Cesarean scar pregnancy associated with uterine artery pseudoaneurysm: a case report

Cesarean scar pregnancy (CSP) and uterine artery pseudoaneurysms (UAPs) are associated with massive uterine hemorrhage and mortality. As a result of their low prevalence, the occurrence of CSP and a UAP in the same patient is extremely rare. The authors describe a patient who was initially misdiagnosed with trophoblastic disease by ultrasonography. The lesion had a blood-rich area of 75 x 65 x 61 mm on ultrasonography. Pelvic angiography revealed a UAP in the right side of the uterus. The patient underwent uterine artery embolization (UAE) immediately after the correct diagnosis was confirmed. Curettage was undertaken under ultrasound guidance one week postoperatively. Histopathological examination of the resected tissue revealed degenerative chorionic villi and trophoblasts with blood clots. Serum levels of beta-human chorionic gonadotropin (β-hCG) and uterine ultrasound recovered to normal levels two weeks and three months later, respectively.

Assessment of ovarian reserve using anti-Müllerian hormone levels in benign gynecologic conditions and surgical interventions: a systematic narrative review

The usefulness of anti-Müllerian hormone (AMH) for the quantitative evaluation of ovarian reserve has been established. Therefore, serum AMH has been recently applied to the assessment of ovarian reserve outside infertility treatment. We conducted a computer-based search, using keywords, through the PubMed database from inception until May 2014 and summarized available studies evaluating ovarian damage caused by gynecologic diseases, such as endometriosis and ovarian tumor, as well as surgical interventions, such as cystectomy and uterine artery embolization (UAE), to discuss the usefulness of serum AMH. Most of the studies demonstrated a decline of serum AMH levels after cystectomy for endometriomas. It is not conclusive whether electrocoagulation or suturing is preferable. The effects of other gynecologic diseases and interventions, such as hysterectomy and UAE, on ovarian reserve are controversial. Serum AMH levels should be considered in determining the indication and selection of operative methods for benign gynecologic conditions.

[Clinical value of MRI in cesarean scar pregnancy]

OBJECTIVE

To explore the clinical value of MRI in diagnosing and treating cesarean scar pregnancy (CSP).

METHODS

A retrospective analysis was conducted on the clinical manifestations of 54 patients diagnosed with CSP between January 2009 to January 2013 in Peking University Third Hospital. Based on the patients' MRI image and other clinical datas, we did transvaginal operation on patients with CSP1, and transvaginal combined with abdominal operations on patients with CSP2. The intraoperative blood loss, operation time, postoperative hospital stay, and the length of time required for of serum hCG dropping to normal of the patients were analyzed.

RESULTS

The average age of the 54 patients was (34±5) years and the average duration of gestation was (56±16) days, all patients' vital sign were stable, the hCG level was 23-142 962 U/L before treatment. Twelve patients were diagnosed with CSP1 by MRI, and 5 of them had focus of 1-2 cm in diameter, the 5 patients' serum hCG level was 436-1 159 U/L and 23-32 days after drug administration, their hCG level returned to normal; the other 7 patients had focus of 2.0-4.4 cm in diameter, and their hCG level was 2 218-63 446 U/L, lesion resection was done on the 7 patients by hysteroscope or under B-ultrasound monitor. Forty-two patients were diagnosed with CSP2, and their focus were 1.0-7.1 cm in diameter, and serum hCG level were 23-142 962 U/L. We did bilateral uterine artery occlusion by laparoscope or laparotomy during operation for 22 patients or bilateral uterine artery embolization (UAE) before operation for 20 patients, then we did lesion resections. The blood loss during operation of CSP1 or CSP 2 was 50.1, 267.2 ml; operation time was 30, 128 minutes; postoperative hospital stay was 4.6, 6.7 days; their serum hCG returned to normal 13-30 days after the surgery. All the 54 patients' uterus were and the patients undergoing operations were all cured without the second operation.

CONCLUSION

MRI is an effective method to conduct clinical treatment in CSP.

