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Almazedi B, Hunt GEG, Bowker A. Impact of superior hypogastric nerve block during uterine fibroid embolisation on pain scores, opioid requirements, and same-day discharge: a case-control study. Clin Radiol 2024; 79:378-385. [PMID: 38383252 DOI: 10.1016/j.crad.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/05/2024] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
AIM To assess the safety and efficacy of superior hypogastric nerve block (SHNB) in managing periprocedural pain associated with uterine fibroid embolisation (UFE) and in facilitating same-day discharge. MATERIALS AND METHODS Prospectively enrolled case-control study with retrospective analysis comprising 119 eligible patients who underwent UFE for symptomatic fibroids was undertaken at a UK teaching hospital between January 2016 and September 2022. SHNB was administered to 62 participants in addition to systemic analgesia; 57 participants received systemic analgesia alone. SHNB was performed mid-UFE using 20 ml of 0.25% levobupivacaine. Pain scores were assessed using an 11-point (0-10) verbal numerical rating scale (NRS). The study received research and ethics committee approval. Statistical analysis was performed using the chi-square and independent t-test or Mann-Whitney U-test. A p-value of <0.05 defined significance. RESULTS Participants who received SHNB experienced significantly less pain during the first 6 h post-procedure (averaged median pain score 2.6 versus 3.8, p=0.031). SHNB reduced the proportion of participants requiring post-procedural anti-emetics (45% versus 63%, p<0.05). For participants entered on the day-case pathway (SHNB = 34, no-SHNB = 16), those who received SHNB had a higher rate of successful same-day discharge (62% versus 31%, p=0.044). This SHNB group required significantly less opioids for periprocedural pain relief (median oral morphine equivalents; 44 mg versus 80 mg, p=0.020). No SHNB-related adverse events occurred. CONCLUSION SHNB is safe and effective in reducing perioperative pain, opioid requirements, and anti-emetic use in patients undergoing UFE for symptomatic fibroids. SHNB, as an adjunct to analgesic optimisation, facilitates same-day discharge, which is often limited by severe post-embolisation pain.
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Affiliation(s)
- B Almazedi
- Vascular Imaging Unit, Department of Radiology, York Teaching Hospital, York, UK; York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
| | - G E G Hunt
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - A Bowker
- Vascular Imaging Unit, Department of Radiology, York Teaching Hospital, York, UK; York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
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Sasakura Y, Katsumori T, Nishizawa K, Nishimura T, Yoshikawa T, Takahata A, Yamada K. Incidence and changes in endometrial-leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis. Eur Radiol 2023; 33:8157-8164. [PMID: 37284865 DOI: 10.1007/s00330-023-09794-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To investigate whether the number and size of endometrial-leiomyoma fistulas (ELFs) change following uterine artery embolization (UAE) for leiomyoma and the correlation between ELFs and vaginal discharge (VD). MATERIALS & METHODS This study was a retrospective analysis of 100 patients who underwent UAE at a single institution between May 2016 and March 2021. They all underwent MRI at baseline, 4 months, and 1 year after UAE. The number and size of the ELFs were compared with the MRI images each time. The ELF tumor characteristics and the correlation between the ELFs and VD were assessed. Additional gynecologic interventions due to VD associated with ELFs were evaluated. RESULTS No ELF was observed at baseline. Ten ELFs were noted in nine patients at 4 months, and 35 ELFs were noted in 32 patients 1 year after UAE. The ELFs significantly increased over time (p = 0.004, baseline vs. 4 months; p < 0.001, 4 months vs. 1 year). The ELF size did not significantly change over time (p = 0.941). The tumors developing ELFs after UAE were mainly located at the submucosal or intramural area contacting the endometrium at baseline, with a mean size of 7.1 (2.6) cm. Nineteen patients (19%) had VD 1 year after UAE. There was no significant correlation between VD and the number of ELFs (p = 0.80). No patients underwent additional gynecologic interventions due to VD associated with ELFs. CONCLUSION ELFs increased in number and did not disappear over time after UAE in most tumors. CLINICAL RELEVANCE STATEMENT Despite the MR imaging findings, within the limited data of this study, ELFs were not seemingly associated with clinical symptoms, including VD. KEY POINTS • Endometrial-leiomyoma fistula (ELF) is a complication of uterine artery embolization (UAE). • ELFs increased in number over time after UAE and did not disappear in most tumors. • Most tumors developing ELFs after UAE were located near/contacted the endometrium and were larger.
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Affiliation(s)
- Yasuteru Sasakura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan.
| | - Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Kaori Nishizawa
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Tomoaki Nishimura
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga, 520-3046, Japan
| | - Tatsuya Yoshikawa
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Akiko Takahata
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, 602-8566, Kyoto, Japan
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Lal A, Vijayvergiya R, Singhal M. Ipsilateral Uterine Artery Access Through Unilateral Transfemoral Approach Using Simple-Curve Catheter. Indian J Radiol Imaging 2023; 33:543-547. [PMID: 37811184 PMCID: PMC10556336 DOI: 10.1055/s-0043-1770086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Uterine artery embolization (UAE) is a technique for management of various obstetrical and gynecological problems. Transfemoral approach (TFA) is preferred which can be unilateral or bilateral; however, unilateral puncture is preferred due to lesser chances of puncture-related complications as compared to bilateral puncture. UAE through unilateral TFA is possible with use of reverse loop catheters (Roberts uterine catheter [RUC] or Gandras catheter) to access ipsilateral uterine artery. Other way of cannulating the ipsilateral uterine artery is by maneuvering catheters to form Waltman's loop/Simmon's reverse loop. With advent of RUC, unilateral TFA became standard of care. In the recent past, RUC was retracted from Indian market and its nonavailability had mandated use of either bilateral TFA or use of catheters and techniques used in the past for unilateral TFA. Herein, we describe a technique of doing UAE by unilateral TFA using simple gentle curve catheter (Picard) by making a reverse curve loop.
