Uterine Fibroids: Uterine Artery Embolization versus Abdominal Hysterectomy for Treatment—A Prospective, Randomized, and Controlled Clinical Trial

Pinto, Isabel; Chimeno, Paloma; Romo, Alicia; Paúl, Laura; Haya, Javier; Cal, Miguel A. de la; Bajo, J.M.

doi:10.1148/radiol.2262011716

Cited by 229 publications

(154 citation statements)

References 41 publications

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“…It is considered as a safe and simple procedure with only transient complications. Uterine artery embolization is usually indicated to treat postpartum hemorrhage (14) and as an alternative to hysterectomy or myomectomy for women with symptomatic uterine fibroids (15). In cervical pregnancy, a successful association of selective uterine artery embolization with surgical and pharmacological treatment is used by most authors (7-9).…”

Section: Discussionmentioning

confidence: 99%

Conservative treatment of a twin cervical pregnancy with uterine artery embolization

Farhat

Salah²,

Askri³

et al. 2008

Diagn Interv Radiol

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248C ervical pregnancy is a rare form of ectopic pregnancy, which accounts for about 0.1% of such pregnancies (1). The diagnosis of cervical pregnancy is difficult and commonly delayed. It is made in the majority of cases in the presence of massive blood loss, necessitating an emergency hysterectomy in about 50% of cases (2). Cervical pregnancy has a high morbidity potential because of hemorrhage. However, mortality has decreased because of early ultrasonographic diagnosis and new treatment options to prevent life-threatening bleeding.In this report, we present our successful experience with preoperative embolization of the uterine artery. Case reportA 41-year-old gravida 2 para 1 woman presented to the emergency department with amenorrhea for 11 weeks and painless vaginal spotting for 2 days. She was treated for threatened abortion by a progestative agent. Her obstetrical history was significant for a lower-segment cesarean section because of severe preeclampsia. She had no previous intrauterine procedures, pelvic inflammatory disease, or intrauterine devices. Her medical and surgical history were otherwise unremarkable.Four days after her initial visit, she presented to our obstetrical emergency service for persistence of painless vaginal spotting and dizziness. Clinical examination showed stable vital signs, and her abdomen was soft and nontender. Gynecological examination revealed a slightly enlarged uterus without adnexal masses. Vaginal examination revealed an anterior position of the cervix, which was extremely thin, with the external os closed; speculum examination showed a small amount of cervical bleeding. Hemoglobin was 12 g/dL and hematocrit was 34.2%.Transabdominal and transvaginal ultrasound (US) examinations confirmed the presence of a cervical twin pregnancy with two gestational sacs. One sac contained a live fetus with a 40 mm crown-rump length (CRL); the other contained a fetus with a CRL of 31 mm and no cardiac activity. Magnetic resonance imaging (MRI) was performed to improve diagnostic accuracy. It confirmed the cervical implantation of two gestational sacs and showed a fine cervical myometrium (Fig. 1).To preserve fertility, conservative treatment was proposed to the patient. Treatment was initiated by intraamniotic injection of potassium chloride guided by US to stop fetal heartbeat. Cardiac activity stopped immediately after injection. The following day, the patient underwent percutaneous catheterization of the femoral artery (5 F catheter) under local anesthesia. The selective uterine artery angiograms showed that the embryonic vessels were filled predominantly from the left side uterine artery (Fig. 2). We started by embolizing left uterine artery. Embolization was performed with resorbable particles mixed with diluted contrast material. This mixture was injected until the uterine arterial flow ABSTRACT Cervical pregnancy is a rare form of ectopic pregnancy. Its treatment has been described by different authors. We report our successful experience of a cervical twin pregnancy that was ...

