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Uterine artery embolization

August 29, 2023

Uterine artery embolization is a procedure in which an interventional radiologist uses a catheter to deliver small particles that block the blood supply to the uterine body. The procedure is done for the treatment of uterine fibroids and adenomyosis.[1][2] This minimally invasive procedure is commonly used in the treatment of uterine fibroids and is also called uterine fibroid embolization.

Uterine artery embolization
Arteries of the female reproductive tract (posterior view): uterine artery, ovarian artery and vaginal arteries.
SpecialtyInterventional radiology
[edit on Wikidata]

Medical uses Edit

Uterine artery embolization is used to treat bothersome bulk-related symptoms or abnormal or heavy uterine bleeding due to uterine fibroids or for the treatment of adenomyosis. Fibroid size, number, and location are three potential predictors of a successful outcome.[3][4][5]

Long-term patient satisfaction outcomes are similar to that of surgery.[6] There is tentative evidence that traditional surgery may result in better fertility.[6] Uterine artery embolization also appears to require more repeat procedures than if surgery was done initially.[6]

It has shorter recovery times.[7] Uterine artery embolization is thought to work because uterine fibroids have abnormal vasculature together with aberrant responses to hypoxia (inadequate oxygenation to tissues).[8]

Uterine artery embolization can also be used to control heavy uterine bleeding for reasons other than fibroids, such as postpartum obstetrical hemorrhage.[9] and adenomyosis.

According to the American Journal of Gynecology, uterine artery embolization costs 12% less than hysterectomy and 8% less than myomectomy.[10]

Adverse effects Edit

The rate of serious complications is comparable to that of myomectomy or hysterectomy. The advantage of somewhat faster recovery time is offset by a higher rate of minor complications and an increased likelihood of requiring surgical intervention within two to five years of the initial procedure.[7]

Complications include the following:

  • Death from embolism, or sepsis (the presence of pus-forming or other pathogenic organisms, or their toxins, in the blood or tissues) resulting in multiple organ failure[11]
  • Infection from tissue death of fibroids, leading to endometritis (infection of the uterus) resulting in lengthy hospitalization for administration of intravenous antibiotics[12]
  • Misembolization from microspheres or polyvinyl alcohol particles flowing or drifting into organs or tissues where they were not intended to be, causing damage to other organs or other parts of the body[13] such as ovaries, bladder, rectum, and rarely small bowel, uterus, vagina, and labia.[14]
  • Loss of ovarian function, infertility,[15] and loss of orgasm[citation needed]
  • Failure – continued fibroid growth, regrowth within four months[citation needed]
  • Menopause – iatrogenic, abnormal, cessation of menstruation and follicle stimulating hormones elevated to menopausal levels[16]
  • Post-embolization syndrome – characterized by acute and/or chronic pain, fevers, malaise, nausea, vomiting and severe night sweats; foul vaginal odor coming from infected, necrotic tissue which remains inside the uterus; hysterectomy due to infection, pain or failure of embolization[17]
  • Severe, persistent pain, resulting in the need for morphine or synthetic narcotics[18]
  • Hematoma,[14] blood clot at the incision site; vaginal discharge containing pus and blood, bleeding from incision site, bleeding from vagina, fibroid expulsion (fibroids pushing out through the vagina), unsuccessful fibroid expulsion (fibroids trapped in the cervix causing infection and requiring surgical removal),[citation needed] life-threatening allergic reaction to the contrast material,[14] and uterine adhesions[citation needed]