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Affiliation(s)
- Anupam Lal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Musa B, Alswang JM, Di Ioia R, Grubic L, Naif A, Mbuguje EM, Vuong V, Newsome J, Shaygi B, Ramalingam V, Gaupp FML. Uterine artery embolization in Tanzania: a procedure with major public health implications. CVIR Endovasc 2023; 6:40. [PMID: 37548779 PMCID: PMC10406993 DOI: 10.1186/s42155-023-00384-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND The burden of uterine fibroids is substantial in sub-Saharan Africa (SSA), with up to 80% of black women harboring them in their lifetime. While uterine artery embolization (UAE) has emerged as an effective alternative to surgery to manage this condition, the procedure is not available to the vast majority of women living in SSA due to limited access to interventional radiology (IR) in the region. One of the few countries in SSA now offering UAE in a public hospital setting is Tanzania. This study aims to assess the safety and effectiveness of UAE in this new environment. METHODS From June 2019 to July 2022, a single-center, retrospective cohort study was conducted at Tanzania's first IR service on all patients who underwent UAE for the management of symptomatic fibroids or adenomyosis. Patients were selected for the procedure based on symptom severity, imaging findings, and medical management failure. Procedural technical success and adverse events were recorded for all UAEs. Self-reported symptom severity and volumetric response on imaging were compared between baseline and six-months post-procedure using paired sample t-tests. RESULTS During the study period, 92.1% (n = 35/38) of patients underwent UAE for the management of symptomatic fibroids and 7.9% (n = 3/38) for adenomyosis. All (n = 38/38) were considered technically successful and one minor adverse event occurred (2.7%). Self-reported symptom-severity scores at six-months post-procedure decreased in all categories: abnormal uterine bleeding from 8.8 to 3.1 (-5.7), pain from 6.7 to 3.2 (-3.5), and bulk symptoms from 2.8 to 1 (-1.8) (p < 0.01). 100% of patients reported satisfaction with outcomes. Among the nine patients with follow-up imaging, there was a mean volumetric decrease of 35.5% (p = 0.109). CONCLUSIONS UAE for fibroids and adenomyosis can be performed with high technical success and low complication rates in a low-resource setting like Tanzania, resulting in significant symptom relief for patients. Building capacity for UAE has major public health implications not only for fibroids and adenomyosis, but can help address the region's leading cause of maternal mortality, postpartum hemorrhage.
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Affiliation(s)
- Balowa Musa
- Radiology and Imaging Department, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar Es Salaam, Tanzania
| | - Jared Mark Alswang
- Harvard Medical School, Harvard University, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Rose Di Ioia
- Faculty of Medicine and Health Sciences, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1A3, Canada
| | - Lydia Grubic
- Marian University College of Osteopathic Medicine, 3200 Cold Spring Rd, Indianapolis, IN, 46222, USA
| | - Azza Naif
- Department of Radiology and Imaging, Muhimbili National Hospital, P.O. Box 65000, Dar Es Salaam, Tanzania
| | - Erick Michael Mbuguje
- Department of Radiology and Imaging, Muhimbili National Hospital, P.O. Box 65000, Dar Es Salaam, Tanzania
| | - Victoria Vuong
- Department of Radiology, University of California San Diego Medical Center, 200 W. Arbor Drive, San Diego, CA, 92103, USA
| | - Janice Newsome
- Department of Radiology, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 30322, USA
| | - Behnam Shaygi
- Department of Radiology, London North West University Healthcare NHS Trust, A404 Watford Rd, Harrow, HA1 3UJ, UK
| | - Vijay Ramalingam
- Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA, 02215, USA
| | - Fabian Max Laage Gaupp
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
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Cappelli A, Mosconi C, Cocozza MA, Brandi N, Bartalena L, Modestino F, Galaverni MC, Vara G, Paccapelo A, Pizzoli G, Villa G, Seracchioli R, Renzulli M. Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids of Different Sizes: A Single Center Experience. J Pers Med 2023; 13:906. [PMID: 37373895 DOI: 10.3390/jpm13060906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
The present study aimed to evaluate the clinical and radiological 1-year outcomes of uterine artery embolization (UAE) performed in a selected population of women with symptomatic myomas and who do not wish to conceive. Between January 2004 and January 2018, a total of 62 patients with pre-menopausal status and with no wish to conceive in the future underwent UAE for the treatment of symptomatic fibroids. All the patients underwent magnetic resonance imaging (MRI) and/or transvaginal ultrasonography (TV-US) before and after the procedure at 1-year follow-up. Clinical and radiological parameters were recorded, stratifying the population into 3 groups according to the size of the dominant myoma (group 1: <50 mm; group 2: ≥50 and ≤80 mm; group 3: >80 mm). Mean fibroid diameter was significantly reduced (42.6% ± 21.6%) at 1-year follow-up, with excellent improvements in terms of both symptoms and quality of life. No significant difference was observed regarding baseline dimension and the number of myomas. No major complications were reported (2.5%). The present study confirms the safety and efficacy of UAE in the treatment of symptomatic fibroids in pre-menopausal women with no desire to conceive.
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Affiliation(s)
- Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Maria Adriana Cocozza
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Laura Bartalena
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Francesco Modestino
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Maria Cristina Galaverni
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Giulio Vara
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Alexandro Paccapelo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Gloria Pizzoli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gioia Villa
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
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Tanaka ME, Keefe N, Caridi T, Kohi M, Salazar G. Interventional Radiology in Obstetrics and Gynecology: Updates in Women's Health. Radiographics 2023; 43:e220039. [PMID: 36729949 DOI: 10.1148/rg.220039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Interventional radiology has had an expanding role in women's health over the past few decades, with recent accelerated growth and development. Interventional radiology is fundamental in the treatment of multiple conditions that affect women, including pelvic venous disease, uterine fibroids, and adenomyosis, and in postpartum management. Patient workup, classification, and treatment techniques have continued to evolve as interventional radiology has become more prevalent in the treatment of patients affected by these conditions. The authors provide a review of the pathophysiology of, patient workup for, and treatment of pelvic venous disease and uterine artery embolization for various disease processes. The authors also highlight updates from the past 5-10 years in diagnosis, classification, and treatment strategies. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Mari E Tanaka
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Nicole Keefe
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Theresa Caridi
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Maureen Kohi
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Gloria Salazar
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
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Kröncke T. An update on uterine artery embolization for uterine leiomyomata and adenomyosis of the uterus. Br J Radiol 2023; 96:20220121. [PMID: 36222200 PMCID: PMC9975358 DOI: 10.1259/bjr.20220121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/11/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022] Open
Abstract
Uterine artery embolization (UAE) is an established technique to treat benign diseases of the uterus such as uterine leiomyomata (fibroids) and adenomyosis. This article reviews the use of UAE in these conditions and summarizes the evidence regarding safety and efficacy of the technique based on the current literature.
