Unilateral Uterine Artery Embolization Research Articles

Unilateral Uterine Artery Embolization as a Treatment for Patients with Symptomatic Fibroids-Experience in a Case Series.

Background and Objectives: Uterine artery embolization (UAE) has become an accepted and widely performed therapy for patients with symptomatic (reporting at least two of the following symptoms: severe or prolonged menstrual bleeding, abdominal pain, tension in abdomen, problems with urination, constipation or anemia) uterine fibroids. Although in the majority of cases, bilateral occlusion is required to obtain a successful clinical outcome, there are patients in whom treatment of only one uterine artery could be attempted. There are several reasons for unilateral UAE: hemodynamic conditions, technical difficulties, anatomical variants and unilateral dominancy of blood supply to the fibroid. Our aim is to present our 10-year experience with unilateral UAE and evaluate the radiological and clinical outcomes. Materials and Methods: Records of 369 patients with fibroids who underwent UAE from 2010 to 2021 were analyzed. We identified 26 patients treated with unilateral uterine artery embolization and analyzed the data of these patients. All patients attended medical consultation, were assessed using a five-grade symptom scale and underwent MRI examination. Clinical response was evaluated at least 6 months after the procedure and was categorized to one of the following groups: complete improvement, partial improvement, no change and a worsening in symptoms. Results: Twenty-two patients (85%) reported at least partial improvement 6 months following the procedure. One patient required secondary embolization due to recanalization. The secondary procedure was successful, and complete improvement was achieved. One patient did not observe any clinical improvement, and in two cases, symptom recurrence was observed. All three patients were referred for surgical treatment. No major complications were noted. Overall, the success rate was 88%. Conclusions: The results of our study support the statement that elective unilateral embolization is an appropriate treatment in patients with a dominant uterine artery.

Unilateral Uterine Artery Embolization Therapy For Secondary Postpartum Hemorrhage In Pseudoaneurysma Of The Sinistra Uterinary Artery Post-Cesarean Section

Introduction: Uterine artery pseudoaneurysm is one of the rare malformations of uterine blood vessels due to incomplete closure of the torn uterine artery wall. This condition accounts for about 3% of postpartum hemorrhage cases that could be life-threatening. Transcatheter arterial embolization has recently emerged as a safe and highly effective alternative treatment. Case Presentation: A 30-year-old woman complained of abdominal pain accompanied by a large amount of blood from the birth canal, which was felt on the 28th day after a cesarean section. The patient underwent laparotomy and had grade III intra-abdominal adhesions. On CT-Angiography investigation, we found saccular type aneurysm in the left uterine artery, hematometra, and fluid collection on the right side of the periuterine, multiple paraaortic lymphadenopathies, hepatomegaly, and left adnexal cyst. With the pseudoaneurysm, the patient was planned to undergo uterine artery embolization. The patient was discarded. During follow-up, results of CT-scan pelvic angiography include dilated and convoluted right uterine artery. Conclusion: In this case report, uterine artery embolization (UAE) was performed; this procedure was chosen because the effectiveness of embolization was 97% and could maintain the desire for future pregnancies. The fertility prognosis in this case report was quite good after unilateral uterine artery embolization was performed concerning regular menstrual cycles.

Unilateral uterine artery embolization and Bakri tamponade balloon insertion in the treatment of acute puerperal uterine inversion: a case report

BackgroundAcute puerperal uterine inversion is rare but may cause massive postpartum blood loss due to uterine atony. Therefore, these patients must be diagnosed, and uterine replacement must be performed as soon as possible. However, in some cases, active bleeding due to uterine atony becomes uncontrollable, even though the uterine inversion itself is treated. In these cases, additional treatments, including surgical procedures, are needed.Case presentationA 41-year-old Japanese woman, gravida 1, para 0, was hospitalized for labor induction at 40 weeks and 3 days of gestational age. She had a vacuum-assisted delivery after 3 days of oxytocin administration, but acute uterine inversion occurred. Although replacement of the inverted uterus was successful by manual repositioning and Bakri balloon tamponade insertion, massive postpartum hemorrhage caused by uterine atony became uncontrollable. In this situation, since disseminated intravascular coagulation had developed, we used uterine artery embolization to stop the bleeding. After detecting the pseudo-aneurysmal sac and tortuous vessels of the right uterine artery, transcatheter right-sided uterine artery embolization was performed. Thirteen days after uterine artery embolization, she was discharged with no complications.ConclusionsIn cases of disseminated intravascular coagulation caused by massive postpartum bleeding, uterine artery embolization may often be selected. In our case, since we performed angiography to detect the main bleeding site, the hemorrhage could be stopped with unilateral uterine artery embolization alone, without hysterectomy.

