Uterine artery embolization
The aim of this intervention is to stop blood flow inside the fibroids combined with minimal damage to the uterine unchanged artery branches. This is possible due to the fact that the blood supply to the nodes is carried from perifibroidnogo plexus - the vasculature that surrounding the myoma on the periphery. These vessels have a diameter of 0.5 mm, ie several times more than normal myometrium artery. After that through catheter insertion in these vessels plastic parties (emboli) about 0.5 mm in diameter, myoma loses a blood flow. This leads to ischemia fibroids with subsequent partial necrosis, degeneration and scarring.
First uterine artery embolization (UAE) applied Oliver (USA) in 1979 to stop postpartum hemorrhage. Since then, this technique is widely used around the world to stop uterine postpartum hemorrhage and woman inoperable malignant growth bleeding of genital sphere.
In 1995, Jacques Ravina (France) was the first who described the result of applying this method on patients with uterine myoma. Initially used as a step of preoperative preparation, UAE caused a significant reduction of nodes size, regression of clinical symptoms and patients refused to had open surgery. Nevertheless, the article was unnoticed, and this method had a wide spreading only after publication in 1996 by US authors (Mac Lucas, Goodwin) with results of more series of interventions.
- - Symptomatic uterine fibroids
- - Asymptomatic uterine fibroids with growth tendancy
UAE in these patients applies in the case of:
- When myomectomy is impossible or unpractical (multiple nodes, surgically inconvenient location of nodes);
- Relapse after myomectomy;
- Contraindications to open surgery or high surgical risk (heart disease, respiratory failure, adhesive disease, etc.);
- The personal preferences of the patient, non-hormonal or operating treatment.
- Malignant growth of the uterus (except inoperable).
- Untreated small pelvis inflammatory disease.
- Intolerance of contrast agents.
- Disorders of blood clotting.
- Subserous node on the stem.
- Violation of patency of iliac arteries.
The desire to have children in the future is not a contraindication to the UAE. Worldwide, there are a large number of cases of normal pregnancy after UAE. Endometriosis is not a contraindication to the UAE. Moreover, there are studies that explored the efficacy of uterine artery embolization in the treatment of some forms of endometriosis. However, in the case of a combination with endometriosis fibroid patient requires careful study to identify which of the disease is largely symptomatic.
The intervention is carried out on an empty stomach. After premedication (antispasmodics, sedatives, drugs of choice anesthesiologist) the patient is delivered to the X-ray operating room. The puncture site (in most cases, the right femoral artery at the groin) is processed by a sterilizing solution; the patient is covered with sterile linen. After dressing the protective apron, sterile gown and gloves endovascular surgeon makes artery puncture, through which enters a special device – introducer, into a lumen. Its purpose - to ensure the insertion of endovascular instruments (catheters, wires) inside the artery without damaging its walls. Then, into the aorta under the control of X-ray television carried the catheter and angiography is performed to detect the uterine arteries and possible options for a discharge. Then, using a system of catheter-conductor produced uterine artery catheterization. The catheter is located in the uterine artery so as to prevent ingress of emboli in other arteries besides master batch. Through the lumen of the catheter into the uterine artery is inserted emboli, mixed with saline. Periodically is done angiography to control the degree of uterine artery embolization. The catheter is inserted in an opposite uterine artery, embolization is repeated. If necessary, the control arteriography is repeated, a catheter and introducer in turn are removed from the artery lumen. The puncture site is pressed by hand until it stops bleeding from the puncture hole (usually 5-10 minutes), and then on this place is imposed a pressure bandage. The total duration of the intervention depends on the experience of the surgeon and vascular anatomy, an average of 30-60 minutes. By the next morning, the patient is prescribed bed rest in order to avoid possible complications at the puncture site (hematoma, thrombosis). In the morning the bandag is removed, the patient remains stationary observation for 2-3 days, and then is discharged to outpatient treatment.