Uterine Artery Embolization For Treatment Research Articles

Technical success rate of uterine artery embolisation for treatment of uterine leiomyomas at the University of the Free State

The technical success rate of uterine artery embolisations at the Department of Diagnostic Radiology, University of the Free State (UFS) is reported. From November 1998 to July 2001, 67 women, aged 35 - 75 years, received uterine artery embolisation. The procedure was usually performed through a single 4-French sheath set which was introduced into the right femoral artery using a 4- French catheter and injecting PVC particles (150 - 550 micron). Embolisation was performed successfully in 85.5% of the women. The mean total fluoroscopy time was 16.8 minutes, ranging from 4.8 minutes to 47.3 minutes.

Three‐dimensional Color Doppler Sonography and Uterine Artery Arteriography of Fibroids

To assess the accuracy of three-dimensional color Doppler sonography and uterine artery arteriography in depicting changes in fibroid vascularity before and after embolization. Preembolization and postembolization three-dimensional color Doppler sonography and selective uterine artery arteriography were retrospectively compared in 15 patients who underwent uterine artery embolization for treatment of symptomatic fibroids. Three-dimensional color Doppler sonography was performed by using a scanner with color power angiographic imaging capability. Vascularity was quantified by using an estimation of power-weighted pixel density as described by our group in previously published studies. Uterine artery arteriography was performed by using a standard selective microcatheter embolization technique. For purposes of comparison, fibroids were classified as either hypervascular or hypovascular relative to myometrial vascularity before and minutes to several hours after uterine artery embolization. Changes in fibroid vascularity (i.e., from hypervascular to hypovascular) as depicted by three-dimensional color Doppler sonography were compared with those shown on uterine artery arteriography and classified as being in agreement or disagreement. In 13 (87%) of 15 patients there was agreement; in 2 (13%) of 15 there was disagreement. In both cases of disagreement, three-dimensional color Doppler sonography showed collateral flow not depicted by uterine artery arteriography The mean reduction in quantitated vascularity after uterine artery embolization was 44% (range, 19%-78%). Three-dimensional color Doppler sonography accurately depicts fibroid vascularity and in some cases can reveal collateral flow not depicted by uterine artery arteriography.

Leiomyomata treated with uterine artery embolization: factors associated with successful symptom and imaging outcome.

To determine whether baseline variables are associated with treatment success after uterine artery embolization for treatment of uterine leiomyoma. Two hundred consecutive patients who underwent uterine artery embolization at one institution were prospectively examined. Baseline clinical variables measured included age, race, prior oral contraceptive use or progesterone treatment, prior gonadotropin-releasing hormone agonist treatment, and prior births. Imaging parameters were baseline uterine volume, baseline leiomyoma volume and location, and number of leiomyomas. After treatment, follow-up imaging and questionnaire data were obtained at 3 and 12 months. Associations between baseline characteristics and outcome variables of interest were assessed by using linear regression, logistic regression, Pearson product moment correlation coefficients, and Kendal tau correlation coefficients, with adjustment for confounding variables when indicated. Regression models indicated that larger dominant leiomyoma volume was associated with a smaller percentage reduction in volume at 3 months (P =.03). A submucosal leiomyoma location was associated with a greater volume reduction at 3 months (P =.04), but this difference did not persist at 12 months (P =.09). The odds of reported menstrual bleeding improvement at 3 months were higher with a submucosal leiomyoma location (P =.04); however, this association was not statistically significant after adjustment (P =.07). The odds of improved bulk-related symptoms were not associated with leiomyoma volume change or location. Smaller baseline leiomyoma size and submucosal location are more likely to result in a positive imaging outcome. There are limited associations between other baseline parameters and either symptom change or imaging outcome.

Alternative treatment for symptomatic fibroids.

The present review discusses treatment options for symptomatic fibroids. Although the standard treatment of fibroids has been surgical hysterectomy, an increasing number of reports indicate that uterine artery embolization with preservation of the uterus is a promising alternative. Other surgical and medical approaches reported during the past year are also addressed. The review summarizes patient selection, contraindications, results, complications and future considerations. Complications following uterine artery embolization treatment for symptomatic fibroids have been minor in comparison with those following hysterectomy. Although patient satisfaction is good, none of the studies included control individuals and further studies are needed to optimize patient selection and to evaluate long-term results of treatment.

Aberrant uterine artery as a cause of uterine artery embolization treatment failure

Aberrant uterine artery as a cause of uterine artery embolization treatment failure

Uterine artery embolization in an undiagnosed uterine sarcoma

Background: Uterine sarcomas are rare malignancies that resemble benign uterine leiomyomata. Uterine artery embolization is offered increasingly for treatment of uterine leiomyomata, which might lead to embolization of undiagnosed uterine sarcoma. Case: A 52-year-old woman, gravida 7, para 6, with perimenopausal menometrorrhagia was diagnosed with uterine leiomyomata after physical examination and transvaginal ultrasound. An endometrial biopsy was negative for malignancy. After medical treatment was unsuccessful, she had uterine artery embolization. She then passed a piece of tissue from her vagina, the pathology report of which was necrotic high-grade sarcoma. During surgery we confirmed that the tumor was confined to the uterus. Conclusion: Uterine sarcoma cannot be diagnosed except by pathologic examination of a resected specimen. Women considering uterine artery embolization for treatment of apparent leiomyomata should be counseled on the risk of decreased survival by delaying diagnosis and treatment of uterine sarcoma.