Term Pregnancy after Unilateral Uterine Artery Embolization for Aggressive Uterine Arteriovenous Malformation

Uterine Arteriovenous Malformation (AVM) is a potentially life-threatening condition. Uterine Artery Embolization (UAE) is a treatment method of choice for women who wish to preserve fertility. Pregnancies after UAE are at risk of perinatological complication. We described a management of uterine AVM with unilateral uterine artery embolization followed by a successful term pregnancy.

An Academic Tertiary Referral Center's Experience with a Vascular Surgery–Based Uterine Artery Embolization Program

Despite growing endovascular experience within the vascular surgery community, some catheter-based interventions-such as uterine artery embolization (UAE)-remain outside the clinical scope of most vascular surgeons, owing in part to established referral patterns and limited awareness among referring colleagues. We present our experience with a vascular surgery-based, multidisciplinary UAE program at an academic tertiary referral center. In a collaborative effort between vascular surgeons and gynecologists, a pelvic vascular disease program has been established to provide palliative, prophylactic, and therapeutic embolizations including, but not limited to, UAE. For UAE, inclusion criteria are women over the age of 18 years with symptomatic uterine fibroids demonstrated on magnetic resonance imaging and a negative endometrial biopsy. Exclusion criteria are desire for future pregnancy and previous embolization(s). Technique and perioperative protocol is presented. Data including symptom resolution, reintervention rates, and complications were prospectively gathered and retrospectively reviewed. Over an 18-month period, 30 patients with symptomatic fibroids were referred for potential UAE. Five patients were excluded because of uncertainty about future pregnancy wishes (4) and prior embolization (1). Twenty-four bilateral and 2 unilateral UAEs were performed (mean age, 46.3years [range 28-53years]). Presenting symptoms were pelvic and abdominal pain (25), cramps (25), menorrhagia (25), dysmenorrhea (25), urinary frequency (12), and dyspareunia (5). Technical success, defined as successful microcatheterization of uterine arteries and delivery of a particulate liquid embolic agent (embospheres, 500-700 microns), was 100%. There were no perioperative or delayed complications. Twenty-one patients (87.5%) reported complete symptomatic relief without further intervention at the time of last follow-up. Three patients (12.5%) reported pain relief but had persistent vaginal bleeding requiring hysterectomy 12months after UAE. All patients underwent a 23-hr observation postoperatively for pain control. Mean follow-up was 7.4months (1-23months) and included pelvic ultrasound assessment of fibroid size at 1, 3, and 6months after UAE and annually thereafter. One patient was lost to follow-up. Fibroid shrinkage was noted in all patients. Given the willingness and capability to work-up, admit, treat, and follow-up patients, vascular surgery was deemed the preferred service for UAE by the referring gynecologists. Within the framework of a collaborative, multidisciplinary program, vascular surgery can play a prominent role in providing safe and effective UAE.

An Academic Tertiary Referral Center's Experience With a Vascular Surgery-Based Uterine Artery Embolization Program

Despite growing endovascular experience within the vascular surgery community, some catheter-based interventions, such as uterine artery embolization (UAE), remain outside the clinical scope of most vascular surgeons owing mostly to established referral patterns and limited awareness among referring colleagues. We present our experience with a vascular surgery-based, multidisciplinary UAE program at an academic tertiary referral center. In a collaborative effort between vascular surgery and gynecology, a Pelvic Vascular Disease Program has been established to provide palliative, prophylactic, and therapeutic embolizations including but not limited to UAE. For UAE, inclusion criteria are women older than 18 years with symptomatic uterine fibroids demonstrated on magnetic resonance imaging and negative endometrial biopsy. Exclusion criteria are desire for future pregnancy and previous embolizations. Technique and perioperative protocol are presented. Data including symptom resolution, fibroid size, need for further procedures, and complications were prospectively gathered and retrospectively reviewed. During an 18-month period, 30 patients with symptomatic fibroids were referred for potential UAE. Five patients were excluded because of uncertainty about future pregnancy wishes (four) and prior embolization (one). Twenty-four bilateral and two unilateral UAEs were performed (mean age, 46.3 years [range, 28-53 years]). Presenting symptoms were pelvic and abdominal pain (25), cramps (25), menorrhagia (25), dysmenorrhea (25), urinary frequency (12), and dyspareunia (5). Technical success, defined as successful microcatheterization of uterine arteries and delivery of a particulate liquid embolic agent (embospheres, 500-700 μm), was 100%. There were no perioperative or delayed complications. Twenty-one patients (87.5%) reported complete symptomatic relief without further intervention at the time of last follow-up. Three patients (12.5%) reported pain relief but had persistent vaginal bleeding requiring hysterectomy 12 months after UAE. All patients underwent a 23-hour observation postoperatively for pain control. Mean follow-up was 7.4 months (1-23 months) and included pelvic ultrasound assessment of fibroid size at 1 month, 3 months, and 6 months after UAE and annually thereafter. One patient was lost to follow-up. Fibroid shrinkage was noted in all patients. Given the willingness and capability to work up, admit, treat, and follow up patients, vascular surgery was deemed the preferred service for UAE by the referring gynecologists. Within the framework of a collaborative, multidisciplinary program, vascular surgery can play a growingly more prominent role in providing safe and effective UAE.

