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Uterine Artery Embolization

Uterine Artery Embolization. Dennis DeSimone, MIV Virginia College of Osteopathic Medicine Radiology, January 2007. Background. Menorrhagia is a very common gynecologic complaint The complaint of heavy menstrual bleeding accounts for nearly 30% of all hysterectomies. Background.

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Uterine Artery Embolization

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  1. Uterine Artery Embolization Dennis DeSimone, MIV Virginia College of Osteopathic Medicine Radiology, January 2007

  2. Background • Menorrhagia is a very common gynecologic complaint • The complaint of heavy menstrual bleeding accounts for nearly 30% of all hysterectomies

  3. Background Uterine Fibroids - a source of significant uterine bleeding

  4. Background • Surgical management has been the standard of treatment in menorrhagia due to organic causes • Dilatation and curettage • Transcervical resection of the endometrium • Endometrial ablation • Uterine balloon therapy • HydroThermAblator • Hysterectomy

  5. Background • Modern gynecology dictates the trend toward conservative therapy • Cost containment • Patient’s desire to preserve their uterus • Evidence that nearly 50% of uterine pathology findings from hysterectomies for menorrhagia are free of disease and histopathologic abnormalities.

  6. Uterine artery embolization • A relatively new approach to treating fibroid tumors. • 90% of patients report significant improvement • Tumors shrink by 50% • Uterus shrinks by 40% • Main risks: • Pain • Secondary amenorrhea http://www.umm.edu/ir/fibroids/

  7. Uterine artery embolization • The beads target the blood supply to the fibroid

  8. Before and after Pelvic angiogram after uterine artery embolization. Notice absence of large fibroid vessels. • Pelvic angiogram with large uterine arteries and fibroids before UAE.

  9. Methods • UAE • Performed under local or epidural/spinal anesthesia • Particles the size of grains of sand are used for the embolization. Polyvinyl alcohol particles is an example of the material used.

  10. Results • UAE technical failure rate of 5% • 86% of UAE, target embolization was carried out • Occasionally, UAE patients will require hysterectomy due to inability to embolize the target artery

  11. Results • There is a shorter procedure time for UAE vs. hysterectomy, 79 minutes vs 95 minutes • There is minimal blood loss • Low hospital admission time with UAE, only an overnight stay is required • Procedural complication rates are low

  12. Conclusions • UAE has a low MAJOR complication rate • Hospital stay, time off from work, and time until resumption of normal activities for UAE patients is reduced • Short term minor complications of the procedure include hematoma, pain, nausea • UAE may be a reasonable alternative to hysterectomy ■Patients who desire to avoid major surgery ■Those who do not desire future pregnancy

  13. References • http://www.umm.edu/ir/fibroids/ • http://www.emedicine.com/med/topic1449.htm • http://www.madisonradiologists.com/SvcUterineArteryEmbolization.htm

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