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Affiliation(s)
- Thomas Kröncke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
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Serrano E, Vas D, Matute M, Gómez F. Técnicas de radiología intervencionista para el manejo del sangrado uterino anormal (SUA). CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2022.100797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Simon A, Robinson F, Anzivino A, Boyer M, Hendricks-Wenger A, Guilliams D, Casey J, Grider D, Valea F, Vlaisavljevich E. Histotripsy for the Treatment of Uterine Leiomyomas: A Feasibility Study in Ex Vivo Uterine Fibroids. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1652-1662. [PMID: 35641394 DOI: 10.1016/j.ultrasmedbio.2022.04.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Uterine fibroids (leiomyomas), the most common benign tumors in women of reproductive age, are a frequent cause of abnormal vaginal bleeding and other reproductive complaints among women. This study investigates the feasibility of using histotripsy, a non-invasive, non-thermal focused ultrasound ablation method, to ablate uterine fibroids. Human fibroid samples (n = 16) were harvested after hysterectomy or myomectomy procedures at Carilion Memorial Hospital. Histotripsy was applied to ex vivo fibroids in two sets of experiments using a 700-kHz clinical transducer to apply multicycle histotripsy pulses and a prototype 500-kHz transducer to apply single-cycle histotripsy pulses. Ultrasound imaging was used for real-time treatment monitoring, and post-treatment ablation was quantified histologically using hematoxylin and eosin and Masson trichrome stains. Results revealed that multicycle histotripsy generated diffuse cavitation in targeted fibroids, with minimal cellular ablative changes after treatment with 2000 pulses/point. Single-cycle pulsing generated well-confined bubble clouds with evidence of early coagulative necrosis on histological assessment in samples treated with 2000 pulses/point, near-complete ablation in samples treated with 4000 pulses/point and complete tissue destruction in samples treated with 10,000 pulses/point. This study illustrates that histotripsy is capable of fibroid ablation under certain pulsing parameters and warrants further investigation as an improved non-invasive ablation method for the treatment of leiomyomas.
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Affiliation(s)
- Alex Simon
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Faith Robinson
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Anthony Anzivino
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Maggie Boyer
- Department of Biological Systems Engineering, Virginia Tech, Blacksburg, Virginia, USA
| | - Alissa Hendricks-Wenger
- Department of Translational Biology, Medicine and Health, Virginia Tech, Blacksburg, VA, USA
| | - Danielle Guilliams
- Department of Research and Development, Carilion Clinic, Roanoke, Virginia, USA
| | - James Casey
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Department of Obstetrics and Gynecology, Carilion Clinic Gynecological Oncology, Roanoke, Virginia, USA
| | - Douglas Grider
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Dominion Pathology Associates, Roanoke, Virginia, USA
| | - Fidel Valea
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; Department of Obstetrics and Gynecology, Carilion Clinic Gynecological Oncology, Roanoke, Virginia, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA.
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Uterine artery embolization for pedunculated subserosal fibroids: a systematic review and meta-analysis. J Vasc Interv Radiol 2022; 33:1025-1031.e3. [DOI: 10.1016/j.jvir.2021.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/10/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
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Naguib N, Vogl T, Nour-Eldin NE. Re: MRI analysis of uterine ischaemia as a form of non-target embolisation following uterine artery embolisation: incidence, extent and outcome. A reply. Clin Radiol 2022; 77:476. [DOI: 10.1016/j.crad.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 11/26/2022]
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12
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Optimizing the Angiography Protocol to Reduce Radiation Dose in Uterine Artery Embolization: The Impact of Digital Subtraction Angiographies on Radiation Exposure. Cardiovasc Intervent Radiol 2022; 45:249-254. [DOI: 10.1007/s00270-021-03032-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/23/2021] [Indexed: 11/02/2022]
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Yilmaz S, Habibi HA, Yildiz A, Altunbas H. Thyroid Embolization for Nonsurgical Treatment of Nodular Goiter: A Single-Center Experience in 56 Consecutive Patients. J Vasc Interv Radiol 2021; 32:1449-1456. [PMID: 34256121 DOI: 10.1016/j.jvir.2021.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To investigate the safety and efficacy of thyroid artery embolization (TAE) in the treatment of nodular goiter (NG). METHODS During a 5.5-year period, 56 consecutive patients with a NG underwent TAE. In Group A, there were 20 patients with a solitary/dominant 5-11-cm nodule, and in Group B, there were 36 patients with numerous nodules. Of the 56 patients, 47 (84%) had a retrosternal goiter and 25 had hyperthyroidism. In all patients, clinical and radiological evaluations were made at baseline and 6 months after TAE, and these parameters were statistically compared. RESULTS In 56 patients, 145 of the 146 thyroid arteries were successfully embolized. The 30-day mortality rate was 1.8%. Minor and major complications occurred in 25 and 2 patients, respectively. Six months after the TAE, the mean nodule volume was reduced from 80.2 mL to 25.0 mL, the mean thyroid volume was reduced from 147.0 mL to 62.6 mL, and the mean intrathoracic extension was reduced from 31.7 mm to 15.9 mm (P < .001). Of the 22 patients with non-Graves hyperthyroidism, 19 (86%) became euthyroid. The mean thyroid-related patient-reported outcome scores improved from 155.4 to 70.4 (P < .001). Of the 51 patients, 50 (98%) declared that they would recommend TAE to other patients with NG. CONCLUSIONS TAE is safe and effective for the treatment of NG, with a significant volume reduction of the nodule(s) and thyroid gland.
