Uterine artery embolization

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Arteries of the female reproductive tract (posterior view): uterine artery, ovarian artery and vaginal arteries.

Uterine artery embolization (UAE) is a procedure where an interventional radiologist uses a catheter to deliver small particles that block the blood supply to the uterine body. If the procedure is done for the treatment of uterine fibroids it is also called uterine fibroid embolization (UFE).

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Procedure and indications

Under local anesthesia, an interventional radiologist introduces a catheter into the femoral artery at the groin and uses radiographic guidance to advance the catheter into the uterine artery. Microparticles (spheres or beads) are then released, which will block blood flow through the vessel. Even if both uterine arteries are occluded, abdundant collateral circulation prevents the uterus from necrosing. The procedure is not a surgical intervention, and allows the uterus to be kept in place.

UAE is frequently used to relieve symptoms caused by uterine fibroids. It has satisfaction rates similar to hysterectomy and much shorter recovery times. It does affect fertility in some cases and other interventions may provide better results when fertility should be preserved.[1]

UAE can also be used to control heavy uterine bleeding for reasons other than fibroids, such as postpartum obstetrical hemorrhage.[2]

Adverse effects

The rate of serious adverse effects is comparable to that of myomectomy or hysterectomy. The advantage of substantially faster recovery time is offset by a higher rate of minor complications.[1]

Adverse effects that have been reported include death from embolism, or septicemia (the presence of pus-forming or other pathogenic organisms, or their toxins, in the blood or tissues) resulting in multiple organ failure.[3] Infection from tissue death of fibroids, leading to endometritis (infection of the uterus) resulting in lengthy hospitalization for administration of intravenous antibiotics.[4] Misembolization from microspheres or polyvinyl alcohol (PVA) particles flowing or drifting into organs or tissues where they were not intended to be, causing damage to other organs or other parts of the body.[5] Ovarian damage resulting from embolic material migrating to the ovaries. Loss of ovarian function, infertility,[6] and loss of orgasm. Failure of embolization surgery- continued fibroid growth, regrowth within four months. Menopause - iatrogenic, abnormal, cessation of menstruation and follicle stimulating hormones elevated to menopausal levels.[7] Post-Embolization Syndrome (PES) - characterized by acute and/or chronic pain, temperatures of up to 102 degrees, malaise, nausea, vomiting and severe night sweats. Foul vaginal odor coming from infected, necrotic tissue which remains inside the uterus. Hysterectomy due to infection, pain or failure of embolization.[8] Severe, persistent pain, resulting in the need for morphine or synthetic narcotics.[9] Hematoma, blood clot at the incision site. Vaginal discharge containing pus and blood, bleeding from incision site, bleeding from vagina, fibroid expulsion (fibroids pushing out through the vagina), unsuccessful fibroid expulsion (fibroids trapped in the cervix causing infection and requiring surgical removal), life threatening allergic reaction to the contrast material, and uterine adhesions.

See also

References

  1. ^ a b Gupta, J. K.; Sinha, A.; Lumsden, M. A.; Hickey, M. (2012). Uterine artery embolization for symptomatic uterine fibroids. In Gupta, Janesh K. "Cochrane Database of Systematic Reviews". Cochrane database of systematic reviews (Online) 5: CD005073. doi:10.1002/14651858.CD005073.pub3. PMID 22592701. edit
  2. ^ Management of severe postpartum haemorrhage by uterine artery embolization
  3. ^ Vashisht A, Studd JW, Carey AH (2000). "Fibroid Embolisation: A Technique Not Without Significant Complications". British Journal of Obstetrics & Gynecology 107 (9): 1166–1170. doi:10.1111/j.1471-0528.2000.tb11119.x.
  4. ^ de Block S, de Bries C, Prinssen HM (2003). "Fatal Sepss after Uterine Artery Embolization with Microspheres". Journal of Vascular and Interventional Radiology 14 (6): 779–783. PMID 12817046.
  5. ^ Dietz DM, Stahfeld KR, Bansal SK (2004). "Buttock Necrosis After Uterine Artery Embolization". Obstetrics & Gynecology 104 (Supplement): 1159–1161. doi:10.1097/01.AOG.0000141567.25541.26.
  6. ^ Robson S, Wilson K, David M (1999). "Pelvic Sepsis Complicating Embolization of a Uterine Fibroid". The Australian and New Zealand Journal of Obstetrics and Gynaecology 39 (4): 516–517. doi:10.1111/j.1479-828X.1999.tb03150.x.
  7. ^ Walker WJ, Pelage JP, Sutton C (2002). "Fibroid Embolization". Clinical Radiology 57 (5): 325–331. doi:10.1053/crad.2002.0945. PMID 12014926.
  8. ^ Common AA, Mocarski E, Kolin A (2001). "Leiomyosarcoma". Journal of Vascular & Interventional Radiology 12: 1449–1452.
  9. ^ Soulen MC, Fairman RM, Baum R (2000). "Embolization of the Internal Iliac Artery: Still More to Learn". Journal of Vascular & Interventional Radiology 11 (5): 543–545. doi:10.1016/S1051-0443(07)61604-2.

External links