Delayed Postpartum Hemorrhage: A Case of Placenta Accreta With No Known Risk Factors

35-year-old woman, with one previous miscarriage managed conservatively, had a spontaneous vaginal delivery at 35 weeks’ gestation. She required dilatation and curettage for postpartum hemorrhage. During curettage, placenta accreta was suspected. The patient chose to undergo expectant management with oral antibiotic therapy and close follow-up. Further hemorrhage occurred on postpartum day 24. Ultrasound examination showed a 7.3 × 6.4 × 7.6 cm intrauterine mass consistent with placenta increta. Despite unilateral uterine artery embolization, the patient required repeated blood transfusions and eventually underwent hysterectomy on postpartum day 30. Final pathology showed placenta accreta (Figure 1), with a large amount of retained placenta (Figure 2). Expectant management of placenta accreta is reported to be successful in 78% of cases. 1 Uterine artery embolization can be helpful for bleeding associated with placenta accreta, but there is insufficient evidence to suggest that elective

Robotic Catheterization: The Importance of Evaluation by Interventional Radiologists

Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 2007; 356:360–370. 14. Hehenkamp WJ, Volkers NA, Birnie E, Reekers JA, Ankum WM. Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy-results from the randomized clinical Embolisation versus Hysterectomy (EMMY) Trial. Radiology 2008; 246:823–832. 15. Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008; 31:73–85. 16. Pron G, Bennett J, Common A, et al, Ontario UFE Collaborative Group. Technical results and effects of operator experience on uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial. J Vasc Interv Radiol 2003; 14:545–554. 17. Bratby MJ, Hussain FF, Walker WJ. Outcomes after unilateral uterine artery embolization: a retrospective review. Cardiovasc Intervent Radiol 2008; 31:254–259.

Three-dimensional power Doppler assessment of pelvic structures after unilateral uterine artery embolization for postpartum hemorrhage

Abstract Delayed postpartum hemorrhage, defined as bleeding following delivery up to 6 weeks postpartum, is a risk following cesarean or vaginal delivery. Episodes most commonly occur between 8 and 14 days postpartum. Here, we present a case of a 24-year-old woman presenting with delayed postpartum hemorrhage 14 days after delivery, which later proved to be caused by left uterine artery hemorrhage. The hemorrhage was refractory to local treatment and required invasive measures to prevent hypotensive shock. In lieu of a hysterectomy, a unilateral uterine artery embolization (UAE) was performed to preserve fertility in this 24-year-old patient. Three-dimensional power Doppler ultrasonography was performed 3 weeks after UAE to assess the volume and vascularity of the pelvic structures. This case illustrates a viable intervention for women with postpartum hemorrhage who desire to preserve future fertility, as well as a method to detect structural and vascular changes after the treatment to evaluate their future fertility prospects.