Procedure Edit

The procedure is performed by an interventional radiologist under conscious sedation.[14] Access is commonly through the radial[citation needed] or femoral artery via the wrist or groin,[14] respectively. After anesthetizing the skin over the artery of choice, the artery is accessed by a needle puncture using Seldinger technique.[14] An access sheath and guidewire are then introduced into the artery. In order to select the uterine vessels for subsequent embolization, a guiding catheter is commonly used and placed into the uterine artery under X-ray fluoroscopy guidance. Once at the level of the uterine artery an angiogram with contrast is performed to confirm placement of the catheter and the embolizing agent (spheres or beads) is released. Blood flow to the fibroid will slow significantly or cease altogether, causing the fibroid to shrink. This process can be repeated for as many arteries as are supplying the fibroid. This is done bilaterally from the initial puncture site as unilateral uterine artery embolizations have a high risk of failure. With both uterine arteries occluded, abundant collateral circulation prevents uterine necrosis, and the fibroids decrease in size and vascularity as they receive the bulk of the embolization material. The procedure can be performed in a hospital, surgical center or office setting and commonly take no longer than an hour to perform. Post-procedurally if access was gained via a femoral artery puncture an occlusion device can be used to hasten healing of the puncture site and the patient is asked to remain with the leg extended for several hours but many patients are discharged the same day with some remaining in the hospital for a single day admission for pain control and observation. If access was gained via the radial artery the patient will be able to get off the table and walk out immediately following the procedure. The procedure is not a surgical intervention, and allows the uterus to be kept in place, avoiding many of the associated surgical complications.[citation needed]

References Edit

  1. ^ Siskin GP, Tublin ME, Stainken BF, et al. (2001). "Uterine artery embolization for the treatment of adenomyosis: clinical response and evaluation with MR imaging". American Journal of Roentgenology. 177 (2): 297–302. doi:10.2214/ajr.177.2.1770297. PMID 11461849.
  2. ^ Chen C, Liu P, Lu J, et al. [Uterine arterial embolization in the treatment of adenomyosis]. Zhonghua Fu Chan Ke Za Zhi 2002; 37:77.
  3. ^ Spies JB, Roth AR, Jha RC, et al. (2002). "Leiomyomata treated with uterine artery embolization: factors associated with successful symptom and imaging outcome". Radiology. 222 (1): 45–52. doi:10.1148/radiol.2221010661. PMID 11756703.
  4. ^ Pelage JP, Walker WJ, Le Dref O, et al. (2001). "Treatment of uterine fibroids". Lancet. 357 (9267): 1530. doi:10.1016/s0140-6736(00)04683-3. PMC 5267678. PMID 11383541.
  5. ^ Katsumori T, Nakajima K, Mihara T (2003). "Is a large fibroid a high-risk factor for uterine artery embolization?". American Journal of Roentgenology. 181 (5): 1309–1314. doi:10.2214/ajr.181.5.1811309. PMID 14573425.