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Affiliation(s)
- Saim Yilmaz
- Varisson Radiology Center, Yeşilbahçe Mah, Metin Kasapoğlu Cad Nuri Mancar Apt, D:No:42/A, 07160 Muratpaşa/Antalya, Turkey.
| | - Hatice Arıöz Habibi
- Varisson Radiology Center, Yeşilbahçe Mah, Metin Kasapoğlu Cad Nuri Mancar Apt, D:No:42/A, 07160 Muratpaşa/Antalya, Turkey
| | - Akin Yildiz
- Department of Nuclear Medicine, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Hasan Altunbas
- Department of Endocrinology, Akdeniz University School of Medicine, Antalya, Turkey
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O'Reilly MK, Chick JFB, Lee MJ, Geoghegan T. Endometrial assessment of premenopausal women prior to uterine artery embolization: A cross sectional survey of Interventional Radiologists. Clin Imaging 2021; 76:42-45. [PMID: 33549918 DOI: 10.1016/j.clinimag.2021.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/28/2020] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Michael K O'Reilly
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA.
| | | | - Michael J Lee
- Department of Interventional Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - Tony Geoghegan
- Department of Interventional Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
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15
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Timing of Uterine Artery Embolization for Leiomyoma during the Menstrual Cycle. J Vasc Interv Radiol 2021; 32:332-338. [PMID: 33468366 DOI: 10.1016/j.jvir.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate differences in outcomes of uterine artery embolization (UAE) for leiomyoma when performed during different phases of the menstrual cycle. MATERIALS AND METHODS In this single-institution retrospective analysis, 111 premenopausal patients (median [range] age, 44 [33-52] years) undergoing UAE for symptomatic leiomyoma between June 2014 and February 2020 were included. Twenty-one patients underwent UAE in the menstrual phase (the early follicular phase), 27 in the late follicular phase, and 63 in the luteal phase. Baseline characteristics and technical and peri-procedural outcomes were compared among groups. Leiomyoma infarction on contrast-enhanced magnetic resonance imaging 1 week after UAE and 4-month outcomes, including changes in the Uterine Fibroid Symptom and Quality of Life questionnaire scores, the volume reduction rates of the uterus and largest leiomyoma, follicle stimulating hormone values, adverse events, and amenorrhea, were compared among groups. RESULTS A 4-month follow-up was completed for all patients. No significant differences were observed among groups in baseline characteristics or technical and peri-procedural outcomes. There were no significant differences in the multivariate-adjusted 1-week infarction rates of all leiomyoma volumes (P = .161) or multivariate-adjusted 4-month outcomes, including changes in the Uterine Fibroid Symptom and Quality of Life questionnaire symptoms and total scores (P = .864 and P = .798, respectively), the volume reduction rates of the uterus and the largest leiomyoma (P = .865 and P = .965, respectively), and follicle stimulating hormone values (P = .186) among the groups. No significant differences were noted in the 4-month adverse events (P = .260) or amenorrhea (P = .793) among the groups. CONCLUSIONS The present study demonstrated no significant differences in the outcomes of UAE for leiomyoma when performed during different phases of the menstrual cycle.
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Chua KJ, McLucas B. Pain after uterine artery embolization with intrauterine device in situ. BJR Case Rep 2020; 6:20190128. [PMID: 32922837 PMCID: PMC7465736 DOI: 10.1259/bjrcr.20190128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/09/2020] [Accepted: 03/08/2020] [Indexed: 11/26/2022] Open
Abstract
Uterine artery embolization (UAE) is a minimally invasive option for females with symptomatic leiomyomas. Studies detailing a possible risk with an intrauterine device (IUD) in situ during UAE are limited. A 43-year-old female (Gravida 2, Para 2) underwent UAE with an IUD in situ. On post-procedure day 2, the patient presented with severe lower abdominal pain and mild leukocytosis. Following removal of her IUD, the patient experienced immediate pain relief. Caution is given to clinicians who wish to perform UAE with an IUD in situ.
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Affiliation(s)
- Katherine Jane Chua
- Department of Obstetrics & Gynecology, Saint Peter’s University Hospital, New Brunswick, NJ, USA
| | - Bruce McLucas
- Department of Obstetrics & Gynecology, University of California – Los Angeles, Los Angeles, CA, USA
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17
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Kim MD. Uterine Artery Embolization for Leiomyomas and Adenomyosis: A Pictorial Essay Based on Our Experience from 1300 Cases. Korean J Radiol 2020; 20:1462-1473. [PMID: 31544371 PMCID: PMC6757003 DOI: 10.3348/kjr.2019.0205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/14/2019] [Indexed: 12/04/2022] Open
Abstract
Since its introduction in 1995, uterine artery embolization (UAE) has become an established option for the treatment of leiomyomas. Identification of a leiomyoma using arteriography improves the ability to perform effective UAE. UAE is not contraindicated in a pedunculated subserosal leiomyoma. UAE in a cervical leiomyoma remains a challenging procedure. A leiomyoma with high signal intensity on T2-weighted imaging responds well to UAE, but a malignancy with similar radiological features should not be misdiagnosed as a leiomyoma. Administration of gonadotropin-releasing hormone agonists before UAE is useful in selected patients and is not a contraindication for the procedure. The risk of subsequent re-intervention 5 years after UAE is approximately 10%, which represents an acceptable profile. UAE for adenomyosis is challenging; initial embolization using small particles can achieve better success than that by using larger particles. An intravenous injection of dexamethasone prior to UAE, followed by a patient-controlled analgesia pump and intra-arterial administration of lidocaine after the procedure, are useful techniques to control pain. Dexmedetomidine is an excellent supplemental sedative, showing a fentanyl-sparing effect without causing respiratory depression. UAE for symptomatic leiomyoma is safe and can be an alternative to surgery in most patients with a low risk of re-intervention.