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Section: Discussionmentioning

confidence: 99%

Conservative treatment of a twin cervical pregnancy with uterine artery embolization

Farhat

Salah²,

Askri³

et al. 2008

Diagn Interv Radiol

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“…To date, there have been four studies, one multi-center prospective (Spies, 2004a(Spies, , 2004b, one multi-center retrospective cohort (Dutton et al, 2007) and two randomized controlled trials ( RCTs ) ( Pinto et al, 2003), and the EMMY trial published in four papers (Hehenkamp, 2005 published that compared UAE with hysterectomy. In a third RCT, outcomes of UAE were compared with outcomes of a mixed group of hysterectomies and myomectomies (Edwards et al, 2007).…”

Section: Uae Compared To Surgerymentioning

confidence: 99%

Is Embolization Equal to Hysterectomy in Treating Uterine Fibroids?

Strinić¹

2012

Hysterectomy

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“…We calculated the percentage of reduction (with standard deviation) of the AUC as: z reduction of AUC ＝(AUC(pre)-AUC(post))×100/AUC(pre) (2) and that of volume as:…”

Section: Volume Measurementmentioning

confidence: 99%

“…Traditional treatments include hysterectomy or myomectomy; less invasive techniques, such as uterine artery embolization (UAE) and focused ultrasound (FUS), have recently been introduced. 2,3 Observations that maintenance and growth of uterineˆbroids require estrogen and that uterineˆbroids express estrogen and progesterone receptors led to the hypothesis that gonadotropinreleasing hormone analogue (GnRHa) might alleviateˆbroid-related symptoms. 4 Fibroid vasculature diminished signiˆcantly in patients treated with GnRHa.…”

Section: Introductionmentioning

confidence: 99%

Reduction in the Vascular Bed Volume of Uterine Fibroids after Hormonal Treatment: Evaluation with Dynamic Double-Echo R2* Imaging

et al. 2012

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Purpose: To demonstrate the reduction in vascular bed volume (VBV) of uterineˆbroids after administration of gonadotropin-releasing hormone analogue (GnRHa) using magnetic resonance (MR) imaging including dynamic double-echo R 2 * imaging (DDE-R 2 *I) and to assess the value of DDE-R 2 *I as a predictor of such reduction.Methods: Twenty-one women with uterine intramuralˆbroids underwent MR imaging including DDE-R 2 * I before GnRHa treatment. DDE-R 2 * I was acquired using a single-section, double-echo, fast spoiled gradient recalled acquisition in the steady state (SPGR) sequence. We calculated the area under the curve (AUC) of the signal intensity on R 2 *I within a 3×3-cm 2 region of interest that served to represent the VBV. We repeated MR imaging after 2 administrations of GnRHa and repeated image analyses. We statistically analyzed correlations between (A) pre-treatment AUC (AUC(pre)) and AUC reduction and (B) AUC(pre) and volume reduction.Results: The interval between the 2 MR studies ranged from 56 to 119 days (mean: 80.4 days). The average volume of theˆbroids before GnRHa treatment was 647.8 mL compared with 463.4 mL after the therapy (decreased by an average of 28.5z; Pº0.0001). Meanwhile, measured AUC was reduced by 55.3z (483.4 vs. 206.5; Pº0.0001). AUC(pre) correlated with volume reduction (r＝0.68), but not AUC reduction.Conclusions: We conˆrmed reduction in the VBV ofˆbroids using DDE-R 2 * I. The measurement of AUC(pre) on DDE-R 2 *I aids prediction ofˆbroid volume reduction but correlates poorly with the percentage of AUC reduction.

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Uterine Fibroids: Uterine Artery Embolization versus Abdominal Hysterectomy for Treatment—A Prospective, Randomized, and Controlled Clinical Trial

Abstract: Compared with hysterectomy, UAE is safe and effective for treatment of bleeding fibroids, necessitates a shorter hospital stay, and results in fewer major complications.

Cited by 229 publications

References 41 publications

Conservative treatment of a twin cervical pregnancy with uterine artery embolization

Conservative treatment of a twin cervical pregnancy with uterine artery embolization

Is Embolization Equal to Hysterectomy in Treating Uterine Fibroids?

Reduction in the Vascular Bed Volume of Uterine Fibroids after Hormonal Treatment: Evaluation with Dynamic Double-Echo R2* Imaging

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