Outcome of Uterine Embolization and Hysterectomy for Leiomyomas: Results of a Multicenter Study

Spies, James B.; Cooper, Jay M.; Worthington-Kirsch, Robert L.; Lipman, John C.; Mills, Benjie B.; Bennetati, James F.

doi:10.1097/01.ogx.0000143865.73142.25

Cited by 27 publications

(24 citation statements)

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“…O tratamento do leiomioma uterino por embolização arterial vem sendo realizado há mais de 15 anos, estando consagrado como mais uma opção terapêutica para esta enfermidade 7 . Este procedimento proporciona ótimo resultado em relação ao controle dos sintomas (alterações menstruais, algia pélvica e sintomas compressivos) e uma signifi cativa redução nos volumes do útero e dos miomas.…”

Section: Discussionunclassified

Gravidez e parto após embolização arterial para tratamento de leiomioma uterino

Bonduki

Gonçalves

Yokohama

et al. 2006

Rev. Bras. Ginecol. Obstet.

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RESUMOObjetivo: Analisar a evolução da gestação e partos após tratamento de leiomioma uterino por embolização das artérias uterinas. Métodos: Foram incluídas na avaliação inicial 112 pacientes submetidas a embolização de artérias uterinas para tratamento de mioma uterino. Destas, somente nove desejavam o tratamento conservador para manter a capacidade reprodutiva. Este procedimento foi indicado para estas nove pacientes, pois elas não eram susceptíveis ao tratamento conservador cirúrgico. Submeteram-se a embolização das artérias uterinas com partículas de álcool polivinílico ou embosferas com diâmetro de 500 a 700 µm e evoluíram sem intercorrências. Resultados: Durante o acompanhamento dessas nove pacientes houve boa resposta clínica, com redução signifi cativa no volume do útero e dos miomas. Dessas nove, quatro engravidaram, sendo que duas tiveram abortamento precoce e duas evoluíram normalmente até o fi nal da gestação com parto a termo, sendo um deles gemelar. Conclusão: A embolização de artérias uterinas é uma opção para o tratamento de miomas uterinos e apresenta bons resultados clínicos e anatômicos, permitindo manter a capacidade reprodutiva. PALAVRAS-CHAVE:Mioma; Neoplasias uterinas; Leiomioma/terapia; Embolização terapêutica/métodos; Fertilidade; Gravidez ABSTRACT Purpose: To analyze gestation evolution and deliveries after myoma treatment by embolization of the uterine arteries. Methods: In the initial evaluation, 112 patients submitted to embolization of uterine arteries were included for treatment of myoma. From those, only nine wanted to be submitted to conservative treatment in order to keep their reproductive capacity. This procedure was indicated to the nine patients, since they were not susceptible to a conservative surgical treatment. They were submitted to embolization of the uterine arteries with particles of polyvinyl alcohol or embospheres with diameters ranging from 500 to 700 µm, and they have evolved without intercurrence. Results: During the follow-up of these patients, there was a good clinical response with signifi cant reduction in the uterus and myoma volumes. Four of them got pregnant, two had an early abortion and two evolved normally till the end of gestation with a term delivery. One of these had twins. Conclusion: Embolization of the uterine arteries is an option for the treatment of uterine myoma, and presents good clinical and anatomical results, allowing patients to preserve their reproductive capacity.

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Section: Discussionunclassified

Gravidez e parto após embolização arterial para tratamento de leiomioma uterino

Bonduki

Gonçalves

Yokohama

et al. 2006

Rev. Bras. Ginecol. Obstet.

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“…The advantages of UAE over hysterectomy for symptomatic uterine fibroids include the following: uterine preservation; reduced length of hospitalisation; the avoidance of the need for a general anaesthetic; and a lower procedural complication rate and shorter procedural time with quicker recovery. 5,6 In addition, UAE has been shown to be more cost effective than both myomectomy and hysterectomy. 7 Observational studies have shown a significant reduction in symptoms of menorrhagia (84 -90%), pressure effects and pain (79 -91%) and a substantial reduction in uterine volume (50 -60%).…”

Section: Discussionmentioning

confidence: 99%

Uterine artery embolisation for massive uterine fibroids in the presence of submassive pulmonary emboli