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Affiliation(s)
- Man Deuk Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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18
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Katsumori T, Miura H, Yoshikawa T, Seri S, Kotera Y, Asato A. Intra-Arterial Lidocaine Administration for Anesthesia after Uterine Artery Embolization with Trisacryl Gelatin Microspheres for Leiomyoma. J Vasc Interv Radiol 2020; 31:114-120. [DOI: 10.1016/j.jvir.2019.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/12/2019] [Accepted: 09/14/2019] [Indexed: 10/25/2022] Open
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Mailli L, Auyoung EY, Angileri SA, Ameli-Renani S, Ratnam L, Das R, Chun JY, Das S, Manyonda I, Belli AM. Predicting the Fibroid-Migratory Impact of UAE: Role of Pre-embolization MRI Characteristics. Cardiovasc Intervent Radiol 2019; 43:453-458. [PMID: 31650245 PMCID: PMC6997258 DOI: 10.1007/s00270-019-02348-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022]
Abstract
Aim To investigate potential factors on MR imaging that could be used to predict migration of uterine fibroids post-UAE. Methods and Materials We retrospectively reviewed patients referred for UAE having pre-procedural and 6 months post-procedural MRI, at a tertiary centre, over a 1-year period. Pre- and post-UAE images were reviewed in 64 women by two radiologists to identify the sub-type, dimensions, and infarction rate of each dominant fibroid. The shortest distance between the fibroid and the endometrial wall was measured to determine intramural fibroid movement. Paired sample T tests and two-sample T tests were used to compare between pre- and post-embolization variations and between migrated and non-migrated intramural fibroids, respectively. After preliminary results suggested potential predictors of intramural fibroids migration, we tested our findings against the non-dominant intramural fibroids in the same patients. Results Review of images revealed 35 dominant intramural fibroids, of which eight migrated to become submucosal fibroids, while five were either partially or completely expelled. These 13 migrated fibroids had a shorter pre-procedural minimum endometrial distance (range 1–2.4 mm) and greater maximum fibroid diameter (range 5.1–18.1 cm), when compared to non-migrating fibroids. On image reassessment, the migrated non-dominant intramural fibroids had a minimum endometrial distance and maximum fibroid diameter within the same range. Conclusion Intramural fibroids with a minimum endometrial distance less than 2.4 mm and a maximum fibroid diameter greater than 5.1 cm have a high likelihood of migrating towards the endometrial cavity after UAE.
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Affiliation(s)
- Leto Mailli
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK.
| | - Eric Y Auyoung
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Salvatore A Angileri
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Seyed Ameli-Renani
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Lakshmi Ratnam
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Raj Das
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Joo-Young Chun
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Sourav Das
- Department of Obstetrics and Gynaecology, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Isaac Manyonda
- Department of Obstetrics and Gynaecology, St George's University Hospital and NHS Foundation Trust, London, UK
| | - Anna-Maria Belli
- Diagnostic and Interventional Radiology Department, St George's University Hospital and NHS Foundation Trust, London, UK
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20
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Ierardi AM, Petrillo M, Fumarola EM, Coppola A, Angileri SA, Garanzini E, Silipigni S, Pesapane F, Marconi AM, Carrafiello G. Percutaneous microwave ablation of uterine fibroids: correlation between shrinkage and trend symptoms. MINIM INVASIV THER 2019; 30:33-39. [DOI: 10.1080/13645706.2019.1668417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Mario Petrillo
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Enrico Maria Fumarola
- Scuola di Specializzazione in Radiodiagnostica, Università Degli Studi di Milano, Milan, Italy
| | - Andrea Coppola
- Scuola di Specializzazione in Radiodiagnostica, Uninsubria, Varese, Italy
| | - Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Enrico Garanzini
- Scuola di Specializzazione in Radiodiagnostica, Università Degli Studi di Milano, Milan, Italy
| | - Salvatore Silipigni
- Scuola di Specializzazione in Radiodiagnostica, University of Messina, Messina, Italy
| | - Filippo Pesapane
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Anna Maria Marconi
- Ginecology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Unità Operativa di Radiologia, Cà Granda Ospedale Maggiore Policlinico, Fondazione I.R.C.C.S., Milan, Italy
- Dipartimento di Scienze Della Salute, Università Degli Studi di Milano, Milano, Italy
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21
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Katsumori T, Yoshikawa T, Miura H. Insufficient Leiomyoma Infarction in Uterine Artery Embolization: Relationship with Tumor Location. J Vasc Interv Radiol 2019; 30:668-675.e1. [DOI: 10.1016/j.jvir.2018.11.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022] Open
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Yamahana Y, Katsumori T, Miura H, Asai S, Yamada S, Takahata A, Yamada K. Susceptibility weighted MRI after uterine artery embolization for leiomyoma. Magn Reson Imaging 2019; 58:32-37. [PMID: 30654161 DOI: 10.1016/j.mri.2019.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate whether susceptibility-weighted MR imaging (SWI) findings are associated with tumor infarction on contrast-enhanced MRI (CE-MRI) after uterine artery embolization (UAE) for leiomyoma. METHODS This was a single institution, retrospective study. Between February 2016 and April 2017, 27 consecutive patients underwent UAE and completed SWI and CE-MRI before and 1 week after UAE. Two blinded readers independently reviewed the MRI of 261 tumors ≥1 cm in all patients. We evaluated the relationship between the hypointense peripheral rim observed on the tumor surface on post-procedural SWI and the infarction rates (≥90%, <90%) of each tumor based on post-procedural CE-MRI. Inter-reader correlation coefficients (ICC) and the sensitivity and specificity of the rim were measured. RESULTS Substantial inter-reader agreement was noted in post-procedural SWI interpretations (ICC = 0.681, 95% CI; 0.547, 0.771). The rim was observed in 66.7% (174/261) of tumors by reader 1 and 55.9% (146/261) of tumors by reader 2 on post-procedural SWI. Correlations were observed between the rim and ≥90% tumor infarction by readers 1 and 2 (Spearman's coefficient = 0.474 and 0.438, p < 0.001 and p < 0.001, respectively). The sensitivity and specificity of the rim to tumor infarction were 77.2 and 82.6% (reader 1), and 65.8 and 100% (reader 2), respectively. CONCLUSIONS The present study demonstrated that the hypointense peripheral rim was observed on some leiomyomas on SWI immediately after UAE. The rim correlated with tumor infarction on post-procedural CE-MRI. This SWI finding was helpful for evaluating embolic effects on leiomyomas in the acute phase after UAE.