A Preclinical Study of the Safety and Efficacy of Occlusin™ 500 Artificial Embolization Device in Sheep

This study evaluated the safety, effectiveness, and biodegradation of a new embolic agent, Occlusin™ 503 Artificial Embolization Device (OCL 503). The agent consists of biodegradable poly-lactic-co-glycolic acid microspheres (150-212 μm) coated with type I bovine collagen and was compared with Embosphere® Microspheres (300-500 μm) in this controlled study of uterine artery embolization (UAE) in sheep. Unilateral UAE was performed in 32 adult ewes randomly assigned. Vessels were embolized to effective stasis. The cohort was divided into four groups, which were sacrificed at 1, 3, 6, and 12 months. Both agents were 100% effective in achieving stasis. At 6 months, all OCL 503-treated arteries were occluded, the microspheres degraded with time, and at 12 months all four animals examined demonstrated recanalization. OCL 503 was found in the untreated uterine artery in one animal with no other evidence of non target embolization. In the Embosphere-treated group, all vessels remained occluded and microspheres were detected in the contralateral uterine artery in 6 of 15 examined vessels and in 10 vaginal, 2 ovarian, and 1 vesical artery. No procedural-related complications were seen in either group. OCL 503 is as effective an embolic agent as Embosphere® Microspheres when embolizing ovine uterine arteries and resorbs with time, allowing recanalization of the treated arteries. No device-related issues or adverse events were observed.

Effectiveness of Elective Unilateral Uterine Artery Embolization: A Case-control Study

Purpose To evaluate the effectiveness of elective unilateral uterine artery embolization (UAE) in limited fibroid disease. Materials and Methods A review of 1,431 UAE recipients at a single institution identified 76 who underwent unilateral embolization, most in the setting of anatomic variants or technical failure. A total of 28 had intentional unilateral UAE because of unilateral disease on magnetic resonance (MR) imaging with supply from only the ipsilateral uterine artery on angiography. These 28 case-group patients were compared with a control group of 28 patients who underwent bilateral UAE contemporaneously. Outcome measures included a chief symptom resolution score, fluoroscopy time, tumor infarction rate, patient satisfaction, analgesia requirements, and maximum pain score. Baseline characteristics and outcome measures were compared with t tests, Pearson χ 2 tests, analyses of variance, and nonparametric tests. Results Three-month clinical follow-up and postprocedure MR imaging were available for 25 of the case-group patients. The unilateral UAE group had fewer analgesia doses demanded (28.8 vs 57.5; P = .049), lower total analgesia dose (22.8 mg vs 34.5 mg; P = .029), shorter fluoroscopy time (10.9 min vs 13.4 min; P = .013), and lower maximum pain score (3.7 vs 5.7; P = .003). There were no differences in chief symptom resolution score (2.1 vs 1.9; P = .27), satisfaction score (4.0 vs 4.0; P = .72), or complete tumor infarction (92% vs 88%; P = .64). Conclusions Unilateral UAE in appropriately selected patients has similar clinical results as standard bilateral UAE and is associated with reduced fluoroscopy time and postprocedural pain.

Abstract No. 59: Elective use of unilateral uterine artery embolization for symptomatic uterine leiomyomata

Abstract No. 59: Elective use of unilateral uterine artery embolization for symptomatic uterine leiomyomata

Outcomes After Unilateral Uterine Artery Embolization: A Retrospective Review

Bilateral uterine artery embolization (UAE) is considered necessary to provide effective treatment for symptomatic uterine fibroids. Occasionally, only unilateral embolization is performed, and this study evaluates these outcomes. As part of a prospective observational study of more than 1600 patients treated with UAE since 1996, there have been 48 patients in whom unilateral embolization has been performed. This study retrospectively reviews clinical response as assessed by our standard questionnaire and radiological response assessed by either magnetic resonance imaging or ultrasound. Two principal groups emerged: the largest, where only the dominant unilateral arterial supply was electively embolized (30 patients); and the second, where there was technical failure to catheterize the second uterine artery as a result of anatomical constraints (12 patients). Favorable clinical response with a reduction in menorrhagia at 1 year was seen in 85.7% (18/21) of those patients with a dominant arterial supply to the fibroid(s). In contrast, in those patients where there was technical failure to embolize one uterine artery, there was a high rate of clinical failure requiring further intervention in 58.3% (7/12). Comparison of the technical failure group with the dominant uterine artery group demonstrated a statistically significant (Fisher's exact test) difference in the proportion of patients with evidence of persistent fibroid vascularity (p < 0.001) and requiring repeat intervention (p < 0.01). We conclude that unilateral UAE can achieve a positive clinical result in the group of patients where there is a dominant unilateral artery supplying the fibroid(s), in contrast to the poor results seen following technical failure.

