Uterine Artery Embolization

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Uterine Artery Embolization

• Patient is a 43 year old woman with 2 children.
  She has had increasingly heavy periods for 2
  years w/ some clotting. Her periods last for 7-10
  days.
• Excessive bleeding has resulted in the loss of
  time at work, missed social events, and anemia
  (low blood counts). Sexual activity is painful.
• In addition she has a sensation of pressure in
  her lower abdomen, urinary frequency during the
  day, and gets up to void at least 3 times each
  night.
• She has no additional health problems

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• MRI shows a dominant transmural myoma in the
  anterior/inferior aspect of the uterus (blue
  arrow). Overall the uterus is 10-12 gestational
  weeks in size (yellow arrow).

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Enhancing normal uterus

• With contrast enhancement the fibroid enhances as
  much as the normal uterine myometrium. This
  confirms that the fibroid is hyper-vascular and
  likely amenable to embolization therapy.

Enhancing typically Spherical fibroid
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• At arteriography, the uterine arteries were
  normal and were embolized without difficulty. 
  Ten mL of particles (500um, 750um) were used - 4
  mL on the left and 6 mL on the right. The case
  took 18 minutes from numbing the puncture site
  until the catheter was removed, with just under 7
  minutes of fluoroscopy. The patient was
  discharged home the same evening on oral
  analgesics.

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Selected Left Uterine artery injection demonstrate
s hyper- vascularity of the fibroid and
relatively decreased flow to the uterus itself.
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Decreased vascularity consistent with
successful embolization.
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Selected Right Uterine artery injection
demonstrates hyper- vascularity of the fibroid
and relatively decreased flow to the uterus
itself.
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Decreased vascularity consistent with
successful embolization.
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• MRI shows a 30-40 decrease in overall uterine
  volume, and a 50-60 decrease in the volume of
  the dominant fibroid.

Non-enhancing infarcted fibroid showing
decreased mass-effect on the bladder and the
vagina
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• With contrast enhancement the normal uterine
  myometrium continues to enhance, but there is no
  enhancement of the fibroid, indicating that it is
  completely infarcted.

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Results

• Her recovery was uneventful. She was back to full
  activity levels by post-UAE day 10.
• Three months after UAE she has had normalization
  of her periods, which now last 5 days.
• Her pelvic pressure symptoms have completely
  resolved.