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Affiliation(s)
- Yasuyuki Yamahana
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Tetsuya Katsumori
- Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto, Shiga 520-3046, Japan
| | - Hiroshi Miura
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Shunsuke Asai
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Sachimi Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Akiko Takahata
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
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Katsumori T, Asai S, Yokota H, Miura H. Volume of embolic agents in uterine artery embolization for leiomyoma: relation to baseline MRI. MINIM INVASIV THER 2018; 28:186-193. [DOI: 10.1080/13645706.2018.1513408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Shunsuke Asai
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Hiroshi Miura
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Uterine Necrosis after Uterine Artery Embolization for Symptomatic Fibroids. Case Rep Obstet Gynecol 2018; 2018:9621741. [PMID: 29998027 PMCID: PMC5994572 DOI: 10.1155/2018/9621741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/21/2018] [Accepted: 04/24/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Uterine artery embolization (UAE) is a minimally invasive intervention that is used in the treatment of fibroids. UAE can lead to complications including postembolization syndrome, postprocedure pain, infection, endometrial atrophy leading to secondary amenorrhea, and uterine necrosis. Uterine necrosis after UAE is very rare and hence poses a clinical dilemma for any clinician in its identification and management. We document a case of uterine necrosis after UAE and conduct a literature review on its causation, clinical features, and management principles. Case A patient presented one month after UAE with abdominal pain and abdominal vaginal discharge. Her work-up revealed features of possible uterine necrosis with sepsis and she was scheduled for a laparotomy and a subtotal hysterectomy was performed. She was subsequently managed with broad spectrum antibiotic and recovered well. Conclusion Uterine necrosis after UAE is a rare occurrence and we hope the documentation of this case will add to the body of knowledge around it. Theories that explain its occurrence include the use of small particles at embolization, the use of Contour-SE a spherical poly-vinyl alcohol, and lack of collateral supply to the uterus. Its symptoms may be nonspecific but unremitting abdominal pain is invariably present. Finally although conservative management may be successful at times, surgical management with hysterectomy will be required in some cases. The prognosis is good after diagnosis and surgical management.
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26
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Chen H, Athreya S. Systematic review of uterine artery embolisation practice guidelines: are all the guidelines on the same page? Clin Radiol 2018; 73:507.e9-507.e15. [DOI: 10.1016/j.crad.2017.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/06/2017] [Indexed: 11/15/2022]
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27
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de Bruijn AM, Lohle PN, Huirne JA, de Vries J, Twisk M, Hehenkamp WJ. Uterine Artery Embolization Versus Hysterectomy in the Treatment of Symptomatic Adenomyosis: Protocol for the Randomized QUESTA Trial. JMIR Res Protoc 2018; 7:e47. [PMID: 29496654 PMCID: PMC5856934 DOI: 10.2196/resprot.8512] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 12/13/2022] Open
Abstract
Background Adenomyosis is a benign uterine disease characterized by invasion of endometrium into the myometrium resulting in heavy menstrual bleeding and pain (dysmenorrhea). Hysterectomy is established as the final treatment option when conservative treatment fails. Uterine artery embolization (UAE) in patients with symptomatic adenomyosis has demonstrated to reduce symptoms and improve quality of life. However, randomized controlled trials are lacking. Objective With this study, we aim to evaluate the impact of UAE on Health-Related Quality of Life (HRQOL) in a randomized comparison to hysterectomy in patients with symptomatic adenomyosis. Methods This is a multicenter non-blinded randomized controlled trial comparing UAE and hysterectomy. Eligible patients are symptomatic premenopausal women without the desire to conceive and who have symptomatic magnetic resonance imaging (MRI)–confirmed pure adenomyosis or dominant adenomyosis accompanied by fibroids. After obtaining informed consent, patients will be randomly allocated to treatment in a 2:1 UAE versus hysterectomy ratio. The primary objective is HRQOL at 6 months following the assigned intervention. Secondary outcomes are technical results, pain management, clinical outcomes, HRQOL, and cost effectiveness during 2 years of follow-up. In addition, transvaginal ultrasound (TVUS) and MRI will be performed at regular intervals after UAE. Results Patient enrollment started November 2015. The follow-up period will be completed two years after inclusion of the last patient. At the time of submission of this article, data cleaning and analyses have not yet started. Conclusions This trial will provide insight for caretakers and future patients about the effect of UAE compared to the gold standard hysterectomy in the treatment of symptomatic adenomyosis and is therefore expected to improve patients’ wellbeing and quality of life. Trial Registration Netherlands Trial Register NTR5615; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5615 (Archived by WebCite at http://www.webcitation.org/6xZRyXeIF)
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Affiliation(s)
- Annefleur Machteld de Bruijn
- Department of Gynaecology and Obstetrics, Vrije Universiteit Medical Center, Vrije Universiteit, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Paul Nm Lohle
- Department of Radiology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Judith Af Huirne
- Department of Gynaecology and Obstetrics, Vrije Universiteit Medical Center, Vrije Universiteit, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands.,Department of Medical and Clinical Psychology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands
| | - Moniek Twisk
