Uterine Embolization Research Articles

Complex Gynecologic Fistulas Presenting 10 Years After Uterine Artery Embolization.

Uterine artery embolization (UAE) is a minimally invasive procedure for treatment of symptomatic uterine leiomyomas, but long-term complications are under-reported. This is the case of a healthy 51-year-old woman who had previously undergone UAE for symptomatic uterine leiomyomas. The patient presented with gross hematuria and pelvic pain 10 years later. She was found to have both a vesicouterine and a uteroduodenal fistula. The patient was successfully treated with hysterectomy, excision of the vesicouterine fistula, partial cystectomy, excision of the duodenal fistula, and primary duodenal repair. Complex gynecologic fistulas may occur as a long-term complication in symptomatic women with a history of UAE.

Treatments for cesarean scar pregnancy: 11-year experience at a medical center

Background Cesarean scar pregnancy (CSP) is a long-term complication after cesarean section that can cause severe maternal morbidity and mortality. Although a variety of treatments have been described, there is no consensus as to the optimal management approach. Many grading systems for CSP have been proposed, among which the classification made by the consensus of Chinese experts in 2016 was shown to provide improved treatment guidance for clinical practice. The purpose of the present study was to analyze the success rate of different treatments for each type of CSP as classified according to the Chinese Expert’s Consensus (2016), and to develop a management strategy for CSP. Methods A retrospective study was performed among patients diagnosed with CSP at Shandong Provincial Hospital between January 2009 and December 2019. We reviewed clinical characteristics, treatment methods, and subsequent outcomes; and analyzed these endpoints using the statistical software package SPSS 22.0 (SPSS, Inc., Chicago, IL). Results For type I CSP, systemic methotrexate (MTX) administration exhibited a success rate of 79.2% for type Ia and 14.3% for type Ib. Local and systemic MTX administration success rates were 88.9% for type Ia and 66.7% for type Ib. Dilation and curettage (D&C), curettage after uterine artery embolization (UAE + C), and hysteroscopic curettage (H + C) were 100% successful. For type II, UAE + C, H + C, and laparoscopy combined with hysteroscopic curettage (L + H+C) were 100% successful. D&C had a success rate of 97.0% for type IIa and 88.9% for type IIb. The success rate of systemic MTX administration was 52.0% for type IIa and 62.5% for type IIb. Both UAE + C and L + H+C had 100% success rates for type IIIa CSPs, while for type IIIb, the success rate was 87.9% for UAE + C vs. 96.6% for L + H+C. Conclusions For type I CSPs, D&C was quick, easy, and safe; for type II, H + C was more suitable. For type III and some type II patients who wished to undergo simultaneous repair of the cesarean defect, L + H+C was the optimal method. UAE can be used as a complementary option instead of a prophylactic measure, and when difficulties with endoscopic surgeries were encountered, conversion to laparotomy was the ultimate treatment.

Adenomyosis with cavitation and infection after uterine artery embolization: A case report

Other than the expected abdominal pain post-embolization, only few complications occur after uterine artery embolization (UAE). Necrotic cavitation of adenomyosis is a particularly rare complication. Here, we describe a patient with adenomyosis who experienced persistent fever after UAE, which ultimately resolved with the spontaneous expulsion of adenomyosis.

Technical Success and Safety of Transradial Uterine Artery Embolisation for Symptomatic Fibroids at a Single Centre in South Africa

Abstract Background The femoral artery has remained the primary means of vascular access for uterine artery embolisation in the treatment of uterine fibroids. Transradial access for coronary artery catheterization is gaining wider acceptance, with studies in the cardiac literature demonstrating key advantages. The primary objective of this study was to compare the technical success and safety of the transradial approach for uterine artery embolization performed at a single centre in South Africa. Methods Data was obtained from consecutive patients undergoing uterine artery embolisation for the treatment of symptomatic fibroids over a 30-month period. Specifically technical success and patient safety were analysed. Results A total of 496 patients were included in the study. Of these 27 patients had primary contraindications to radial access. The remaining 469 patients who underwent radial artery access, technical success was achieved in 459 cases (97.9%). The primary cause of technical failure was radial artery spasm (9.9%). Mean procedure times were 53.5 minutes ± 15.2 minutes with total screening times of 9.6 ± 9.1 minutes. The mean radiation dose area product was 6321.7 ± 3449.8 cGy.cm2. Complications were recorded in 40 (8.5%) patients, of which 7 (1.5%) were major complications. Conclusions This study corroborates evidence that this approach is a safe and effective alternative to the traditional transfemoral route for the treatment of uterine fibroids.