A Single-Center Study Comparing Abdominal Myomectomy with Uterine Artery Embolization for Treatment of Myomas

A Single-Center Study Comparing Abdominal Myomectomy with Uterine Artery Embolization for Treatment of Myomas

A single-center study comparing abdominal myomectomy with uterine artery embolization for treatment of myomas

Purpose: To compare abdominal myomectomy (AM) with uterine artery embolization (UAE) for treatment of myomas with respect to objective and subjective outcomes. Methods: A retrospective chart review of patients who underwent AM (n = 36) and UAE (n = 73) over a 3-year period was done. Follow-up consisted of phone interviews with patients, who reported symptom changes on a six-point scale. Results were compared using the t test and the X 2 test, with P <0.05 as the statistical limit. Results: Although the UAE group was significantly older (45 versus 38), with a lower initial Hct (33 versus 36), the days hospitalized (0 versus 3), days requiring narcotics (2.5 versus 5.9), and days to normal activity (7.5 versus 35) were significantly lower. The AM group lost an average of 380 cc blood, while the UAE group had minimal blood loss. Both groups were similar in the preprocedure incidence of menorrhagia, pain, and pressure. On follow-up, the UAE group showed significant improvement in menorrhagia symptoms compared with the AM group, with no significant difference in improvement of other symptoms. Complications in the AM group (n = 7, 19.4%) included requirement for nonautologous blood transfusion (n = 2), wound infection, adhesions, readmission for ileus, chronic pelvic pain, and chronic incision pain. UAE patient complications (n = 3, 4.1%) included endometritis, readmission for pain, and transient leg numbness. Conclusion: UAE is a good alternative to AM, with fewer hospitalization days, less blood loss, quicker return to work, and fewer complications. Subjective symptom improvement resembled that of AM, with significantly better resolution of menorrhagia.

Transient ovarian failure: a complication of uterine artery embolization

Objective: To report a case of transient ovarian failure shortly after arterial embolization for treatment of uterine fibroids, followed by recovery of ovarian function. Design: Case report. Setting: A university-based hospital. Patient(s): A 49-year-old woman with menorrhagia and anemia secondary to uterine fibroids and refractory to medical management. The follicle-stimulating hormone (FSH) level on cycle day 3 before the procedure was 8.2 mIU/mL. Intervention(s): Bilateral uterine artery embolization for treatment of menorrhagia. Main Outcome Measure(s): Serum FSH level. Result(s): The patient developed amenorrhea and hot flashes 3 months after uterine artery embolization. Her serum FSH level at that time was 140.1 mIU/mL. Four months later, uterine bleeding resumed; her serum FSH level was 2.1 mIU/mL. Conclusion(s): Uterine artery embolization may hasten ovarian failure. This procedure should be reserved for women who have completed their child-bearing or are poor candidates for myomectomy. Patients should be counseled appropriately about the risk of possible ovarian failure.

Ovarian Failure after Uterine Artery Embolization for Treatment of Myomas

Uterine artery embolization (UAE) is an effective, safe, nonsurgical treatment for uterine myomas. Although menstrual irregularities and transient amenorrhea have occurred after UAE, these reports did not provide proper hormonal documentation of ovarian failure. Our patient experienced elevated follicle-stimulating hormone (FSH) levels and vasomotor symptoms (hot flushes) within 4 weeks after the procedure. To our knowledge, this is the first report in the literature of ovarian failure after UAE confirmed by comparing preprocedure FSH levels with postprocedure levels over 12 months.

Selective uterine artery embolization as primary treatment for symptomatic leiomyomata uteri

To analyze initial experience with uterine artery embolization for treatment of symptomatic leiomyomata. Prospective, longitudinal study (Canadian Task Force classification II-2). Private practice, university-affiliated hospital. Three hundred five women (age 26-52 yrs). Uterine artery embolization, performed over 2 years by a single radiologist working in collaboration with a single gynecology practice. Embolization was technically successful in 96% of patients. No major complications occurred. Average reduction in uterine volume was 48%. Control of menorrhagia was reported by 86% of patients at 3 months, 85% at 6 months, and 92% at 12 months after the procedure. Bulk symptoms were satisfactorily controlled in 64% of patients at 3 months, 77% at 6 months, and 92% at 12 months. Six women subsequently underwent hysterectomy and five had myomectomy. Uterine artery embolization appears to be a highly effective treatment for symptomatic uterine leiomyomata. Its impact on fertility and pregnancy remain to be investigated fully. (J Am Assoc Gynecol Laparosc 6(3):279-284, 1999)

Role of uterine artery embolization in treatment of uterine leiomyomata and severe menorrhagia in a private community hospital setting

Role of uterine artery embolization in treatment of uterine leiomyomata and severe menorrhagia in a private community hospital setting