  6. ^ a b c Gupta, JK; Sinha, A; Lumsden, MA; Hickey, M (26 December 2014). "Uterine artery embolization for symptomatic uterine fibroids". The Cochrane Database of Systematic Reviews. 12 (12): CD005073. doi:10.1002/14651858.CD005073.pub4. PMID 25541260.
  7. ^ a b Gupta, Janesh K.; Sinha, Anju; Lumsden, M. A.; Hickey, Martha (2014-12-26). "Uterine artery embolization for symptomatic uterine fibroids". The Cochrane Database of Systematic Reviews (12): CD005073. doi:10.1002/14651858.CD005073.pub4. ISSN 1469-493X. PMID 25541260.
  8. ^ Tal, R.; Segars, J. H. (2013). "The role of angiogenic factors in fibroid pathogenesis: potential implications for future therapy". Human Reproduction Update. 20 (2): 194–216. doi:10.1093/humupd/dmt042. ISSN 1355-4786. PMC 3922145. PMID 24077979.
  9. ^ Management of severe postpartum haemorrhage by uterine artery embolization
  10. ^ Al-Fozan, Haya; Dufort, Joanne; Kaplow, Marilyn; Valenti, David; Tulandi, Togas (November 2002). "Cost analysis of myomectomy, hysterectomy, and uterine artery embolization". American Journal of Obstetrics and Gynecology. 187 (5): 1401–1404. doi:10.1067/mob.2002.127374. PMID 12439538.
  11. ^ Vashisht A, Studd JW, Carey AH (2000). "Fibroid Embolisation: A Technique Not Without Significant Complications". British Journal of Obstetrics and Gynaecology. 107 (9): 1166–1170. doi:10.1111/j.1471-0528.2000.tb11119.x. PMID 11002964. S2CID 12959753.
  12. ^ de Block S, de Bries C, Prinssen HM (2003). "Fatal Sepss after Uterine Artery Embolization with Microspheres". Journal of Vascular and Interventional Radiology. 14 (6): 779–783. doi:10.1097/01.rvi.0000079988.80153.61. PMID 12817046.
  13. ^ Dietz DM, Stahfeld KR, Bansal SK (2004). "Buttock Necrosis After Uterine Artery Embolization". Obstetrics & Gynecology. 104 (Supplement): 1159–1161. doi:10.1097/01.AOG.0000141567.25541.26. PMID 15516436. S2CID 39409507.
  14. ^ a b c d e f Rand, Thomas; Patel, Rafiuddin; Magerle, Wolfgang; Uberoi, Raman (December 2020). "CIRSE standards of practice on gynaecological and obstetric haemorrhage". CVIR Endovascular. 3 (1): 85. doi:10.1186/s42155-020-00174-7. ISSN 2520-8934. PMC 7695782. PMID 33245432.
  15. ^ Robson S, Wilson K, David M (1999). "Pelvic Sepsis Complicating Embolization of a Uterine Fibroid". The Australian and New Zealand Journal of Obstetrics and Gynaecology. 39 (4): 516–517. doi:10.1111/j.1479-828X.1999.tb03150.x. PMID 10687781. S2CID 19991414.
  16. ^ Walker WJ, Pelage JP, Sutton C (2002). "Fibroid Embolization". Clinical Radiology. 57 (5): 325–331. doi:10.1053/crad.2002.0945. PMID 12014926.
  17. ^ Common AA, Mocarski E, Kolin A (2001). "Leiomyosarcoma". Journal of Vascular and Interventional Radiology. 12 (12): 1449–1452. doi:10.1016/s1051-0443(07)61708-4. PMID 11742024.
  18. ^ Soulen MC, Fairman RM, Baum R (2000). "Embolization of the Internal Iliac Artery: Still More to Learn". Journal of Vascular and Interventional Radiology. 11 (5): 543–545. doi:10.1016/S1051-0443(07)61604-2. PMID 10834483.