РЕПРОДУКТИВНОЕ ЗДОРОВЬЕ ЖЕНЩИНЫ ПОСЛЕ УСПЕШНОЙ ЭМБОЛИЗАЦИИ СОСУДОВ МАТКИ И МАЛОГО ТАЗА ПРИ РАЗВИТИИ АКУШЕРСКОГО КРОВОТЕЧЕНИЯ В АНАМНЕЗЕ

Bleeding during pregnancy and childbirth is one of the leading causes of maternal mortality. An effective organ-preserving method of treating uncontrolled obstetric bleeding is uterine artery embolization (EMA). The advantages of EMA are the ease of determining the place of bleeding, reducing repeated bleeding from the collaterals, preserving the uterus and, consequently, fertility.

Influence of Previous Abdominal and Pelvic Surgeries on Uterine Artery Embolization

Influence of Previous Abdominal and Pelvic Surgeries on Uterine Artery Embolization

Outcomes of the UT-PAS protocol: uterine artery embolization and tranexamic acid for placenta accreta spectrum

Outcomes of the UT-PAS protocol: uterine artery embolization and tranexamic acid for placenta accreta spectrum

Трехмерная эхография в оценке степени облитерации полости матки

Objective. To improve treatment outcomes for intrauterine adhesions (IUA) in reproductive-aged patients by implementing an algorithm of three-dimensional (3D) ultrasound diagnostics. Patients and methods. This study included 146 women with suspected IUA. The mean age of patients was 30.7 ± 3.4 years. All patients were retrospectively divided into 5 groups: Group 0 (n = 27) – patients with thin endometrium; group I (n = 29) – patients with grade 1 IUA; group II (n = 22) – patients with grade 2 IUA; group III (n = 37) – patients with grade 3 IUA; group IV (n = 31) – patients with grade 4-5 IUA. The control group consisted of 20 healthy women. Algorithms for using different functions and modes of 3D ultrasound to assess the degree and architectonics of IUA were practiced. Results. Qualitative (polygonal shape of the uterine cavity, invagination of myometrium into the endometrium, fragmentary/total endometrial absence) and quantitative (dynamic examination of endometrial volume) ultrasound criteria defining the degree of IUA in 3D ultrasound according to the ESGE classification were developed. Conclusion. Based on the developed 3D ultrasound criteria, the algorithm and criteria for diagnosing the degree of IUA were established. The analysis of intrauterine architectonics allowed prediction of the course and choice of adhesiolysis technique and to reduce the number of intraoperative complications. Key words: 3D ultrasound, intrauterine adhesions, myomectomy, Asherman’s syndrome, uterine artery embolization, echohysterography

Laparoscopic Myomectomy for Huge Uterine Fibroid in Sub-Saharan Africa: A Case Report

Abstract The prevalence of extensive and multiple uterine fibroids among the Black African population is a significant concern, as it limits the available management options. The focus on girl child education and improvement in women empowerment have contributed to an increased demand for less invasive options in the management of uterine fibroids. This trend aims to improve cosmesis and, more importantly, facilitate an early return to work and normal activity. In sub-Saharan Africa, the available management options for uterine fibroids have primarily been limited to abdominal myomectomy and hysterectomy. However, anecdotal reports indicate the use of less invasive management options such as uterine artery embolization, laparoscopic radiofrequency ablation, and laparoscopic myomectomy. These interventions are reserved for small- and medium-sized fibroids, with the largest being <15 cm and usually not more than five myoma nodules. We present a case report of laparoscopic myomectomy for a huge uterine fibroid weighing 2.4 kg in a nulliparous patient. In well-selected, properly evaluated patients with large subserous uterine fibroids, laparoscopic myomectomy emerges as a viable option that could be offered as an armamentarium in the management of huge fibroids, particularly in sub-Saharan Africa.

