Uterine artery embolisation

Abstract

A B S T R A C TPurpose of study: Fibroids are commonest benign tumour of the uterus. It presents with bleeding per vagina in most of the cases. Surgical treatment consists of myomectomy or hysterectomy with or without salpingo oophrectomy, with its inherent morbidity, prolonged hospital stay and psychosocial problems. Surgery is not the best option especially in unmarried and nullipara. Materials and methods:Thirty-five patients were subjected to uterine artery embolisation (UAE).Mean age was 35.51 ± 7.36 years. Two patients were suffering from advanced carcinoma of cervix, 32 had fibroid of uterus, one had endometriosis. Three patients were unmarried, three did not have any issue, three had associated haemodynamically significant cardiac disorders, one had polycystic renal disease, and one had hypernephroma. Four patients had multiple fibroids. The UAE was done through contralateral femoral artery puncture, bilaterally, with the help of Judkin's right coronary catheter. Ultrasound was repeated after 3 months. Results:The UAE was successful in all patients. Mean procedural time was 75 minutes. Hospital stay was 1 day only. Bleeding stopped in all 35 patients. One patient had recurrence of bleeding after 2 months and underwent surgery. Fibroids disappeared in eight patients, decreased in size by > 75% in 11 patients, and by 50-75% in six patients. Five patients did not report back with ultrasound. Two patients had normal delivery after UAE. Uterine fibroids are among the most common tumours of the female reproductive tract that occur in pre-menopausal women. In one study of women, 17-44 years of age undergoing tubal sterilisation, fibroids were found in 9% of whites and 16% of blacks. 1 The overall incidence has been reported to be 29.7/1000 patient/year, with considerable variation according to age. 2 In most studies, the peak incidence has been shown to occur among women who are in their early to mid-40s. 3,4 These are among the commonest causes of bleeding per vagina (P/V), among young females. Other causes of bleeding are ante-partum haemorrhage, post partum haemorrhage, dysfunctional uterine bleeding, and carcinoma of uterus and cervix. Conclusion Materials and methodsThirty-five non-randomised patients having excessive bleeding P/V were taken up for uterine artery embolisation (UAE). All the patients were evaluated in the Obstetrics and Gynaecology (OBG) Department of our college. All were subjected to clinical examination followed by ultrasonography. The patients suspected to have malignancy were subjected to endometrial biopsy. Those found to have malignancy were excluded. Patients found to have uterine fibroids or advanced stage of malignancy, not responding to chemotherapy/radiotherapy were taken up for UAE. The patients were explained the procedure and the possible complications. Only if they agree for the procedure, were they taken up for UAE.The procedure was done under local anaesthesia. Urinary bladder was catheterised. Bilateral femoral artery puncture

Uterine Artery Embolization for Fibroid: Pre and Post Procedure Size Response According to the Location

“…Failed therapy was reported among 2 females, one of which needed hysterectomy 6 weeks after the procedure and another requiring myomectomy 6 month after the procedure. All these findings were like what was reported by Bhardwaj R, et al [17]. Where authors found that fibroids disappeared in 8 out of 35 patients (22.9%), decreased in size by > 75% in 11 patients (31.4%), and by 50-75% in 6 patients (17.1%).…”

“…Exclusion criteria included: Uterine malignancy, severe allergy to iodinated contrast media, subserosal pedunculated fibroids, recent or ongoing pelvic inflammatory disease, adenomyosis cases, post-partum haemorrhage cases and presence any contraindication to interventional radiology. The targeted sample was 150 women to estimate an average reduction after embolization in the fibroid size by about 50%-75% [17], with precision of 7% at 95% confidence level. The sample women will be selected consecutively from those who attended the interventional radiology department during the study period.…”

Postabortal Bleeding: A Diagnostic Dilemma Resolved As Arteriovenous Malformation and Successfully Managed With Uterine Artery Embolization

“…If advancement past the vaginal or ovarian branch proves challenging, a micro coil is strategically placed at the origin of the unit [10]. When no significant opacification of the ovarian or vaginal team was observed, additional contrast was administered, followed by embolization at this catheter location [11]. The embolization procedure prioritized using particles first, followed by gel foam, with meticulous documentation of the volumes employed for each patient [12].…”

The influence of mifepristone to caspase 3 expression in adenomyosis

“…Clinical treatment options range from use of drug therapy, surgery, and uterine artery embolization (UAE). Treatment of AM uterine artery embolization is a novel approach that not only can ease the symptoms of dysmenorrhea, be able to retain the uterus, and have very clear short-term effects, but it still requires further in-depth evaluation regarding the recurrence rate, lesion vascular recanalization, and its influence on ovarian and reproductive function with longer-term studies [3,4].…”