Alternative therapies in management of leiomyomas

Leiomyomas are benign soft-tissue neoplasms that arise from smooth muscle. Relief of symptoms (abnormal uterine bleeding, pain, pressure) is the major goal in management of women with significant symptoms. For symptomatic myomas, hysterectomy is a definitive solution; however, there are emerging less-invasive options. Magnetic resonance imaging-guided focused ultrasound surgery, cryomyolysis, and temporary occlusion of the uterine arteries are treatment options that are minimally invasive interventions with the benefit of preserving the uterus. This review summarizes procedure techniques, eligibility, complications, and outcomes of these alternate therapies.

Uterine arteriovenous malformation after gestational trophoblastic disease: a report of two cases

BACKGROUND

Uterine arteriovenous malformation (AVM) is considered a rare condition. Diagnosis is critical because patients are at risk of significant vaginal hemorrhage that has been traditionally managed with surgery.

CASE

We report 2 cases of uterine AVM after gestational trophoblastic disease in young women who were treated with uterine artery embolization, allowing preservation of reproductive capability.

CONCLUSION

Embolization addresses both the preservation of future reproductive function and the prevention of major surgery and anesthesia. Success rates have been quoted as > 90% with minimal complications after uterine artery embolization.

Management of cervical ectopic pregnancy with uterine artery embolization: a case report

BACKGROUND

Cervical ectopic pregnancy is a rare occurrence but carries the risk of life-threatening maternal hemorrhage.

CASE

A 35-year-old woman, gravida 4 para 2, presented to the Emergency Room with the complaint of pelvic cramping and vaginal spotting. Initial quantitative serum beta-hCG value was 79,506.7 mIU/mL. Obstetrical ultrasound demonstrated a single, live pregnancy of approximately 8 weeks' gestation located within the endocervical canal. Pelvic MRI confirmed a live cervical ectopic pregnancy. Following discussion of management options, the decision was made to employ uterine artery embolization (UAE). Subsequent to UAE and by hospital day 4, no embryonic cardiac activity was noted. Postdischarge day 12 gynecologic ultrasound demonstrated a small, complex endocervical fluid collection compatible with resolving cervical pregnancy.

CONCLUSION

If clinical circumstances are amenable to trial of embolization, interventional radiology should be consulted for cervical ectopic pregnancy management. In cases in which there may be relative contraindications to methotrexate therapy alone and there is desire to avoid hysterectomy, clinicians should give consideration to a combination of strategies, including UAE, to manage cervical pregnancy. The case report highlights a review of the current literature and discusses options for conservative cervical ectopic pregnancy management.

Uterine artery embolization: pre- and post-procedural evaluation using magnetic resonance imaging

Magnetic resonance (MR) imaging has become the preferred method in assessing the uterus and pelvis prior to and following uterine artery embolization (UAE). The multiplanar imaging capabilities, increased spatial and contrast resolution, anatomic detail and assessment of fibroid viability that MR provides over ultrasound allows for accurate pre-treatment planning and post-treatment assessment. The purpose of this article is to demonstrate the use of MR in the selection of patients, anatomic evaluation and procedural planning before UAE, describe the use of MR in evaluating treatment response after UAE and illustrate the use of MR in identifying post-UAE complications. An understanding of these principles is essential in guiding appropriate therapy, determining treatment effectiveness and identifying associated complications before and after UAE.

The effect of uterine artery embolization on premenstrual symptoms in patients with symptomatic fibroids or adenomyosis

PURPOSE

To evaluate whether uterine artery embolization (UAE) can reduce the premenstrual symptoms in women undergoing UAE for fibroid tumors or adenomyosis.

