Uterine Fibroid Vascularization and Clinical Relevance to Uterine Fibroid Embolization

Abstract

Embolization has become a first-line treatment for symptomatic uterine fibroid tumors. Selective catheterization and embolization of both uterine arteries, which are the predominant source of blood flow to fibroid tumors in most cases, is the cornerstone of treatment. Although embolization for treatment of uterine fibroid tumors is widely accepted, great familiarity with the normal and variant pelvic arterial anatomy is needed to ensure the safety and success of the procedure. The uterine artery classically arises as a first or second branch of the anterior division of the internal iliac artery and is usually dilated in the presence of a uterine fibroid tumor. Angiography is used for comprehensive pretreatment assessment of the pelvic arterial anatomy; for noninvasive evaluation, Doppler ultrasonography, contrast material-enhanced magnetic resonance (MR) imaging, and MR angiography also may be used. After the uterine artery is identified, selective catheterization should be performed distal to its cervicovaginal branch. For targeted embolization of the perifibroid arterial plexus, injection of particles with diameters larger than 500 mum is generally recommended. Excessive embolization may injure normal myometrium, ovaries, or fallopian tubes and lead to uterine necrosis or infection or to ovarian failure. Incomplete treatment or additional blood supply to the tumor (eg, via an ovarian artery) may result in clinical failure. The common postembolization angiographic end point is occlusion of the uterine arterial branches to the fibroid tumor while antegrade flow is maintained in the main uterine artery.

IGF-1 and VEGF can be used as prognostic indicators for patients with uterine fibroids treated with uterine artery embolization

“…UAE treatment can induce ischemia and atrophy of the uterine fibroids (14) and is less invasive than the traditional surgical approach. Furthermore, UAE treatment can successfully preserve the uterus and maintain its normal physiological functions (15,16).…”

MRI traceability of superparamagnetic iron oxide nanoparticle-embedded chitosan microspheres as an embolic material in rabbit uterus

“…The goal of UFE is to produce hemorrhagic infarction of fibroids while maintaining endometrial and myometrial perfusion (12)(13)(14). Chitosan microspheres of both size ranges were able to deeply penetrate the inner uterus.…”

Preprocedural MRI and MRA in planning fibroid embolization

“…The anterior division gives rise to vesical, uterine, vaginal, and middle rectal arteries (visceral branches), obturator, inferior gluteal and internal pudendal arteries (parietal branches). The posterior division gives rise to iliolumbar, lateral sacral, and superior gluteal arteries (parietal branches) (23).…”

“…According to two series, encompassing 2012 patients undergoing UAE for symptomatic fibroids, five cases of unilateral congenital absence were detected (incidence of 0.24%) (25,26). When the uterine artery is absent, it is often replaced by the ipsilateral ovarian artery or may be replaced by small arterial pelvic branches (23). The congenital absence of both uterine arteries is very rare, with few case reports in the literature.…”

“…Both ovarian arteries arise from the abdominal aorta a few centimeters inferior to the renal arteries in 80%-90% of cases and have a characteristic corkscrew appearance (23).…”