ОЦЕНКА БЛИЖАЙШИХ И ОТДАЛЕННЫХ РЕЗУЛЬТАТОВ АКУШЕРСКОГО КРОВОТЕЧЕНИЯ С ЭМБОЛИЗАЦИЕЙ МАТОЧНЫХ АРТЕРИЙ И ПЕРЕНЕСЕННОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИЕЙ (КЛИНИЧЕСКИЙ СЛУЧАЙ)

The study aims to present a complicated clinical case of a woman who almost died due to comorbid obstetric pathology associated with a coronavirus infection. The term “near miss” refers to the detailed analysis of each clinical case classified as a critical obstetric condition, as well as the registration of patients with such conditions in the Russian register established in 2021 to prevent maternal mortality and make management decisions. A severe clinical near miss case of a female patient included the following serious obstetric syndromes: postpartum obstetric hemorrhage followed by uterine artery embolization, endomyometritis by the third day, partial thrombosis of the branches of the right lower lobe pulmonary artery by the seventh day, thrombosis of parametrial vessels, partial necrosis of the uterus by the eighth day, and a new coronavirus infection COVID-19 by the thirteenth day after delivery. The complexity of diagnosis and treatment is demonstrated in the results of the study in the acute period and in the outcome of the disease.

ЭМБОЛИЗАЦИЯ МАТОЧНЫХ АРТЕРИЙ КАК МЕТОД ЛЕЧЕНИЯ МИОМЫ МАТКИ, ВЛИЯНИЕ НА РЕПРОДУКТИВНОЕ ЗДОРОВЬЕ ЖЕНЩИН. ОБЗОР ЛИТЕРАТУРЫ

Uterine leiomyoma is one of the common causes of hysterectomy in premenopausal women. According to the 2021 clinical guidelines of the Ministry of Health RF “Uterine myoma”, uterine artery embolisation is an alternative method for surgical treatment when the surgical risk is high and there are no contraindications in patients who are not planning a pregnancy.

Modern view on uterine artery embolization in the therapy of hypotonic postpartum hemorrhage

Modern view on uterine artery embolization in the therapy of hypotonic postpartum hemorrhage

Retracted: Effect of Uterine Artery Ligation and Uterine Artery Embolization on Postpartum Hemorrhage Due to Uterine Asthenia after Cesarean Section and Its Effect on Blood Flow and Function of Uterine and Ovarian Arteries.

[This retracts the article DOI: 10.1155/2022/1337234.].

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.

Efficacy of Uterine Artery Embolization for Control of Postpartum Hemorrhage

Efficacy of Uterine Artery Embolization for Control of Postpartum Hemorrhage

Treatment of Abnormal Uterine Bleeding Due to a Leiomyoma in a Bicornuate Uterus with Uterine Artery Embolization: The First Case in the Literature

Treatment of Abnormal Uterine Bleeding Due to a Leiomyoma in a Bicornuate Uterus with Uterine Artery Embolization: The First Case in the Literature

Pelvic pain management with ultrasound-guided superior hypogastric plexus block (SHPB) after uterine artery embolization for symptomatic myomatosis

Pelvic pain management with ultrasound-guided superior hypogastric plexus block (SHPB) after uterine artery embolization for symptomatic myomatosis

Effectiveness of Uterine Arterial Embolization and Risk Factors Associated with Its Failure in Patients with Primary Postpartum Hemorrhage After Cesarean Section