MATERIALS AND METHODS

Among 141 women who underwent UAE for symptomatic fibroid tumors or adenomyosis at a single institution between March 2011 and February 2013, 54 premenstrual symptoms in 39 patients were prospectively analyzed. Premenstrual symptoms were rated by the patient on a scale of 0 to 10, with 0 representing no symptom and 10 representing the baseline severity. The change in premenstrual symptom score was calculated by subtracting the baseline score from the post-UAE score. At 3-6 months after UAE, each woman also completed a symptom severity questionnaire to assess the severity of menstrual bleeding to compare the changes in premenstrual symptoms scores between women with and without menorrhagia.

RESULTS

Back pain, headache, and gastrointestinal symptoms (eg, constipation, indigestion, lower abdominal pain) were significantly improved after UAE (P < .05). Muscle pain, fatigue, nervousness, breast tenderness, and systemic edema were also improved, but not significantly so. The mean premenstrual symptom score change in patients with menorrhagia was significantly greater than in those without menorrhagia (-6.4 vs -3.7; P = .044).There was no correlation between the degree of menorrhagia score change and the degree of premenstrual symptom score change (P = .186).

CONCLUSIONS

UAE could be a method to alleviate some premenstrual symptoms in patients with uterine fibroid tumors or adenomyosis.

Prophylactic uterine artery embolization assisted cesarean section for the prevention of intrapartum hemorrhage in high-risk patients

Purpose

To evaluate the safety and efficacy of prophylactic uterine artery embolization (UAE)-assisted cesarean section for the prevention of intrapartum hemorrhage.

Materials and Methods

Twelve consecutive pregnant women (mean age 31 years; range 25–38) with uterine scarring and placenta previa and/or placenta accreta underwent UAE in conjunction with cesarean section to prevent intrapartum hemorrhage. For UAE, the left uterine artery was catheterized prophylactically under fluoroscopic guidance before the cesarean section incision was made. After the infant had been delivered, bilateral UAE was performed with the placenta still in situ. After successful bilateral UAE, the placenta was detached from the uterine wall.

Results

Technical success was achieved in all 12 cases. Ten patients retained their uterus, and the other 2 underwent hysterectomy. The mean operative blood loss was 1,391 mL (range 600–3,600 mL). The total mean fluoroscopy time and mean absorbed dose (air kerma) were 9 min 40 s (range 4 min 35 s–15 min 24 s) and 91.79 mGy (range 30.2–171), respectively. The average fetal fluoroscopy time was 1 min 42 s (range 41 s to 3 min 16 s) with an average X-ray dose of 17.66 mGy (range 6.04–23.90).

Conclusion

UAE-assisted cesarean section is safe and effective in the prevention of intrapartum hemorrhage in patients with uterine scarring and/or placental abnormalities.

[Clinical study on 39 cases with caesarean scar pregnancy with sonographic mass]

OBJECTIVE

To study the clinical features, differential diagnosis and treatment of caesarean scar pregnancy (CSP) with sonographic mass.

METHODS

A retrospective analysis was performed on 39 patients of CSP with sonographic mass undergoing treatment in Peking Union Medical College Hospital from 2005 to 2012.14 cases with misdiagnosis of gestational trophoblastic neoplasm, among 4 cases were administered by chemotherapy with methotrexate (MTX) , cisplatin, fluorouracil (5-FU) and dactinomycin. According to treatment methods, 39 cases were divided into five groups: 3 cases in methotrexate, 16 cases in dilation and curettage, 15 cases in excision of CSP lesion via laparoscopy, 6 cases in excision of CSP lesion via laparotomy, and 4 cases in transabdominal hysterectomy (TAH).

