytoma.ConclusionsIn our case Onyx™-20 embolization via direct percutaneous puncture of a highly vascularized tumour was shown to be a safe and efficient tool prior to surgery. Despite high-flow arteriovenous shunts, direct percutaneous administration of non-adhesive ethanol liquid was an efficient alternative to transarterial catheter embolization. The perioperative blood loss could be substantially diminished.

Adrenal artery pseudoaneurysm in pheochromocytoma presenting with catastrophic retroperitoneal hemorrhage

Spontaneous rupture of adrenal pheochromocytoma is an extremely rare condition which presents as an abdominal catastrophe. Unrecognized, this transformation can rapidly lead to death. We report a case of a 63-year-old male who presented with hemorrhagic shock secondary to ruptured adrenal pheochromocytoma. The clinical course is notable for immediate transarterial catheter embolization for control of bleeding, followed by optimization and elective adrenalectomy. High mortality is associated with an operative intervention in the face of an unrecognized pheochromocytoma. This reinforces the need for maintaining a high index of suspicion in the setting of a suprarenal mass despite hypotension.

The role of microRNAs in liver cancer

Hepatocellular carcinoma and cholangiocarcinoma constitute the majority of primary malignant tumors located in the liver, with hepatocellular carcinoma accounting for approximately 80% of these tumors and cholangiocarcinoma representing the remaining 20%. Both are aggressive malignancies, heterogeneous in terms of biological activities and clinical behavior, with dismal outcomes and an increasing incidence worldwide. Radical surgical resection remains the gold standard to date, as adjuvant therapeutic modalities have failed to show a consistent and adequate curative response. However, radical surgical resection is not feasible in most of the patients with such tumors, as tumor size or functional status of the parenchyma does not permit extended hepatic resection. In addition, patients who undergo curative resection often have a high rate of relapse. Multimodal therapeutic approaches, such as the combination of invasive methods (surgical resection, radiofrequency ablation, and two-step or three-step procedures with intermittent portal vein embolization) with interferon-α, systemic chemotherapy, or transarterial catheter embolization, may prolong survival in some patients, but have, however, failed to demonstrate satisfactory results. Therefore, an obvious need emerges for the discovery of new biomarkers to understand the events leading to hepatocarcinogenesis, to relate different phenotypes with differences in clinical behavior and prognosis, and, if possible, to predict response rates to adjuvant therapeutic modalities or, furthermore, to establish novel mechanism-based treatments for hepatic tumors.

Transarterial embolization for the management of hemarthrosis of the knee

BackgroundThe purpose of this retrospective study was to evaluate transarterial catheter embolization (TAE) for the management of hemarthrosis of the knee in 35 patients treated at two different hospitals. MethodsFrom June 1998 through January 2011, 35 patients (22 men and 13 women, mean age 57 years) underwent TAE for hemarthrosis of the knee using polyvinyl alcohol particles (PVA particles), multi-curled 0.018in. microcoils or a combination of both. In one patient a detachable microcoil was used. Hemarthrosis developed after arthroscopy in 9, after trauma in 3, after arthroplasty in 18 and after sepsis in 2 patients. 2 patients had severe gonarthrosis and in one patient hemarthrosis was due to Marfan's syndrome. Angiographies showed abnormal and increased vasculature in 23 patients, one or more pseudoaneurysms in 8 and arterio-venous fistula in 2 patients. One patient showed both, pseudoaneurysm and hypervascularization and another one pseudoaneurysm and arterio-venous fistula. ResultsTechnical success was achieved in 100%. None of the patients developed procedure-related complications such as periarticular skin- or tissue necrosis, including a patient who underwent TAE of two different bleeding sources in two consecutive sessions. Clinical success was 93.4%. Two patients showed recurrent swelling of the knee, 377 and 824 days after TAE respectively. However, only one of them required secondary TAE because of abnormal and increased vasculature. ConclusionsIn our view, TAE is the treatment of choice for the management of hemarthrosis of the knee. It is an effective and minimally invasive technique with very low complication rates.

