Uterine Artery Embolization For Fibroids Research Articles

A New Twist on the Waltman Loop for Uterine Artery Embolization for Fibroids

The usual ipsilateral approach for uterine artery embolization is to form a Waltman loop. Newer nonbraided 4-F catheters can be problematic because of their tendency to kink or unfold while the loop is being formed. Herein, a modification of the Cope suture technique is described by which a Waltman loop is formed with use of a 4-0 Tevdek suture that allows the catheter to be folded back on itself, drawing it into the ipsilateral iliac artery. If necessary, the catheter can be prevented from unlooping by twisting the catheter on itself to lock it in position. The technique allows for efficient catheterization of the ipsilateral uterine artery.

Utility of Nonselective Abdominal Aortography in Demonstrating Ovarian Artery Collaterals in Patients Undergoing Uterine Artery Embolization for Fibroids

To review the incidence of ovarian collateral supply to uterine fibroids as demonstrated by nonselective abdominal aortography before uterine artery embolization (UAE) and to evaluate the effect of such visualization on interventional management. The aortograms of 51 consecutive patients (mean age, 42.4 y; range, 30--53 y) undergoing UAE for symptomatic uterine fibroids were reviewed retrospectively for the visualization of ovarian arteries extending into the pelvis. If ovarian arteries were visualized, their size relative to the ipsilateral external iliac artery was measured. Arteries believed large enough to represent a significant blood supply to the uterine fibroids were further evaluated after UAE to determine whether flow persisted. In 13 of 51 patients (25%), a total of 18 ovarian arteries were identified. They were bilateral in five patients and unilateral in eight. Their sizes relative to the ipsilateral external iliac artery ranged from 8% to 57% (mean, 26%). Eight ovarian arteries with a relative size > or = 25% were further evaluated. Five of the eight (62.5%) were not visible after UAE. Of the three persistent ovarian collateral arteries, two were successfully embolized. The patient with the untreated collateral artery experienced persistent menorrhagia. Preembolization aortography with the catheter tip at level of the renal arteries demonstrated ovarian collateral arteries in 25% of patients with uterine fibroids. However, their detection influenced treatment in only 6% of the reported cases.

Uterine artery embolization for uterine fibroids: a radiologist's perspective.

Uterine artery embolization for uterine fibroids: a radiologist's perspective.

Uterine artery embolization for the treatment of uterine fibroids: An outpatient procedure

Objective: Our objectives were to establish an outpatient program for uterine artery embolization of fibroids and to monitor the following: percentage of patients who required immediate hospitalization or admission within 2 weeks, outcomes in terms of the degree of ultrasound regression of the fibroids, patient satisfaction, reduction of pressure symptoms, and reduction of bleeding. Study Design: Patients were screened by a gynecologist with the use of a designed care algorithm; they then underwent uterine embolization, performed by an interventional radiologist. Patients were evaluated at 6 weeks and 6 months after the procedure, and ultrasound studies were performed both before and at 2 to 6 months after the procedure. Results: Of 35 patients, 29 (83%) went home on the day of the procedure, whereas 6 were observed overnight. Three (9%) patients required admission within 1 week. Of 26 patients, 24 (92%) were satisfied with the reduction of bleeding, and 14 of 18 (78%) were satisfied with the reduction in pressure symptoms. The mean decrease in uterine volume was 36%, and the mean decrease in the size of the dominant fibroid was 49%. Conclusions: Uterine artery embolization for the treatment of uterine fibroids might be done on an outpatient basis with a low rate of same-day admissions and delayed admissions. Patient satisfaction was high, and uterine artery embolization might become an accepted option for the treatment of uterine fibroids. (Am J Obstet Gynecol 2001;184:1556-63.)