RESULTS

(1) Clinical characteristics:the mean age was (33 ± 5) years old.Five patients had undergone two prior caesarean sections. The median interval from the last caesarean delivery to CSP was 4 years. Thirty-five cases presented vaginal bleeding or abnormal serum β-hCG level from 5 cases with medical abortion, 9 cases with artificial abortion and 21 cases with dilation and curettage. The sonography showed cystic-solid or solid mass with mixed echoes in the lower segment of anterior uterine wall, surrounded by peritrophoblastic vasculature.(2) Treatment outcome:diagnosis of gestational trophoblastic neoplasm was suspected or made in 20 patients, four of whom were even treated by chemotherapy. MTX therapy was given to 3 patients, 2 of whom were cured. Dilation and curettages were given to 16 patients, 11 of whom were cured. 8 patients underwent curettage with sonographic guidance after uterine artery embolism, and 8 patients with laparoscopic or hysteroscopic guidance. All of 15 patients underwent excision of CSP lesion via laparoscopy were cured. 4 patients were treated by TAH. (3) Time of in hospital and operation:in laparoscopy group, the average hospitalization days were (3.5 ± 1.6) days, the average operation duration was (54 ± 16) minutes. In laparotomy group, the average hospitalization days were (9.7 ± 5.8) days, and the average surgical duration was (87 ± 15) minutes.It reached significant difference (P < 0.05) .

CONCLUSIONS

CSP with sonographic mass was the consequence of continued growth of residual pregnancy mass after incomplete abortion or curettage of CSP with gestation sac. The similar sonographic image might lead to misdiagnosis. Individual therapy was recommended. Excision of CSP lesion via laparoscopy might be the primary option for its advantages in differential diagnosis, caesarean scar defect repair and successful ratio.

[Clinical study on 57 cases with caesarean scar pregnancy]

OBJECTIVE

To investigate treatment of caesarean scar pregnancy (CSP) and associated problem.

METHODS

From January 2011 to January 2013, 57 cases with CSP undergoing treatment in Affiliated Hospital of Hebei University were studied retrospectively. Among 57 patients, it was divided into 12 cases treated by curettage (curettage group); 22 cases treated by uterine artery embolization(embolization group);8 cases treated by laparotomy(laparotomy group) and 15 cases treated by transvaginal debridement(transvaginal group).

RESULTS

(1)Successful rate of curettage group, embolization group, laparotomy group and transvaginal group were 12/12, 86% (19/22), 7/8, 13/15. (2) The intraoperative blood loss and the hospital stay were 20 (17-28) ml,(5.1 ± 1.9) days in curettage group, 10 (5-15) ml, (10.2 ± 3.2) days in embolization group, 200 (80-300) ml, (11.3 ± 3.3) days in laparotomy group, 50 (45-100) ml, (6.8 ± 1.2) days in transvaginal group. There was statistically different between curettage group and embolization group (P < 0.05). There was statistically different between laparotomy group and transvaginal group (P < 0.05).

CONCLUSIONS

Curettage, uterine artery embolization, abdominal and transvaginal scar debridement surgery can be used in treatment of the CSP. It should be carefully chosen with surgical intervention, if myometrium was implanted greater than 1/2, or near to serosa.It should be carefully chosen with vaginal surgery, if the blood flow signals was rich around the lesion.

[Therapeutic effect of hysteroscopic surgery in treatment of small mass of caesarean scar pregnancy]

OBJECTIVE

Study the effect of hysteroscopic surgery in treatment of small mass of caesarean scar pregnancy (CSP).

METHODS

From January 2000 to January 2013, 61 cases lesions ≤ 2.5 cm diameter of endogenous CSP undergoing treatment in Luohe Central Hospital were studied retrospectively. According to different treatment, they were divided into 21 cases in hysteroscopic surgery group, 23 cases in methotrexate+operation group and 17 cases in bilateral uterine artery embolism+curettage group.Intraoperative blood loss, operative time, hospitalization time after treatment and β-hCG to normal time were compared among those three groups.

RESULTS

The surgical blood loss, hospitalization time after treatment, β-hCG to normal time were (49.8 ± 6.2) ml, (3.5 ± 0.8) days, (21.2 ± 2.4) days in hysteroscopic group, (87.0 ± 30.5) ml, (12.5 ± 1.0) days, (29.6 ± 2.2) days in methotrexate+operation group, the difference was statistically significant (P < 0.05). The operation time were (33 ± 4) minutes in hysteroscopic surgery group and (35 ± 6) minutes in methotrexate+operation group, which did not reached significant difference (P > 0.05). Length of hospital stay after treatment of hysteroscopic surgery group is less than the bilateral uterine artery embolism+curettage group significantly (P < 0.05).Operation time, surgical bleeding and β-hCG to normal time had no obvious difference between hysteroscopic surgery and in bilateral uterine artery embolism+curettage group (P > 0.05).