- Department of Gynecology, Medical Center Zuiderzee, Lelystad, Netherlands
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- Department of Gynaecology and Obstetrics, Vrije Universiteit Medical Center, Vrije Universiteit, Amsterdam, Netherlands
| | - Wouter Jk Hehenkamp
- Department of Gynaecology and Obstetrics, Vrije Universiteit Medical Center, Vrije Universiteit, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam, Netherlands
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Kim YS, Han K, Kim MD, Kim GM, Kwon JH, Lee J, Choi W, Won JY, Lee DY. Uterine Artery Embolization for Pedunculated Subserosal Leiomyomas: Evidence of Safety and Efficacy. J Vasc Interv Radiol 2018; 29:497-501. [PMID: 29477623 DOI: 10.1016/j.jvir.2017.11.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate safety and efficacy of uterine artery embolization (UAE) for pedunculated subserosal (PS) leiomyomas. MATERIALS AND METHODS Of 1,069 patients who underwent UAE for symptomatic leiomyomas or adenomyosis from 2007 to 2016, 55 patients (mean age 40.3 y ± 4.8) with 66 PS leiomyomas (mean diameter 6.61 cm ± 2.04) were enrolled. Each PS leiomyoma was categorized into 1 of 2 groups: high-risk PS leiomyoma (stalk diameter < 25% of diameter of leiomyoma) and low-risk PS leiomyoma (stalk diameter 25%-50% of diameter of leiomyoma). MR imaging was performed 3 months after UAE. Rates of infarction and volume reduction were compared between PS leiomyomas and non-PS dominant leiomyomas and between high-risk and low-risk PS leiomyomas. Complications related to PS leiomyomas were assessed. RESULTS At a median follow-up of 96 days (range, 36-348 d) after UAE, none of the patients (0%) had complications related to PS leiomyomas, even among high-risk cases. Mean volume reductions of 38.2% and 38.4% were achieved for PS leiomyomas and non-PS dominant leiomyomas, respectively (P = .953). There were 3 (5.5%) minor adverse events, but none were related to PS leiomyoma. There was no significant difference in volume reduction and infarction rates between low-risk and high-risk PS leiomyomas. CONCLUSIONS UAE is safe and effective in patients with PS leiomyomas even for high-risk cases (stalk diameter < 25% of diameter of leiomyoma). PS leiomyoma should not be considered a contraindication for UAE.
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Affiliation(s)
- Yong Seek Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea.
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Junhyung Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Woosun Choi
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
| | - Do Yun Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea
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Vallejo Benitez A, Rodríguez Zarco E, Pabón Carrasco S, de la Chica Rubio V, Pereira Gallardo S, Cabezas Palacios N. Fracasos de la embolización en el tratamiento del mioma uterino. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2018. [DOI: 10.1016/j.gine.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maciel C, Tang YZ, Sahdev A, Madureira AM, Vilares Morgado P. Preprocedural MRI and MRA in planning fibroid embolization. Diagn Interv Radiol 2017; 23:163-171. [PMID: 28163256 DOI: 10.5152/dir.2016.16623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This pictorial review aims to discuss and illustrate the up-to-date use of preprocedural magnetic resonance imaging (MRI) in selecting patients and planning uterine artery embolization (UAE). The merits of magnetic resonance angiography (MRA) in demonstrating the pelvic vasculature to guide UAE are highlighted. MRI features of fibroids and their main differential diagnoses are presented. Fibroid characteristics, such as location, size, and enhancement, which may impact patient selection and outcome, are presented based on recent literature. Pelvic arterial anatomy relevant to UAE, including vascular variants are illustrated, with conventional angiography and MRA imaging correlation. MRA preprocedural determination of the optimal projection angles for uterine artery catheterization is straightforward and constitutes an important strategy to minimize ionizing radiation exposure during UAE. A reporting template for MRI/MRA preassessement of UAE for fibroid treatment is provided.
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Affiliation(s)
- Cristina Maciel
- Department of Radiology, Centro Hospitalar São João, Porto, Portugal.
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Predelivery uterine arteries embolization in patients affected by placental implant anomalies. Radiol Med 2017; 123:71-78. [PMID: 28756581 DOI: 10.1007/s11547-017-0796-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study is to report on a single center experience of managing patients affected by placenta previa major and/or accretism by embolizing uterine arteries immediately before the cesarean delivery to reduce blood loss and secondary the rate of hysterectomies. MATERIALS AND METHODS Sixty-nine patients have been prospectively enrolled. Inclusion criteria were radiological diagnosis of placenta anomalies and risk factors for peri/postpartum hemorrhage. The delivery was electively scheduled between the 35th week and the 36th week of pregnancy. The embolization procedure was performed in the gynecological operating room with a mobile C-arm by injecting calibrated microparticles 500-700 μm. A contrast-enhanced MRI was acquired in a subgroup of 10 patients 6 months after the delivery to evaluate the uterine wall status. RESULTS Hysterectomy had been performed in 43.5%; 52.2% did not require blood transfusions; 1.2 blood units per patient had been meanly transfused. The mean fluoroscopy beam-on time was 195 s per patient. The mean uterine dose was 26.75 mGy. No pH anomalies were measured from the umbilical cord blood; the Apgar score at 5 min was ≥8. The analysis of the neuro-developmental milestones showed normal cognitive development in all children at 6 months. The uterine wall enhancement evaluated with contrast-enhanced MRI 6 months after the embolization procedure showed preserved myometrial perfusion without area of necrosis. CONCLUSIONS In this series of patients, the predelivery uterine arteries' embolization was a safe and effective procedure; this may represent a technical alternative that interventional radiologists can consider when facing this challenging scenario.