External links Edit

August 29, 2023
uterine, artery, embolization, procedure, which, interventional, radiologist, uses, catheter, deliver, small, particles, that, block, blood, supply, uterine, body, procedure, done, treatment, uterine, fibroids, adenomyosis, this, minimally, invasive, procedure. Uterine artery embolization is a procedure in which an interventional radiologist uses a catheter to deliver small particles that block the blood supply to the uterine body The procedure is done for the treatment of uterine fibroids and adenomyosis 1 2 This minimally invasive procedure is commonly used in the treatment of uterine fibroids and is also called uterine fibroid embolization Uterine artery embolizationArteries of the female reproductive tract posterior view uterine artery ovarian artery and vaginal arteries SpecialtyInterventional radiology edit on Wikidata Contents 1 Medical uses 2 Adverse effects 3 Procedure 4 References 5 External linksMedical uses EditUterine artery embolization is used to treat bothersome bulk related symptoms or abnormal or heavy uterine bleeding due to uterine fibroids or for the treatment of adenomyosis Fibroid size number and location are three potential predictors of a successful outcome 3 4 5 Long term patient satisfaction outcomes are similar to that of surgery 6 There is tentative evidence that traditional surgery may result in better fertility 6 Uterine artery embolization also appears to require more repeat procedures than if surgery was done initially 6 It has shorter recovery times 7 Uterine artery embolization is thought to work because uterine fibroids have abnormal vasculature together with aberrant responses to hypoxia inadequate oxygenation to tissues 8 Uterine artery embolization can also be used to control heavy uterine bleeding for reasons other than fibroids such as postpartum obstetrical hemorrhage 9 and adenomyosis According to the American Journal of Gynecology uterine artery embolization costs 12 less than hysterectomy and 8 less than myomectomy 10 Adverse effects EditThe rate of serious complications is comparable to that of myomectomy or hysterectomy The advantage of somewhat faster recovery time is offset by a higher rate of minor complications and an increased likelihood of requiring surgical intervention within two to five years of the initial procedure 7 Complications include the following Death from embolism or sepsis the presence of pus forming or other pathogenic organisms or their toxins in the blood or tissues resulting in multiple organ failure 11 Infection from tissue death of fibroids leading to endometritis infection of the uterus resulting in lengthy hospitalization for administration of intravenous antibiotics 12 Misembolization from microspheres or polyvinyl alcohol particles flowing or drifting into organs or tissues where they were not intended to be causing damage to other organs or other parts of the body 13 such as ovaries bladder rectum and rarely small bowel uterus vagina and labia 14 Loss of ovarian function infertility 15 and loss of orgasm citation needed Failure continued fibroid growth regrowth within four months citation needed Menopause iatrogenic abnormal cessation of menstruation and follicle stimulating hormones elevated to menopausal levels 16 Post embolization syndrome characterized by acute and or chronic pain fevers malaise nausea vomiting and severe night sweats foul vaginal odor coming from infected necrotic tissue which remains inside the uterus hysterectomy due to infection pain or failure of embolization 17 Severe persistent pain resulting in the need for morphine or synthetic narcotics 18 Hematoma 14 blood clot at the incision site vaginal discharge containing pus and blood bleeding from incision site bleeding from vagina fibroid expulsion fibroids pushing out through the vagina unsuccessful fibroid expulsion fibroids trapped in the cervix causing infection and requiring surgical removal citation needed life threatening allergic reaction to the contrast material 14 and uterine adhesions citation needed Procedure EditThe procedure is performed by an interventional radiologist under conscious sedation 14 Access is commonly through the radial citation needed or femoral artery via the wrist or groin 14 respectively After anesthetizing the skin over the artery of choice the artery is accessed by a needle puncture using Seldinger technique 14 An access sheath and guidewire are then introduced into the artery In order to select the uterine vessels for subsequent embolization a guiding catheter is commonly used and placed into the uterine artery under X ray fluoroscopy guidance Once at the level of the uterine artery an angiogram with contrast is performed to confirm placement of the catheter and the embolizing agent spheres or beads is released Blood flow to the fibroid will slow significantly or cease altogether causing the fibroid to shrink This process can be repeated for as many arteries as are supplying the fibroid This is done bilaterally from the initial puncture site as unilateral