CONCLUSION

Hysteroscopy surgery in treatment of small mass endogenous CSP is effective, shorter hospitalization time, quick recovery.

Clinical analysis of diagnosis and treatment of 13 cases with cesarean scar pregnancy

OBJECTIVE

To explore effective methods in diagnosing and treating cesarean scar pregnancy (CSP) after cesarean section.

MATERIALS AND METHODS

The clinical data of 13 cases with CSP who were admitted to the present hospital from October 2009 to February 2012 were retrospectively analyzed.

RESULTS

The agreement diagnostic rate was 92.3% (12/13). On the basis of transvaginal color Doppler ultrasonography 12 patients had medical therapy combined with uterine artery embolization (UAE) and curettage was successfully performed. One patient was diagnosed through an emergency setting due to symptomatology.

CONCLUSION

Early accurate diagnosis of CSP is the key to perform proper and successful treatment.

Uterine fibroid embolisation: initial experience in our local population

OBJECTIVE

To evaluate the results of uterine fibroid embolisation as a treatment option for symptomatic uterine fibroids in the local population.

METHODS

The retrospective study was done at the Department of Diagnostic and Interventional Radiology, Shifa International Hospital, Islamabad, and comprised records of 12 patients with symptomatic uterine fibroids who had undergone uterine fibroid embolisation with the use of polyvinyl alcohol between May 2008 and July 2012. All of these patients had been assessed by a gynaecologist. Pre-embolisation workup was done by pelvic Magnetic Resonance Imaging. A detailed questionnaire was prepared to assess clinical improvement and interval change in fibroid size on follow-up imaging.

RESULTS

A technically successful embolisation was done in all patients. All patients experienced immediate postprocedure pain, but responded to conservative treatment. Clinical follow-up showed a significant reduction in symptoms within six months of the procedure, with 88% improvement in menorrhagia and 100% improvement in pain. Follow-up imaging showed reduction in fibroid sizes ranging from 17-63%. Two patients developed infection, which is a known complication of this procedure.

CONCLUSION

Uterine fibroid embolisation is a well-recognised treatment option for symptomatic uterine fibroids. Ascertaining its long-term results in our local population will, however, require additional studies with larger patient populations.

Degeneration of leiomyoma in patients referred for uterine fibroid embolization: incidence, imaging features and clinical characteristics

PURPOSE

Imaging features and clinical characteristics of degenerated leiomyoma in patients referred for uterine fibroid embolization (UFE) were analyzed to assess the incidence of degenerated leiomyoma.

MATERIALS AND METHODS

Patients referred for UFE between 2008 and 2009 were retrospectively analyzed (n=276). Patients ranged in age from 27 to 51 years (mean 38.0 years). All patients underwent screening MRI with contrast enhancement. Medical histories and clinical symptoms were evaluated.

RESULTS

Among the 276 patients who underwent MRI, 14 (5.1%) showed degenerated leiomyomas. Symptoms were abdominal pain (n=4, 26.7%), menorrhagia (n=5, 35.7%) and bulk-related symptoms (n=5, 35.7%) and no symptoms (n=5, 35.7%). Of the 14 patients with degenerated leiomyomas, 5 (42.9%) had a history of pregnancy in the past two years. For T1-weighted imaging (T1WI), a high signal intensity (SI) of the leiomyoma was the most common finding (n=9, 64.3%) and a hyperintense rim (n=4, 28.6%) was the second most common. On T2-weighted imaging (T2WI), a low SI of the leiomyoma was found in six patients (42.9%), a high SI in four (28.6%) and a heterogeneous SI in four (28.6%) patients. Conservative management was performed in 11 (78.6%) patients, surgery in 3 (21.4%) and uterine artery embolization in one (7.1%) patient.

