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Teo UL, Kopeika J, Pundir J, El-Toukhy T. Peri-operative morbidity and fertility outcome after repeat abdominal myomectomy for large fibroid uterus. J OBSTET GYNAECOL 2019; 40:673-677. [DOI: 10.1080/01443615.2019.1647520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ung Lim Teo
- Department of Obstetrics and Gynaecology, Guys’ and St. Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Julia Kopeika
- Department of Obstetrics and Gynaecology, Guys’ and St. Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Jyotsna Pundir
- Department of Obstetrics and Gynaecology, Guys’ and St. Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Tarek El-Toukhy
- Department of Obstetrics and Gynaecology, Guys’ and St. Thomas’ Hospital NHS Foundation Trust, London, UK
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2
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Chen LK, Yang BL, Chen KC, Tsai YL. Successful Transarterial Embolization of Uterine Arteriovenous Malformation: Report of Three Cases. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e15358. [PMID: 27110329 PMCID: PMC4835739 DOI: 10.5812/iranjradiol.15358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 05/24/2014] [Accepted: 05/31/2014] [Indexed: 12/25/2022]
Abstract
Uterine arteriovenous malformations (AVMs) are relatively rare disorders that can cause life-threatening vaginal bleeding. We describe three childbearing-age females, who had abdominal pain and heavy vaginal bleeding, and were diagnosed as uterine AVM by color Doppler and angiography. The patients received successful superselective transarterial embolization (TAE) with N-butyl cyanoacrylate (NBCA). Three years after treatment, one of them was admitted to our hospital for vaginal delivery at 39 weeks of gestation, and the baby was healthy.
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Affiliation(s)
- Liang-Kuang Chen
- Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, National Taiwan University, Taipei, Taiwan
- Corresponding author: Liang-Kuang Chen, Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. Tel: +886-228332211, Fax: +886-228389359, E-mail:
| | - Bi-Li Yang
- Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Tzu Chi University, Taipei, Taiwan
| | - Kuo-Chang Chen
- Department of Diagnostic Radiology, Shin Kong Wu Ho-Su Memorial Hospital, Chung Shan Medical University, Taipei, Taiwan
| | - Yieh-Loong Tsai
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, Kaohsiung Medical University, Taipei, Taiwan
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3
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Bongers M, Brölmann H, Gupta J, Garza-Leal JG, Toub D. Transcervical, intrauterine ultrasound-guided radiofrequency ablation of uterine fibroids with the VizAblate® System: three- and six-month endpoint results from the FAST-EU study. ACTA ACUST UNITED AC 2014; 12:61-70. [PMID: 25774122 PMCID: PMC4349947 DOI: 10.1007/s10397-014-0873-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Abstract
This was a prospective, longitudinal, multicenter, single-arm controlled trial, using independent core laboratory validation of MRI results, to establish the effectiveness and confirm the safety of the VizAblate® System in the treatment of symptomatic uterine fibroids. The VizAblate System is a transcervical device that ablates fibroids with radiofrequency energy, guided by a built-in intrauterine ultrasound probe. Fifty consecutive women with symptomatic uterine fibroids received treatment with the VizAblate System. Patients had a minimum Menstrual Pictogram score of 120, no desire for fertility, and met additional inclusion and exclusion criteria. The VizAblate System was inserted transcervically and individual fibroids were ablated with radiofrequency energy. An integrated intrauterine ultrasound probe was used for fibroid imaging and targeting. Anesthesia was at the discretion of each investigator. The primary study endpoint was the percentage change in perfused fibroid volume, as assessed by contrast-enhanced MRI at 3 months. Secondary endpoints, reached at 6 months, included safety, percentage reductions in the Menstrual Pictogram (MP) score and the Symptom Severity Score (SSS) subscale of the Uterine Fibroid Symptom-Quality of Life questionnaire (UFS-QOL), along with the rate of surgical reintervention for abnormal uterine bleeding and the mean number of days to return to normal activity. Additional assessments included the Health-Related Quality of Life (HRQOL) subscale of the UFS-QOL, medical reintervention for abnormal uterine bleeding, and procedure times. Fifty patients were treated, representing 92 fibroids. Perfused fibroid volumes were reduced at 3 months by an average of 68.8 ± 27.8 % (P < 0.0001; Wilcoxon signed-rank test). At 6 months, mean MP and SSS scores decreased by 60.8 ± 38.2 and 59.7 ± 30.4 %, respectively; the mean HRQOL score increased by 263 ± 468 %. There were two serious adverse events (overnight admissions for abdominal pain and bradycardia, respectively) and no surgical reinterventions. These 6-month results suggest that the VizAblate System is safe and effective in providing relief of abnormal uterine bleeding associated with fibroids, with appropriate safety and a low reintervention rate.