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Abstract
OBJECTIVE The purpose of this study was to compare the outcomes of second uterine artery embolization (UAE) with those of first UAE for symptomatic uterine leiomyoma. MATERIALS AND METHODS In this single-institution retrospective study, between December 1997 and May 2016 first UAE was performed on 423 consecutively registered patients and second UAE on 11 consecutively registered patients to treat leiomyoma. The primary endpoint was infarction of all tumor tissue as seen at postprocedural contrast-enhanced MRI. The secondary endpoints were angiographic findings, embolization, MRI, and clinical outcomes 1 year after UAE. The outcomes were compared between the two groups. Multivariable linear regression analysis was performed to assess independent correlations with tumor infarction. RESULTS Most of the baseline demographic features and technical outcomes in the two groups were similar. In the second UAE group, all but one uterine artery was reopened. More collateral vessels were observed at the second UAE (1.1/patient versus 0.23/patient, p = 0.043). Contrast-enhanced MRI after UAE revealed that the tumor infarction rate was significantly lower in the second UAE group (69.8 ± 33.9% vs 96.8 ± 9.0%, p = 0.025). The difference remained significant after adjustments for possible confounders (p < 0.001). Whether UAE was a first or a second procedure was significantly associated with tumor infarction rate (p < 0.001). The uterine volume reduction rate 1 year after UAE was significantly lower in the second UAE group (33.4 ± 18.1% versus 46.9 ± 16.6%, p = 0.008). No other 1-year outcomes were significantly different between the groups. CONCLUSION Second UAE was effective but inferior to first UAE in that it resulted in less tumor infarction at contrast-enhanced MRI and had a lower uterine volume reduction rate.
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Katsumori T, Miura H, Arima H, Hino A, Tsuji Y, Masuda Y, Nishimura T. Tris-acryl gelatin microspheres versus gelatin sponge particles in uterine artery embolization for leiomyoma. Acta Radiol 2016; 58:834-841. [DOI: 10.1177/0284185116674499] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Tris-acryl gelatin microspheres (TAGM) and gelatin sponge particles (GS) have been used in uterine artery embolization (UAE) for leiomyoma. No direct comparisons of both embolic agents have been reported. Purpose To compare the outcomes of UAE with TAGM with those of UAE with GS for uterine leiomyoma. Material and Methods This was a non-randomized, single-institute, non-inferiority study. Between July 2008 and August 2015, 67 consecutive patients with symptomatic leiomyoma underwent UAE. GS was used for the first 49 patients and TAGM was used for the following 18 patients. The primary endpoint was tumor infarction on contrast-enhanced magnetic resonance imaging (MRI) 1 week after UAE. The secondary endpoints were changes in symptoms and quality-of-life scores with UFS-QOL questionnaires at 4 months, and adverse events (AEs) in the 4 months after UAE. Results The baseline characteristics of both groups were similar. Complete or nearly complete tumor infarction (≥90%) was achieved in 94.4% (17/18) of the TAGM group and 93.6% (44/47) of the GS group. This difference (0.8%; 95% CI, –11.9% to 13.5%) indicated the non-inferiority of the TAGM group to the GS group, with a pre-specified non-inferiority margin of 20%. No significant differences were observed in improvements in symptoms or quality-of-life scores at 4 months ( P = 0.56 and P = 0.19) or in 4-month AEs ( P = 0.29). Conclusion The outcomes of UAE with TAGM were comparable to those of UAE with GS, suggesting that both embolic agents are acceptable for the treatment of leiomyoma.
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Affiliation(s)
| | - Hiroshi Miura
- Department of Radiology, Saiseikai Shiga Hospital, Shiga, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akihiko Hino
- Department of Neurosurgery, Saiseikai Shiga Hospital, Shiga, Japan
| | - Yusuke Tsuji
- Department of Radiology, Saiseikai Shiga Hospital, Shiga, Japan
| | - Yoko Masuda
- Department of Radiology, Saiseikai Shiga Hospital, Shiga, Japan
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Rischbieter P, Sinclair C, Lawson A, Ahmad S. Uterine artery embolisation as an effective choice for symptomatic fibroids: Five-year outcome. SA J Radiol 2016. [DOI: 10.4102/sajr.v20i1.959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Uterine artery embolisation for the treatment of symptomatic uterine fibroids is a relatively new but internationally recognised procedure. The present study seeks to report the results of the largest South African series of uterine artery embolisations for symptomatic fibroids to date. It is the fourth article to be published in South Africa on the outcomes of this procedure, and the largest South African series to date. Objective: To evaluate the long-term efficacy of uterine artery embolisation in women with symptomatic fibroids in a tertiary hospital in South Africa. Methods: Eighty-two women who presented for uterine artery embolisation at a single site in South Africa for symptomatic fibroids were retrospectively studied. Outcomes included recurrence and re-intervention rates, patient satisfaction and complication rate. Results: Two patients required repeat embolisation, and one patient experienced fibroid recurrence without further intervention. No repeat myomectomies were performed. Eighty percent of patients reported being satisfied, 12% partially satisfied and 7% not satisfied. No major complications were reported. Conclusion: Uterine artery embolisation was shown to be a good choice in the treatment of symptomatic fibroids and presents favourable long-term outcomes in the South African population.
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Zupi E, Centini G, Sabbioni L, Lazzeri L, Argay IM, Petraglia F. Nonsurgical Alternatives for Uterine Fibroids. Best Pract Res Clin Obstet Gynaecol 2015; 34:122-31. [PMID: 26711881 DOI: 10.1016/j.bpobgyn.2015.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 11/18/2015] [Indexed: 12/31/2022]
Abstract
Uterine leiomyomata are the direct cause of a significant health-care burden for women, their families, and society as a whole. Because of the long experience with the mode of treatment, surgical myomectomy remains the gold standard for treating reproductive-age women; however, in the recent years, the wide evolution of less invasive approaches led to a change in the options used by the clinician to treat symptomatic fibroids. Minimally invasive procedures such as uterine artery embolization (UAE) are increasingly used to treat symptomatic fibroids. Other alternative treatments are becoming more diffuse, such as magnetic resonance-guided high-frequency focused ultrasound surgery (MRgFUS), cryomyolysis, vaginal occlusion, and laparoscopic closure of the uterine arteries. Both advantages and limitations of these techniques under development must be taken into account, but this wider range of choices is being increasingly considered for a tailored treatment. This article aims to enable health-care providers with the tools to provide the latest evidence-based care in the minimally invasive or noninvasive management of this common problem.
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Affiliation(s)
- Errico Zupi
- Department of Biomedicine and Prevention University of Tor Vergata, Rome, Italy.
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Lorenzo Sabbioni
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - István Máté Argay
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Felice Petraglia
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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