CONCLUSION

The incidence of degeneration of leiomyoma in patients referred for UFE was 5.1%. Patients presented with variable clinical symptoms with or without a history of pregnancy. MR imaging showed a high SI on T1WI and various SIs on T2WI without contrast enhancement. An understanding of the degeneration of leiomyomata is essential when considering UFE.

Conservative management of cesarean scar pregnancy with uterine arteriovenous malformation: a case report

BACKGROUND

Cesarean scar pregnancy is a rare type of ectopic pregnancy in which implantation occurs in a previous lower segment cesarean scar. It may be associated with uncontrolled hemorrhage ending in hysterectomy. It can become potentially life threatening for the patient when it further gets complicated by uterine arteriovenous malformation (AVM). To the best of our knowledge there are only a few previous reports of AVM complicating a scar pregnancy. It is still unclear which treatment is most optimal.

CASE

We describe a case of a scar pregnancy complicated by uterine AVM. The diagnosis was made using 3D color Doppler ultrasound, showing a highly vascular tumor in the isthmic region of the uterus. Computed tomography angiography supported the diagnosis. The patient underwent selective embolization of the uterine artery followed by weekly intramuscular injections of methotrexate. Recovery was uneventful.

CONCLUSION

The decision regarding mode of treatment should be made by the patient and the clinician based on the local expertise and experience. Judicious use of medical management (methotrexate) and uterine artery embolization may prevent hysterectomy and allow preservation of fertility.

Antepartum embolization in management of labor induction in placenta previa

The authors present a case of a 29-year-old woman, gravid 2 para 1, who experienced complete placenta previa and underwent vaginal delivery, after performing antepartum uterine artery embolization and rivanol amniotic injection due to contraindication of obstetric surgery. In this case, treatment was successful despite thromboembolism. Hypercoagulability in pregnancy needs to be addressed.

Cervical pregnancy treated by uterine artery embolisation combined with office hysteroscopy

OBJECTIVE

To evaluate the safety and efficacy of uterine artery embolisation in conjunction with hysteroscopic resection of trophoblast in the conservative treatment of cervical ectopic pregnancies.

STUDY DESIGN

Five women diagnosed with cervical pregnancies at University Hospital of Foggia, Italy, between May 2009 and February 2012 underwent uterine artery embolisation followed by office hysteroscopic resection of trophoblast. Data on operating time, blood loss, blood transfusion, conversion to other techniques, complications related to surgery, change of serum β-hCG level, hospitalisation days and outcome of the women after discharge were collected.

RESULTS

The mean hysteroscopic operative time was 9.8 min, and the blood loss was negligible in all cases. Blood transfusion was not needed for any of the women. None of the women required conversion to other techniques. In all cases the operations were uneventful. The serum β-hCG level in all the cases declined to normal within 15 days of surgery. The total hospitalisation time was 4 days in all the cases. No vaginal bleeding or other side effects were observed throughout and after the treatment, all women recovered without complications.

CONCLUSIONS

Uterine artery embolisation with office hysteroscopic resection is an effective option in treatment of cervical ectopic pregnancy.

Role of uterine artery Doppler in the management of uterine leiomyoma by arterial embolization

OBJECTIVES

To study Doppler changes in the uterine artery immediately following and 3 months after uterine artery embolization (UAE) and to test the feasibility of using uterine artery Doppler as a predictor of the predominant side of arterial supply to leiomyomas, amount of embolizing material needed and leiomyoma tumor volume at follow-up.

METHODS

The study included 38 patients undergoing UAE for leiomyomas. Uterine artery Doppler was performed transabdominally before, within 6 hours after and 3 months after UAE to determine the peak systolic (PSV) and end-diastolic (EDV) velocities and resistance index (RI). Leiomyoma volume was measured using contrast-enhanced magnetic resonance imaging (MRI) before and 3 months after UAE. The predominant side of arterial supply to the leiomyoma was determined on digital subtraction angiography using the uterine artery diameter and tumor blush after contrast injection. For correlations with leiomyoma volume, the average PSV, EDV and RI of both sides was used, while for prediction of the predominant side of supply and for correlation with the amount of embolizing material needed, separate measurements from each side were used.

