Uterine artery embolisation for symptomatic fibroids: the effect of the large uterus on outcome

Prollius, A.; Vries, CS de; Loggenberg, E.; Plessis, Adré du; Nel, Mariëtte; Wessels, P

doi:10.1046/j.1471-0528.2003.00019.x

Cited by 34 publications

(23 citation statements)

References 8 publications

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“…16 Recent evidence has supported the efficacy of UAE in patients with massive uterine fibroids. 17 VTE is a very rarely reported complication of UAE affecting <0.1%, compared with a case prevalence of 1 -2% for hysterectomy. 13,18 In a recent study several surrogate markers of hypercoagulability were noted to increase post-UAE, suggesting that the procedure may induce a prothrombotic state.…”

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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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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“…Incorporation of UAE into routine clinical practice is widely endorsed and its role in heavy menstrual bleeding has been investigated recently. [13] Previously, a local study by Prollius et al [10] reported a mean reduction in uterine volume of 188 cm 3 in 51 women on follow-up at 12 months. There are limited local data on the long-term effect of UAE on symptomatic fibroid volume reduction using follow-up ultrasound imaging.…”

Section: Corresponding Author: Z Abdool (Zeelhaabdool@upacza)mentioning

confidence: 98%

“…A growing body of evidence supports the role of UAE in the treatment of symptomatic fibroids since its introduction by Ravina et al in 1995. [7][8][9][10][11][12] Since uterine fibroids receive their blood supply via end arteries and do not depend on collateral arteries, occlusion causes ischaemic necrosis and shrinkage (Fig. 2).…”

Section: Corresponding Author: Z Abdool (Zeelhaabdool@upacza)mentioning

confidence: 99%

The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital

et al. 2017

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RESEARCHBackground. Symptomatic uterine fibroids have a significant impact on women's health. Surgical intervention (myomectomy and hysterectomy) has been the mainstay of treatment. Women living with symptomatic uterine fibroids contribute significantly to a growing waiting list for surgery in South African public hospitals. Uterine artery embolisation (UAE) is a newer treatment option and has shown to be a minimally invasive, safe and effective alternative to surgery for such women. Objective. To evaluate the efficacy of UAE in women with symptomatic fibroid uterus. Methods. A prospective, observational, single-centre study of 51 women with symptomatic fibroid uterus who underwent UAE at Steve Biko Academic Hospital from February 2007 to November 2012. Results. A total of 51 women underwent UAE, 3 of whom were lost to follow-up. The remaining 48 women were followed for a mean duration of 43.6 months. There was a statistically significant reduction in the mean uterine and dominant myoma volumes, as well as improvement in the haemoglobin levels (p=0.001). The mean uterine and dominant fibroid volume reductions were 38% and 58%, respectively. Minor complications were reported in 19% of the women (fever, post-embolisation syndrome and vaginal fibroid passage were frequently reported complications). Reintervention (hysterectomy and gonadotropin-releasing hormone analogue use) was required in 35% of women. Conclusion. UAE has a good clinical effect on fibroid volume reduction. It is a treatment option that can be considered prior to major surgery in a select group of women with symptomatic fibroid uterus. The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital Uterine fibroids, also known as leiomyomas, are the most commonly occurring benign tumours of the uterus.[1] Symptomatic fibroid tumours have a major negative impact on the woman's quality of life and reproductive potential.[2] Great health disparities exist worldwide, with African black women experiencing earlier debilitating symptoms and more varied responses to treatment compared with their white counterparts. [3,4] The economic burden of treating symptomatic women is substantial. A recent total cost estimate (direct and indirect) by Soliman et al.[5] in a 2015 systematic review, ranges from USD11 717 -USD25 023 per patient per year after diagnosis or surgery. The true economic impact on South African (SA) public health systems is likely to be higher than the average estimates owing to high disease burden, limited access to treatment, longer waiting times for surgery, low hysterectomy uptake and the presence of severe symptoms among African black women. [4] Surgical management (hysterectomy or myomectomy) has traditionally been the mainstay of treatment (Fig. 1). Recently, umbilical artery embolisation (UAE) and magnetic resonanceguided high-intensity focused ultrasound (MR-g HIFU) has emerged as both an attractive and effective treatment.[6] UAE has proven to be safe and an e...

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“…6 This treatment has been shown to control both menorrhagia and symptoms caused by the bulk of fibroids in 85-90% of patients. 7,8 Complications are rare and include post-treatment sepsis, late infection of the endometrium or myometrium, severe ischemic injury to the uterus (1-2%), spontaneous passage of fibroid tissue and amenorrhea. 7,8 Initially, polyvinyl alcohol particles were used as the embolic agent, injected through catheters placed in the uterine arteries.…”

mentioning

confidence: 99%

“…7,8 Complications are rare and include post-treatment sepsis, late infection of the endometrium or myometrium, severe ischemic injury to the uterus (1-2%), spontaneous passage of fibroid tissue and amenorrhea. 7,8 Initially, polyvinyl alcohol particles were used as the embolic agent, injected through catheters placed in the uterine arteries. There were good results for symptom improvement, [9][10][11] but mechanical drawbacks were reported.…”

mentioning

confidence: 99%

Characterization of acrylic polyamide plastic embolization particles in vitro and in human tissue sections by light microscopy, infrared microspectroscopy and scanning electron microscopy with energy dispersive X-ray analysis

et al. 2006

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Vascular embolization is a well-established practice for the treatment of tumors and vascular lesions. Rounded beads (microspheres) of various materials (collagen, dextran and trisacryl-polymer-gelatin) were developed to solve problems encountered with earlier versions of embolic material. We performed histochemistry, Fourier transform infrared microspectroscopy and scanning electron microscopy with energy dispersive X-ray analysis on two uterine and one hepatic specimen with unidentified intravascular foreign material, and examined a reference embolization product for comparison. The hematoxylin and eosin stained tissue sections showed multiple foci with unidentified intravascular foreign material and fibrous obliteration of vessel lumens. Only one case had a clinical history of previous embolization but without specifying the material used. One case was submitted for identification of a 'parasite'. The material stained positively with Sirius red and mucicarmine, variably with Masson's trichrome stain and Movat pentachrome, and did not stain centrally with periodic acid Schiff with diastase. Infrared spectrophotometric analysis of the material from all three cases demonstrated the spectrum of acrylic polyamide plastic. A control sample of EmboGoldt exhibited infrared microspectroscopic spectra similar to the three tissue specimens. Analysis by scanning electron microscopy with energy dispersive X-ray analysis demonstrated some differences in elemental composition between the tissue sections and the selected reference material. To our knowledge, this is the first report of infrared spectrophotometric analysis with scanning electron microscopy with energy dispersive X-ray analysis of an acrylic polyamide plastic embolization product both in vitro and in human histologic tissue sections. In cases lacking appropriate clinical information, identification by these methods and/or a panel of special stains may assist pathologists unfamiliar with this material's light microscopic appearance.

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Uterine artery embolisation for symptomatic fibroids: the effect of the large uterus on outcome

Cited by 34 publications

References 8 publications

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

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

The impact of uterine artery embolisation on fibroid volume at 43.6 months in women with symptomatic fibroids at a tertiary-level hospital

Characterization of acrylic polyamide plastic embolization particles in vitro and in human tissue sections by light microscopy, infrared microspectroscopy and scanning electron microscopy with energy dispersive X-ray analysis

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