Background: Postpartum hemorrhage (PPH), a serious labor-related complication, is the leading cause of maternal mortality, which requires an emergent intervention. Uterine arterial embolization (UAE) is an effective treatment for hemostasis of intractable PPH. Several risk factors have been reported for the failure of UAE. Objectives: To evaluate the clinical outcomes of UAE for the treatment of primary PPH following cesarean section (CS) and to determine the risk factors associated with the failure of this procedure. Patients and Methods: This retrospective, single-center study was approved by the institutional review board, and the requirement to obtain informed consent was waived. All patients referred to a tertiary care center, who underwent UAE for primary PPH between January 2018 and December 2020, were included. The patients’ medical records and radiological findings, including the patients’ characteristics, mode of delivery, initial vital signs and laboratory findings after hospitalization, procedure details, and embolization outcomes, were evaluated for data collection. Technical success was defined as appropriate embolization of target vessels on a completion angiogram. Clinical success was defined as adequate cessation of bleeding after the first embolization, without any need for subsequent embolization or surgical intervention. Statistical analysis was performed to determine factors related to the clinical failure of UAE in CS cases. Results: UAE was performed for 25 patients (mean age, 37.2 years; range, 25 - 45 years). The technical success rate was estimated at 100% (n = 25), and the clinical success rate was 76% (n = 19). There were no patients with permanent adverse sequelae or death. The univariate analyses showed that hemodynamic instability (P = 0.006), lower hemoglobin levels (P = 0.02), and prolonged activated partial thromboplastin time (aPTT) (P = 0.017) were related to clinical failure. The logistic regression analysis adjusted for age showed that the area under the curve (AUC) was 0.86 for hemoglobin (95% CI: 0.7 - 1; cutoff value: 0.667), 0.816 for aPTT (95% CI: 0.625 - 1; cutoff value: 0.411), and 0.868 for hemodynamic instability (95% CI: 0.661 - 1; cutoff value: 0.622). Conclusion: UAE is a safe and effective treatment for primary PPH following CS. Hemodynamic instability, low hemoglobin levels, and prolonged aPTT can be predictive factors for the poor outcomes of UAE in CS patients. These factors are rapid and straightforward criteria, which can be simply applied, even in emergency situations.

Pituitrin Injection before Hysteroscopic Curettage for Treating Type I Cesarean Scar Pregnancy in Comparison with Uterine Artery Embolization: A Retrospective Study.

The effectiveness and safety of pituitrin injection coupled with hysteroscopy and suction curettage as treatment for type I cesarean scar pregnancy (CSP) have not been studied enough in the literature, by comparing it to uterine artery embolization (UAE) followed by suction curettage we aim to determine its efficacy. Data of 53 patients (the PIT group) with type I CSP treated with pituitrin injection combined with hysteroscopic suction curettage and 137 patients (the UAE group) with type I CSP treated with UAE followed by suction curettage were collected in retrospect. The clinical data were analyzed statistically to compare the efficacy and safety between the two groups. The PIT group had a shorter duration of postoperative vaginal bleeding, postoperative hospitalization, and overall hospitalization length (P < 0.05). The PIT group had lower overall hospitalization costs and a lower rate of adverse events than the UAE group (P < 0.05). There was no significant difference between the two groups in terms of treatment success rate, the average length of operation, blood loss during the procedure, time when serum β-hCG returned to normal range, and menstrual recovery time after hospital release (P > 0.05). UAE and pituitrin injection followed by hysteroscopic suction curettage are good choices for type I CSP treatment. However, pituitrin injection with hysteroscopic suction curettage outperforms UAE followed by suction curettage. Thus, pituitrin injection may be an option of high priority for type I CSP.

Treatment of Cesarean Scar Ectopic Pregnancy in China with Uterine Artery Embolization-A Systematic Review and Meta-Analysis.

We performed a thorough search and included all forms of quality studies on this topic that reported UAE as a part of first-line management of CSP. We included only studies originating in China. Ultimately, 37 studies were included for qualitative and quantitative synthesis of evidence. After screening retrieved records and extracting data from eligible studies, we pooled continuous data as a mean estimate and 95% confidence interval (CI), and dichotomous data as proportion and 95% CI. CSP patients treated with protocols including UAE had a mean time of 30 days for serum β-hCG normalization, 95% CI [26.816, 33.881]. They had a mean estimated intraprocedural blood loss of 4.19 ± 3.76 mL, a mean hospital stay of nine days, 95%CI [7.914, 9.876], and a success rate of 93.4%, 95%CI [0.918, 0.951]. The severe complication rate was 1.2%, 95%CI [0.008, 0.017]. UAE, in combination with other procedures is being used effectively for the treatment of CSP in China. Protocols including UAE have a success rate of approximately 93.4%, and a severe complication rate of approximately 1.2%. This data's utility is limited by vast differences in the studied protocols and questionable feasibility outside of China.