uterine artery embolizations have a high risk of failure With both uterine arteries occluded abundant collateral circulation prevents uterine necrosis and the fibroids decrease in size and vascularity as they receive the bulk of the embolization material The procedure can be performed in a hospital surgical center or office setting and commonly take no longer than an hour to perform Post procedurally if access was gained via a femoral artery puncture an occlusion device can be used to hasten healing of the puncture site and the patient is asked to remain with the leg extended for several hours but many patients are discharged the same day with some remaining in the hospital for a single day admission for pain control and observation If access was gained via the radial artery the patient will be able to get off the table and walk out immediately following the procedure The procedure is not a surgical intervention and allows the uterus to be kept in place avoiding many of the associated surgical complications citation needed References Edit Siskin GP Tublin ME Stainken BF et al 2001 Uterine artery embolization for the treatment of adenomyosis clinical response and evaluation with MR imaging American Journal of Roentgenology 177 2 297 302 doi 10 2214 ajr 177 2 1770297 PMID 11461849 Chen C Liu P Lu J et al Uterine arterial embolization in the treatment of adenomyosis Zhonghua Fu Chan Ke Za Zhi 2002 37 77 Spies JB Roth AR Jha RC et al 2002 Leiomyomata treated with uterine artery embolization factors associated with successful symptom and imaging outcome Radiology 222 1 45 52 doi 10 1148 radiol 2221010661 PMID 11756703 Pelage JP Walker WJ Le Dref O et al 2001 Treatment of uterine fibroids Lancet 357 9267 1530 doi 10 1016 s0140 6736 00 04683 3 PMC 5267678 PMID 11383541 Katsumori T Nakajima K Mihara T 2003 Is a large fibroid a high risk factor for uterine artery embolization American Journal of Roentgenology 181 5 1309 1314 doi 10 2214 ajr 181 5 1811309 PMID 14573425 a b c Gupta JK Sinha A Lumsden MA Hickey M 26 December 2014 Uterine artery embolization for symptomatic uterine fibroids The Cochrane Database of Systematic Reviews 12 12 CD005073 doi 10 1002 14651858 CD005073 pub4 PMID 25541260 a b Gupta Janesh K Sinha Anju Lumsden M A Hickey Martha 2014 12 26 Uterine artery embolization for symptomatic uterine fibroids The Cochrane Database of Systematic Reviews 12 CD005073 doi 10 1002 14651858 CD005073 pub4 ISSN 1469 493X PMID 25541260 Tal R Segars J H 2013 The role of angiogenic factors in fibroid pathogenesis potential implications for future therapy Human Reproduction Update 20 2 194 216 doi 10 1093 humupd dmt042 ISSN 1355 4786 PMC 3922145 PMID 24077979 Management of severe postpartum haemorrhage by uterine artery embolization Al Fozan Haya Dufort Joanne Kaplow Marilyn Valenti David Tulandi Togas November 2002 Cost analysis of myomectomy hysterectomy and uterine artery embolization American Journal of Obstetrics and Gynecology 187 5 1401 1404 doi 10 1067 mob 2002 127374 PMID 12439538 Vashisht A Studd JW Carey AH 2000 Fibroid Embolisation A Technique Not Without Significant Complications British Journal of Obstetrics and Gynaecology 107 9 1166 1170 doi 10 1111 j 1471 0528 2000 tb11119 x PMID 11002964 S2CID 12959753 de Block S de Bries C Prinssen HM 2003 Fatal Sepss after Uterine Artery Embolization with Microspheres Journal of Vascular and Interventional Radiology 14 6 779 783 doi 10 1097 01 rvi 0000079988 80153 61 PMID 12817046 Dietz DM Stahfeld KR Bansal SK 2004 Buttock Necrosis After Uterine Artery Embolization Obstetrics amp Gynecology 104 Supplement 1159 1161 doi 10 1097 01 AOG 0000141567 25541 26 PMID 15516436 S2CID 39409507 a b c d e f Rand Thomas Patel Rafiuddin Magerle Wolfgang Uberoi Raman December 2020 CIRSE standards of practice on gynaecological and obstetric haemorrhage CVIR Endovascular 3 1 85 doi 10 1186 s42155 020 00174 7 ISSN 2520 8934 PMC 7695782 PMID 33245432 Robson S Wilson K David M 1999 Pelvic Sepsis Complicating Embolization of a Uterine Fibroid The Australian and New Zealand Journal of Obstetrics and Gynaecology 39 4 516 517 doi 10 1111 j 1479 828X 1999 tb03150 x PMID 10687781 S2CID 19991414 Walker WJ Pelage JP Sutton C 2002 Fibroid Embolization Clinical Radiology 57 5 325 331 doi 10 1053 crad 2002 0945 PMID 12014926 Common AA Mocarski E Kolin A 2001 Leiomyosarcoma Journal of Vascular and Interventional Radiology 12 12 1449 1452 doi 10 1016 s1051 0443 07 61708 4 PMID 11742024 Soulen MC Fairman RM Baum R 2000 Embolization of the Internal Iliac Artery Still More to Learn Journal of Vascular and Interventional Radiology 11 5 543 545 doi 10 1016 S1051 0443 07 61604 2 PMID 10834483 External links Edithttp www merciafibroidclinic com Informational resource to help understand uterine fibroids and minimally invasive treatment options Uterine Fibroid Embolization Retrieved from https en wikipedia org w index php title Uterine artery embolization amp oldid 1160453861, wikipedia, wiki, book, books, library,

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