Conservative treatment of cervical pregnancy with selective unilateral uterine artery embolization

Cervical pregnancy is a rare form of ectopic pregnancy, and the most effective method of its treatment is still under investigation. We would like to call attention to selective uterine artery embolization as an effective modern treatment method. A patient with suspected cervical pregnancy and 7-week amenorrhea was admitted to the hospital after unsuccessful use of emergency contraception. Transvaginal ultrasound showed gestational sack located 11 mm from the external cervical os. Crown-rump length was 11.2 cm, and the fetal heartbeat was present. The level of serum chorionic gonadotropin was 31,930 U/L. Treatment with systemic methotrexate was unsuccessful, and unilateral uterine artery embolization was performed followed by dilatation and curettage of the cervical canal. Three days after the procedure, sonographic examination showed contracted cervical canal. After a period of two months, normal uterine artery flow was registered by Doppler ultrasonography on both sides. Uterine artery embolization in case of cervical pregnancy reduces the risk of bleeding and can be the method of choice when treatment with methotrexate fails. Unilateral embolization is effective when angiography shows unequal disposition of the arterial connections supplying the embryo.

Predictors of hysterectomy after uterine artery embolization for leiomyoma

This study was undertaken to describe long-term outcomes after uterine artery embolization for leiomyoma. Data from Kaiser Permanente Northern California members undergoing uterine artery embolization for leiomyoma before July 2001 were collected. Survival analysis was performed to describe hysterectomy rates and identify predictors of hysterectomy. Uterine artery embolization was performed in 562 women from 1997-2001. Thirty-three women (5.9%) had unilateral uterine artery embolization. One hundred women (18%) underwent hysterectomy after uterine artery embolization, and 32 (5.7%) had additional uterine sparing procedures. Only unilateral uterine artery embolization predicted subsequent hysterectomy (relative risk = 2.19; 95% CI 1.34-3.57), whereas age, indication, uterine volume, embolizing particle, and radiologist experience did not. The rate of hysterectomy at 5 years was 19.7%; rates for bilateral and unilateral uterine artery embolizations were 18.5% and 39.2%, respectively. Fifty-four women (9.6%) had emergency room visits and 17 (3%) had unplanned readmissions. Uterine artery embolization for leiomyoma permits uterine conservation in more than 80% of women monitored long-term. When bilateral procedures cannot be performed, failure rates are considerably higher.

Uterine artery embolization: A pilot study in a rabbit model

Eight female adult ex-breeder New Zealand white rabbits underwent bilateral, unilateral, or superselective unilateral uterine artery embolization. The histopathologic changes after embolization in New Zealand white rabbits resemble those in humans, making rabbits an appropriate model for experimental uterine artery embolization.

Pseudoaneurysm of the Uterine Artery Requiring Bilateral Uterine Artery Embolization

To report a case of uterine artery pseudoaneurysm which initially failed unilateral uterine artery embolization that subsequently responded to bilateral embolization. A case report. University hospital. 32-year-old G(2) P(1) female. Left uterine artery embolization followed by right uterine artery embolization 1 day later. Vaginal bleeding, hemoglobin. Unilateral uterine artery embolization failed to control vaginal bleeding. Repeat embolization of the contralateral side was successful. Uterine artery embolization is an effective method of treating delayed postpartum hemorrhage secondary to a pseudoaneurysm of the uterine artery.

Outcome in patients undergoing unilateral uterine artery embolization for symptomatic fibroids

AIMS: To evaluate patients undergoing uterine artery embolization for symptomatic fibroids who, for technical reasons, underwent unilateral rather than bilateral embolization. PATIENTS: Prospective data were collected on 109 patients undergoing uterine artery embolization for symptomatic fibroids. Of these, six underwent unilateral embolization. They were followed with ultrasound or magnetic resonance imaging (MRI) at 3, 6 and 12 months. Patients' histories were reviewed and patients were asked to evaluate their symptoms at 3, 6 and 12 months on a scoring system, which scored their pre-embolization symptoms as 10. RESULTS: In one case the patient's symptoms did not change in the first 3 months. This patient underwent a second embolization procedure to occlude the non-embolized uterine artery. In four cases the patients' symptoms had begun to resolve at 3 months and by 12 months the patients no longer required any further treatment. In one case the patient passed a 10 cm fibroid per vagina 2 months post uterine artery embolization. After this the patient had a normal uterus on MRI and no further symptoms. CONCLUSION: Where planned bilateral uterine artery embolization is not possible for technical reasons and a unilateral embolization only is performed a conservative approach is indicated.