Uterine Artery Embolization

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Uterine Artery Embolization

• Dennis DeSimone, MIV
• Virginia College of Osteopathic Medicine
• Radiology, January 2007

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Background

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

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Background
Uterine Fibroids - a source of significant
uterine bleeding
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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

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Background

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

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• 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/
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Uterine artery embolization

• The beads target the blood supply to the fibroid

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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.

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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.

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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

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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

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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

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References

• http//www.umm.edu/ir/fibroids/
• http//www.emedicine.com/med/topic1449.htm
• http//www.madisonradiologists.com/SvcUterineArter
  yEmbolization.htm