Uterine artery embolization for the treatment of symptomatic myomas in Brazilian women

Sena-Martins, Maurício; Roteli-Martins, Cecília Maria; Tadini, Valdir; Souza, Gustavo; Kisilevzky, Néstor; Lazar, Felipe

doi:10.1590/s1516-31802003000500002

Cited by 8 publications

(8 citation statements)

References 24 publications

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“…A redução no volume médio do útero e/ou do mioma dominante após a EAU foram as variáveis mais pesquisadas nos artigos brasileiros (n=7, 63,6%). As reduções médias do volume uterino após EAU variaram de 52% a 27,4%, sendo encontradas 52% (KISILEVSTZ; MARTINS, 2003), 42,9% (NASSER et al, 2010), 41,6% (SENA-MARTINS et al, 2003), 35% (BERNARDO et al, 2011), 32,5% (KISILEVSKY, 2007), 32,3% (GHIARONI et al, 2013) e 27,4% (MESSINA et al). As reduções médias dos volumes dos miomas dominantes após a EAU foram de 40,5% (SENA MARTINS et al, 2003), 31,1% (GHIARONI et al, 2013) e 22% (BERNARDO et al, 2011).…”

Section: Resultsunclassified

Embolização Arterial Para Tratamento De Mioma Uterino: Uma Revisão Da Literatura.

HENRIQUE¹,

ROSSI²,

SCHNECKENBERG³

et al. 2015

Publ. Biologicas

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Miomas uterinos podem causar hemorragia intensa, dores e reduzida probabilidade de gravidez. A histerectomia ou miomectomia tem sido tradicionalmente a principal opção de tratamento, mas com risco de complicações. A embolização da artéria uterina é uma opção de tratamento mais recente. Este estudo objetivou fazer uma revisão sistemática da literatura até junho de 2015, sobre embolização arterial de mioma uterino, em estudos brasileiros, nas bases de dados SciELO e MEDLINE. Um total de 11 artigos foram identificados, todos da Região Sudeste. As 454 mulheres incluídas nos estudos tinham idade entre 22 a 56 anos. As reduções no volume médio do útero após a embolização da artéria uterina (variação de 52% a 27,4%) e/ou reduções do mioma predominante (variação de 40,5% a 22%) foram comparáveis à literatura internacional. Observou-se redução dos sintomas, melhora da qualidade de vida, preservação da função ovariana e, para aquelas submetidas à miomectomia posterior, diminuição do sangramento operatório, incisões menores e maior preservação do útero. Outros achados incluíram redução qualiquantitativa do colágeno nos miomas, redução da absorção de radiação pelo ovário e pele nas pacientes em novo protocolo de arteriografia e aumento do sinal endometrial nas imagens ponderadas em T2 e pós-contraste. Em 15 gestações pós-embolização, houve 14 nascimentos (um gemelar) e dois abortamentos precoces. Sintomas ou complicações após a embolização foram relatados. Em geral, o procedimento apresentou bons resultados nos estudos brasileiros. Como técnica relativamente recente, seria interessante a promoção de mais estudos com acompanhamento da evolução das pacientes em longo prazo.

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Section: Resultsunclassified

Embolização Arterial Para Tratamento De Mioma Uterino: Uma Revisão Da Literatura.

HENRIQUE¹,

ROSSI²,

SCHNECKENBERG³

et al. 2015

Publ. Biologicas

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“…Sena-Martins et al [9] reported 43.7% uterine volume reduction in 32 women followed up by TVPUS. The assessment of homogeneity in parameters such as uterine volume, spatial presentation of nodules, body mass index, race, smoking, parity, hor-…”

Section: Discussionmentioning

confidence: 97%

Gene Expression Analysis of Extracellular Matrix and Cytokines after Uterine Artery Embolization

Bernardo¹,

Bonetti²,

Silva³

et al. 2014

OJOG

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Arterial embolization of myomas (AEM) is an established option for the conservative treatment of uterine leio-myomas; it treats all present uterine nodules at once, is less invasive than other procedures and effective in controlling symptoms, and does not require long term hospitalizations. Nevertheless, the potential impact on endometrial morphological and functional outcomes after the procedure is still controversial based on reports of endometritis or eventual transient ischemia. This study evaluated endometrial reorganization in uterine leiomyoma patients, before and after AEM, through gene expression analyses of extracellular matrix and cytokines genes in the endometrial tissue. Eight patients with leiomyomas were evaluated before AEM and 6 months after. The examinations included transvaginal pelvic ultrasonography, dosing of the follicle-stimulating hormone, and endometrial biopsy during the second phase of the menstrual cycle. RNA was extracted from endometrial samples, cDNA was synthesized, and applied on PCR array™ plates to evaluate the expression of extracellular matrix (ECM) genes and cytokines and their receptors' genes (CYT). The ECM overexpressed genes were MMP (1, 3, 10, 11, and 14), CTGF1, ICAM1, TBHS1, ITGA2, ITGA3, ITGB3, COL7A1, COL12A, SPP1, and TNC; ADAMTS8 was underexpressed. The CYT overexpressed genes were SPP1, BCL6, CXCL12, IL-8, and CEBPB; CXCL13 and CCL21 were underexpressed. The ECM results showed overexpression of proteases that are responsible for dysfunctions in the ECM, and of genes responsible for adhesion and membrane components. The CYT results showed overexpression of chemokines responsible for endometrial repair, and underex-* Corresponding author. A. Bernardo et al. 936pression of cytokines involved in inflammatory processes in the endometrial tissue. AEM treatment did not negatively affect the endometrial function at 6 months after embolization. This study broadens the knowledge about using a procedure that is relevant to the treatment of leiomyomas and contributes to the establishment of future guidelines for the decision making process for physicians and patients.