Uterine artery embolization for fibroids

Uterine artery embolization for fibroids

Successful Embolization of Collaterals from the Ovarian Artery during Uterine Artery Embolization for Fibroids: A Case Report

UTERINE artery embolization (UAE) (also known as uterine fibroid embolization) as a definitive treatment for symptomatic uterine leiomyomata was first reported in 1995 ( 1 Ravina JH Herbreteau D Ciraru-Vigneron N et al. Arterial embolisation to treat uterine myomata. Lancet. 1995; 346: 671-672 Abstract PubMed Google Scholar ). While this and subsequent reports have shown great promise for the technique, clinical failure has been seen in as many as 20% of patients ( 2 Ravina JH Bouret JM Ciraru-Vigneron N et al. Recourse to particular arterial embolization in the treatment of some uterine leiomyoma. Bull Acad Natl Med. 1997; 181: 233-243 PubMed Google Scholar , 3 Goodwin SC Vedantham S McLucas B et al. Preliminary experience with uterine artery embolization for uterine fibroids. JVIR. 1997; 8: 517-526 Abstract Full Text PDF Scopus (326) Google Scholar , 4 Worthington-Kirsch RL Popky GL Hutchins Jr, FL Uterine arterial embolization for the management of leiomyomas: quality-of-life assessment and clinical response. Radiology. 1998; 208: 625-629 PubMed Google Scholar , 5 Spies JB Scialli AR Jha RC et al. Initial results from uterine fibroid embolization for symptomatic leiomyomata. JVIR. 1999; 10: 1149-1157 Abstract Full Text PDF Scopus (259) Google Scholar , 6 Goodwin SC McLucas B Lee M et al. Uterine artery embolization for the treatment of uterine leiomyomata midterm results. JVIR. 1999; 10: 1159-1165 Abstract Full Text PDF Scopus (407) Google Scholar , 7 Hutchins Jr, FL Worthington-Kirsch R Berkowitz RP Selective uterine artery embolization as primary treatment for symptomatic leiomyomata uteri. J Am Assoc Gynecol Laparosc. 1999; 6: 279-284 Abstract Full Text PDF PubMed Scopus (237) Google Scholar ). Among that group have been women undergoing unilateral embolization or having arterial supply to their fibroids from sources other than the uterine artery ( 3 Goodwin SC Vedantham S McLucas B et al. Preliminary experience with uterine artery embolization for uterine fibroids. JVIR. 1997; 8: 517-526 Abstract Full Text PDF Scopus (326) Google Scholar , 7 Hutchins Jr, FL Worthington-Kirsch R Berkowitz RP Selective uterine artery embolization as primary treatment for symptomatic leiomyomata uteri. J Am Assoc Gynecol Laparosc. 1999; 6: 279-284 Abstract Full Text PDF PubMed Scopus (237) Google Scholar , 8 Nikolic B Spies JB Abbara S Goodwin S Ovarian artery supply of uterine fibroids as a cause of treatment failure after uterine artery embolization: a case report. JVIR. 1999; 10: 1167-1170 Abstract Full Text PDF Scopus (103) Google Scholar ). This report describes a patient in whom the right ovarian artery provided the dominant arterial supply to a uterine fibroid. These collateral branches were selectively embolized via the ovarian artery with use of a microcatheter technique, giving satisfactory clinical and anatomic results.

Preliminary Experience With Uterine Artery Embolization for Uterine Fibroids

Preliminary Experience With Uterine Artery Embolization for Uterine Fibroids

Preliminary Experience with Uterine Artery Embolization for Uterine Fibroids

To evaluate the potential usefulness of transcatheter uterine artery embolization as a treatment for fibroid-related vaginal bleeding and pelvic pain refractory to hormonal therapy and myomectomy. Eleven patients (aged 27-55 years; mean, 44.2 years; none desiring future pregnancy) with refractory vaginal bleeding and/or chronic pelvic pain related to uterine leiomyomata underwent uterine artery embolization with use of polyvinyl alcohol (PVA) particles. Clinical improvement was assessed by detailed questionnaire at 2-9 months (mean, 5.8 months) after the procedure. Sonographic measurements of the uterus and dominant masses were obtained before and at 2 months after the procedure. All 11 patients underwent technically successful embolization. Eight of nine women who completed the follow-up questionnaire reported noticeable symptomatic improvement, including three women with complete resolution of symptoms. One woman (the only patient undergoing unilateral embolization) exhibited no clinical response. Another patient developed endometritis and pyometra 3 weeks after the procedure, necessitating hysterectomy. Large reductions in uterine volume (average, 40%) and dominant fibroid size (average, 60%-65%) were sonographically demonstrated. Uterine artery embolization represents a promising new method of treating fibroid-related menorrhagia and pelvic pain. Further investigation will be required to assess clinical response and durability, identify appropriate candidates, and define the optimal angiographic technique and PVA particle size.