Boos

Calver

Moors

et al. 2005

BJOG

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Case reportA 46-year-old woman was admitted to our hospital with acute shortness of breath and pre-syncope. She had known massive uterine fibroids with a history of menorrhagia and dysmenorrhoea, and had been awaiting total abdominal hysterectomy and bilateral salpingo-oophorectomy. She had no past or family history of venous thromboembolism (VTE). She was an ex-smoker with a 16-pack/year smoking history.On examination, she looked unwell, was sweaty and clammy, but apyrexial. Her heart rate was 130 per minute and her blood pressure was 140/95 mmHg. She was tachypnoeic with a respiratory rate of 28 breaths per minute; however, her chest was clear. Abdominal examination revealed an enormous uterus, equivalent to the size of a 30-week pregnancy. There was no clinical evidence of deep vein thrombosis (DVT).She was hypoxic: oxygen saturation on air was 88%; arterial blood gas measurement on 100% oxygen -pH 7.4, PO 2 29.0 mmHg, PCO 2 3.5 mmHg, bicarbonate 18.5 mmol/L, base excess of À7.5 mol/L. Her full blood count revealed a microcytic anaemia with a mean cellular volume of 67.9 fl (normal: 81 -99 fl) and haemoglobin of 9.4 g/dL (normal: 12.0-15.0 g/L). Her D-dimer was significantly elevated at 1.7 Ag/mL (normal: <0.5 Ag/mL). Other blood tests including renal profile, liver function, thyroid function, C-reactive protein and clotting profile were all within normal limits.Her 12 lead electrocardiogram demonstrated sinus rhythm with right bundle branch block and T wave inversion in V1-3 with classic 'S 1 Q III T III ' changes. Her Chest X-ray showed blunting of the basal pulmonary arteries particularly on the right.Transthoracic echocardiography findings were consistent with submassive pulmonary embolism: the left ventricular size and function was normal; the right ventricle was dilated with moderately impaired systolic function; the right atrium was also dilated; the inferior vena cava was distended and failed to collapse with inspiration; the estimated right ventricular systolic pressure was 50 mmHg. A contrast CT pulmonary angiogram revealed occlusive thrombus in the proximal basal left and mid and basal right pulmonary arteries.She was initially managed with aggressive fluid resuscitation and was commenced on intravenous unfractionated heparin (target APTT ratio of 2.0 -3.0). On day 3 she began to heavily menstruate and required a total of nine units of blood over the ensuing 10 days. She was given subcutaneous Zoladex and 30 mg TDS provera to reduce her menstrual blood loss.On day 13 she underwent iliac venography and inferior cavography with insertion of a temporary IVC filter. No free intravascular thrombus was seen in either common iliac vein or within the IVC. There was however significant compression on all three of these veins. Immediately following this, she underwent uterine artery embolisation (UAE). At the time of UAE, her uterus and dominant fibroid measured 3800 and 3220 mL, respectively. Two weeks post-UAE her caval filter was removed, via a jugular route, without complication. A follow up pelvic MRI, ...

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“…Reductions in quality of life due to complications have been estimated from the literature. [15][16][17] This study assumes an National Health Service (NHS) perspective. Costs to the NHS include initial and subsequent Zowall et al…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Magnetic Resonance-Guided Focused Ultrasound Surgery for Treatment of Uterine Fibroids

Zowall

Cairns

Brewer

et al. 2008

Obstetrical &Amp; Gynecological Survey

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Objective To estimate the cost-effectiveness of a treatment strategy for symptomatic uterine fibroids, which starts with Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) as compared with current practice comprising uterine artery embolisation, myomectomy and hysterectomy.Design Cost-utility analysis based on a Markov model.Setting National Health Service (NHS) Trusts in England and Wales.Population Women for whom surgical treatment for uterine fibroids is being considered.Methods The parameters of the Markov model of the treatment of uterine fibroids are drawn from a series of clinical studies of MRgFUS, and from the clinical effectiveness literature. Healthrelated quality of life is measured using the 6D. Costs are estimated from the perspective of the NHS. The impact of uncertainty is examined using deterministic and probabilistic sensitivity analysis. Main outcome measures Incremental cost-effectiveness measured by cost per quality-adjusted life-year (QALY) gained.Results The base-case results imply a cost saving and a small QALY gain per woman as a result of an MRgFUS treatment strategy. The cost per QALY gained is sensitive to cost of MRgFUS relative to other treatments, the age of the woman and the nonperfused volume relative to the total fibroids volume.Conclusions A treatment strategy for symptomatic uterine fibroids starting with MRgFUS is likely to be cost-effective.Keywords Cost-utility analysis, focused ultrasound surgery, uterine fibroids.Please cite this paper as: Zowall H, Cairns J, Brewer C, Lamping D, Gedroyc W, Regan L. Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids. BJOG 2008;115:653-662.

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Outcome of Uterine Embolization and Hysterectomy for Leiomyomas: Results of a Multicenter Study

Cited by 27 publications

References 0 publications

Gravidez e parto após embolização arterial para tratamento de leiomioma uterino

Gravidez e parto após embolização arterial para tratamento de leiomioma uterino

Uterine artery embolisation for massive uterine fibroids in the presence of submassive pulmonary emboli

Cost-Effectiveness of Magnetic Resonance-Guided Focused Ultrasound Surgery for Treatment of Uterine Fibroids

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