RESULTS

Relative to the pre-embolization value, the uterine artery PSV and EDV were significantly reduced (P < 0.05) immediately following UAE, while the RI was significantly elevated (P < 0.05). For prediction of the predominant side of supply, the lowest RI showed the highest accuracy (81.6%). There was no significant correlation between the pre-embolization PSV, EDV or RI and the amount of embolizing material utilized. Immediately post-embolization EDV and RI values were statistically significantly correlated with the 3-month follow-up leiomyoma volume, with RI showing the strongest correlation (P = 0.0400 and 0.0002, rho = 0.34 and - 0.58, respectively). The leiomyoma volume was predicted to have reduced by 38-61% after 3 months if the immediate post-embolization average RI value was between 0.82 and 0.88.

CONCLUSION

Pre-interventional Doppler assessment can be used to predict the predominant side of supply to leiomyomas but not the amount of embolizing material needed. Immediate post-interventional Doppler assessment can predict the leiomyoma volume after UAE.

Embolization of uterine arteriovenous malformations in patients with gestational trophoblastic tumors: a review of patients at Charing Cross Hospital, 2000-2009

OBJECTIVE

To review the indications, efficacy and follow-up for gestational trophoblastic tumor (GTT) patients treated for uterine arteriovenous vascular malformations (AVMs) and bleeding vaginal metastases with modern polyvinyl alcohol particle (PVA)-based radiological embolization.

STUDY DESIGN

GTT patients undergoing embolization were identified from the Charing Cross Hospital database. The patients' records were assessed for indication, technique used, primary and overall success in controlling bleeding, complications and subsequent pregnancy outcome.

RESULTS

During the period 2000-2009, 19 patients were treated for persistent or life-threatening bleeding by PVA-based uterine artery embolization performed via the femoral artery approach. Embolization resulted in control of hemorrhage in 18 of the 19 patients; 15 achieved control after the first procedure, with only 4 patients requiring a second procedure. In 1 case surgical intervention was required to control bleeding. The most frequent morbidity from the procedure was pelvic pain, requiring opiate administration; there were no other regular complications. The fertility outcome for these 19 patients indicates that 9 women have gone on to deliver a total of 12 healthy infants postembolization.

CONCLUSION

For GTT patients with heavy bleeding from AVMs, uterine artery embolization is a safe and effective treatment with low short-term toxicity and no obvious detrimental effect on future fertility.

Uterine artery embolization versus surgery for symptomatic uterine fibroids: a randomized controlled trial and a meta-analysis of the literature

PURPOSE

The aim of our study was to compare the efficacy and safety of uterine artery embolization (UAE) for symptomatic uterine fibroids with surgery.

METHODS

Both a randomized, controlled trial and meta-analysis of existing studies were performed.

RESULTS

Patients were randomly assigned in a 1:1 ratio to undergo either UAE or surgery with 63 patients undergoing UAE and 64 undergoing surgery. A meta-analysis of existing studies was also performed.There were significant improvements in UAE groups in most components of quality of life assessment at 6 months. Besides, the UAE group had a shorter hospital stay (P < 0.01) and a shorter recovery time (P < 0.01) compared with the surgical group. During the follow-up, there were no difference in complications incidence (58 vs. 65%, P > 0.05), but the UAE group had less major complications (0 vs. 6%, P < 0.05). Meta-analysis of existing studies including those from the current study, further suggested that UAE group had a shorter hospital stay, a shorter recovery time and less major complications than the surgical group.

CONCLUSIONS

Compared with surgery, UAE has a shorter hospital stay, a shorter recovery time, and less major complications. More studies in the future need to done to evaluate its long-term effects and impact on fertility.