Renal ablation in patients with end-stage renal disease

Transarterial catheter embolization of the kidneys (TAE) is a minimally invasive, image-guided procedure. In this study outcome and TAE-related complications of the patients who underwent TAE of the kidneys were evaluated retrospectively. Between August 2003 and August 2009, 11 patients underwent selective percutaneous transarterial renal embolization for end stage renal disease associated with uncontrolled hypertension, nephrotic syndrome, bleeding or malignancy. TAE of renal arteries was performed using different embolization agents. Successful renal embolization was possible in all 21 kidneys. All patients became anuric. Non-target embolization was not detectable. Nevertheless, all patients developed some degree of postembolization symptoms including nausea, vomiting, fever or pain. A typical finding after embolization was an increase in the C-reactive protein. Renal embolization is rarely done but should be considered as an alternative to surgical nephrectomy in patients with end stage renal disease due to the lesser invasiveness. Our study confirms the safety and effectivity of percutaneous renal embolization in patients with ESRD. We were able to control the hypertension, nephrotic syndrome, and bleeding caused by ESRD.

Transarterial catheter embolization of a sarcoma for preoperative conditioning

This paper presents a case of an undifferentiated pleomorphic sarcoma/NOS (not otherwise specified; former pleomorphic - storiform malignant fibrous histiocytoma) of the lower leg, of a huge tumor causing ulceration of the cutaneous surface. To improve preoperative conditions, selective transarterial devascularization of the tumor feeders was performed. At operation the tumor was completely ischaemic allowing for clear tumor demarcation with little blood loss during surgery.

Nonsurgical Options for Hepatocellular Carcinoma: Evolving Role of External Beam Radiotherapy

Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and thus poses a global concern. Its incidence is expected to increase in North America secondary to the increasing incidence of patients who develop hepatitis C. Patients who ultimately develop cirrhosis have an increased risk of developing hepatocellular carcinoma. The authors focus on nonsurgical therapies for this disease with an exploration of how external beam radiotherapy can be used alone or with other modalities. The development of partial liver strategies secondary to an explosion in radiation treatment planning and delivery advances is reviewed. Integration of advanced technology has evolved from three-dimensional conformal treatment to intensity-modulated radiation therapy and image-guided radiation therapy, along with stereotactic body radiation therapy, tomotherapy, and proton beam therapy. Current data show a promising future for treatment strategies incorporating radiation with high rates of infield tumor control and low rates of radiation-induced liver disease. Radiation can be delivered in conjunction with transarterial catheter embolization for advanced-stage patients. External beam radiotherapy also has a role in the setting of patients with macrovascular tumor thrombus. Future directions include how to best synergize the effects of radiation strategies with novel agents, given the hypervascularity of HCC. Downstaging of larger lesions with these therapies to resectable or transplantable disease may lead to better outcomes for patients deemed inoperable at diagnosis, and definitive radiotherapy may offer cure to patients with smaller lesions.

Surgical Treatment of Acute Pancreatitis

Acute pancreatitis is a common disease ranging in severity from a mild form to multiple organ failure and sepsis. Approximately half of death due to severe acute pancreatitis occur within 14 days and most are due to multiple organ failure. The late deaths are mostly due to infected necrosis. Treatment of severe acute pancreatitis has shifted from early surgical intervention to aggressive intensive care in recent years. The principle of therapy is mostly conservative in the early phase, and surgery is usually considered in the later phase of disease. Surgical debridement is indicated for removal of infected pancreatic and peri-pancreatic necrosis. With advances in radiological imaging, interventional radiology, and other minimal surgical access procedures, the management of many surgical conditions has changed. Several interventional techniques, including endoscopic retrograde cholangiopancreatography and endoscopic papillotomy , fine needle aspiration for bacteriology, percutaneous or endoscopic drainage of peri-pancreatic fluid collections, pseudocysts, and abscesses, as well as selective transarterial catheter embolization for associated active bleeding have been well established as diagnostic and therapeutic standards in the management of acute pancreatitis. With technical improvements in interventional therapy and minimally invasive surgery, even infected pancreatic necrosis has successfully been treated in selected patients. The minimally invasive endoscopic surgery and interventional therapy for infected necrosis should be limited to specific indications in patients who are critically ill and unsuitable for surgical laparotomy. The conclusion is that severe acute pancreatitis remains a serious medical problem, and the effective control of early multiple organ failure and treatment of systemic complications associated with infected necrosis require innovative strategies.