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“…A second strong point is the fact that it is multicentric thus gathering heterogenic results that can be generalized to a greater scale. As a third point of discussion we will approach the idea of fertility post-RFVTA as this method preserves the uterus offering the possibility of future childbearing.A quick search will reveal a great number of articles about the operative outcomes: immediately after surgery (equipment feasibility, blood loss, length of hospital stay) [2], shortly after at 12 weeks [3] with focus on the size reduction of the tumors and its implications in reducing the main symptoms or at a 1 year follow-up [4] where the focus is again on the results of the technique. The patients' quality of life is either second placed or not mentioned.…”

mentioning

confidence: 99%

“…The patients' quality of life is either second placed or not mentioned. Often the new technique is praised and recommended to patients on the base of the limited data obtained from a short observation [3,4], leaving it to the later studies to prove the lack of long term efficacy [5]. The idea that comes to mind is one that we, in the medical world, often discuss: does the surgeon treat the disease or does (s) he treat the patient?…”

mentioning

confidence: 99%

“…A quick search will reveal a great number of articles about the operative outcomes: immediately after surgery (equipment feasibility, blood loss, length of hospital stay) [2], shortly after at 12 weeks [3] with focus on the size reduction of the tumors and its implications in reducing the main symptoms or at a 1 year follow-up [4] where the focus is again on the results of the technique. The patients' quality of life is either second placed or not mentioned.…”

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confidence: 99%

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The Endurance of Dr. Guido’s Team Should Motivate More Physicians

Craciunas¹

2014

Reprod Syst Sex Disord

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The uncommon diseases described in books are more fascinating for the majority of the medical personnel compred to the day-to-day pathologies they encounter in the clinic. The same goes for the public in our opinion. An example of such 'dull' medical condition is the uterine fibroid or myoma. As far as myomas are concerned, even though up to 80% of the women are affected, just 25% of them realize how deeply their lives are influenced by this condition when the symptoms become unbearable [1]. A sympathetic gynecologist sees beyond the great range of symptoms and imaging results by integrating the patients' quality of life in the equation, resulting into a perfect personalized treatment and optimized follow-up.This study was refreshing to read and really stands out from the multitude of other works regarding the treatment of myomas due to the teams perseverance with regards to the patients' postoperative quality of life. A second strong point is the fact that it is multicentric thus gathering heterogenic results that can be generalized to a greater scale. As a third point of discussion we will approach the idea of fertility post-RFVTA as this method preserves the uterus offering the possibility of future childbearing.A quick search will reveal a great number of articles about the operative outcomes: immediately after surgery (equipment feasibility, blood loss, length of hospital stay) [2], shortly after at 12 weeks [3] with focus on the size reduction of the tumors and its implications in reducing the main symptoms or at a 1 year follow-up [4] where the focus is again on the results of the technique. The patients' quality of life is either second placed or not mentioned. Often the new technique is praised and recommended to patients on the base of the limited data obtained from a short observation [3,4], leaving it to the later studies to prove the lack of long term efficacy [5]. The idea that comes to mind is one that we, in the medical world, often discuss: does the surgeon treat the disease or does (s) he treat the patient? Dr. Guido's team approaches a neutral and objective opinion about the radiofrequency volumetric ablation of uterine fibroids. The technique is outstanding of course, but in the present study it is modestly promoted just as a therapeutic option for myomas. It 'met the needs of the study patients' . There were no comparisons with any other treatment options made, however the authors stated, what we personally find to be a golden rule in medicine, that '[. ..] it is important to track the outcomes of new procedures to confirm the durability of the treatment'.Rarely do we personally find results of follow-ups after the study is completed. This study compares the 2-year follow-up to the 1-year results, emphasizing the impact that perseverance regarding patients monitoring has on evaluating a new technique. The 6 patients underwent re-intervention surgeries after 14 months making the success rate of the RFVTA 100% at 1-year and 95.2% at 2-years. This information benefits primarily the patients. By...

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Uterine artery embolization for the treatment of symptomatic myomas in Brazilian women

Cited by 8 publications

References 24 publications

Embolização Arterial Para Tratamento De Mioma Uterino: Uma Revisão Da Literatura.

Embolização Arterial Para Tratamento De Mioma Uterino: Uma Revisão Da Literatura.

Gene Expression Analysis of Extracellular Matrix and Cytokines after Uterine Artery Embolization

The Endurance of Dr. Guido’s Team Should Motivate More Physicians

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