Efficacy of transarterial embolization as definitive treatment in lower gastrointestinal bleeding

Transarterial catheter embolization (TAE) is integral in the management of lower gastrointestinal bleeding (BLGIT). The efficacy of superselective embolization has reduced the need for emergent surgical resection as a treatment modality. To determine the outcomes of TAE in the management of BLGIT in terms of efficacy rates, recurrent bleeding rates and long term results without the need for surgical intervention. Patients who underwent TAE for BLGIT between September 2000 and May 2006 were analysed. Data were extracted from the records for analysis. Sixty-eight patients with a mean age of 76 years and equal gender distribution were analysed. Sixty-nine per cent presented with haematochezia, 40% with malena. Sixty-three patients had a prior RBC scan performed, all of which were positive. Colonoscopy was attempted in 18 patients of which four managed to localize the bleeding site. Embolization was performed in these patients using mainly polyvinyl alcohol particles and/or microcoils. The morbidity rate was 21%, comprising mainly fever and nonspecific abdominal pain with only four ischaemic complications and one report of colonic infarction. Early recurrent bleeding occurred in six patients. Three were treated with repeat embolization and two required surgery. There were no mortalities. After a mean follow-up of 12 months, 12 (17.6%) patients developed further episodes of BLGIT, necessitating further intervention. Transarterial catheter embolization is effective and safe in the acute management of BLGIT and reduces the need for further definitive surgery in a majority of patients.

Synchronous spontaneous arteriovenous fistula and aneurysm of the deep femoral artery incidentally found in a patient with aortic aneurysmal dissection

The patient was a 77-year-old man with sudden-onset chest and back pain. Computed tomography angiography (CTA) from the abdomen to the proximal thigh showed an aortic aneurysmal dissection (AAD) and a left deep femoral artery (DFA) aneurysm. The AAD was conservatively managed as there was no sign of increase. The left DFA aneurysm was surgically resected to avoid complications such as rupture, thromboembolism, and limb ischemia. On follow-up CTA obtained 3 weeks later, a spontaneous AVF in a varicose vein of the right DFA was noted. There were no symptoms associated with the AVF, and he was conservatively managed. However, the varicose vein gradually increased, and he underwent successful transarterial catheter embolization (TAE) with metal coils without any complications. After vascular repair of the aneurysm and the AVF of the right DFA, there was no sign of recurrence.

Aktueller Stand zur Embolisation der A. uterina in der Behandlung des symptomatischen Uterus myomatosus

A number of new approaches in treating symptomatic leiomyomas of the Uterus have been introduced in recent years. Only little scientific data is available an percutaneous or laparoscopic myolysis using focussed ultrasound, laser, or coagulation guided by magnetic resonance imaging or an laparoscopic ligation of the uterine vessels by means of bipolar coagulation or clipping. Established therapeutic options are limited by a number of disadvantages, except for total laparoscopic hysterectomy with morcellation. The latter is a minimally invasive procedure that spares important pelvic structures and thereby reduces the risk of prolapse and is associated with rapid recovery of the patients. Another minimally invasive therapeutic approach with preservation of the uterus is transarterial catheter embolization of uterine leiomyomas in which the vessels supplying the leiomyomas, in particular the branches of the uterine artery, are partly occluded by injection of synthetic (polyvinyl) beads. Uterine artery embolization has since developed into a good alternative to other therapeutic options. Studies report cure rates ranging from 77-93 %.