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Affiliation(s)
| | - Hans Brölmann
- Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands
| | | | | | - David Toub
- Gynesonics, Inc., Redwood City, CA USA
- Department of Obstetrics and Gynecology, Albert Einstein Medical Center, Philadelphia, PA USA
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4
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Pundir J, Kopeika J, Harris L, Krishnan N, Uwins C, Siozos A, Khalaf Y, El-Toukhy T. Reproductive outcome following abdominal myomectomy for a very large fibroid uterus. J OBSTET GYNAECOL 2014; 35:37-41. [DOI: 10.3109/01443615.2014.930097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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5
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Firouznia K, Ghanaati H, Jalali AH, Shakiba M. Uterine artery embolization for treatment of symptomatic fibroids: a review of the evidence. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e16699. [PMID: 24693405 PMCID: PMC3955520 DOI: 10.5812/ircmj.16699] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 06/25/2013] [Accepted: 08/27/2013] [Indexed: 12/17/2022]
Abstract
Fibroids are the most common benign tumors of the uterus during female reproductive age. Uterine artery embolization (UAE) using embolic particles (PVA, Gelfoam) to occlude the uterine arteries, have been reported as a relatively safe, effective, and durable nonsurgical alternative to hysterectomy in diminishing fibroid-related symptoms. To block the arterial blood supply to the fibroid completely, UAE is typically performed in both uterine arteries by an experienced interventional radiologist. Reduction in menorrhagia has been reported as 80-93 percent and the mean decrease in fibroid size varies from 50-78% in the literature. In our center improvement in menstrual bleeding after 6 months was 80.3%, and uterine fibroids underwent shrinkage of 63.7±33.7% after12 months. Complication rate including amenorrhea ranges from 1% - 7% in the literature. UAE may be followed by menopause in 1% of cases. Nevertheless, it is usually encountered in women in their late 40s. It seems that the future of UAE depends on optimal selection of patients according to volume-shrinkage prediction and fertility outcome. Although pregnancy is possible after embolization, however neither fertility preservation nor improvement can be guaranteed following UAE. Indeed, Women who desire to become pregnant should be cautioned about potential complications during pregnancy. The aim of this review is to discuss about the efficacy, safety, technique, and choice of embolic agent. Also we present the effects of this technique on fertility and pregnancy outcome and also methods for dose reduction during this procedure.
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Affiliation(s)
- Kavous Firouznia
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Kavous Firouznia, Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166581579, Fax: +98-2166581578, E-mail:
| | - Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
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6
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Zhao D, Rogers PAW. Is fibroid heterogeneity a significant issue for clinicians and researchers? Reprod Biomed Online 2013; 27:64-74. [PMID: 23669014 DOI: 10.1016/j.rbmo.2013.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/17/2013] [Accepted: 04/02/2013] [Indexed: 11/16/2022]
Abstract
The clinical and scientific literature overwhelmingly deals with fibroids as a single entity or disease. This convenient assumption of homogeneity may be an important oversight given that substantial evidence exists for heterogeneity between fibroids at many levels. Failure to recognize and accommodate fibroid heterogeneity can have significant ramifications for both clinical treatment decisions and research protocol design. The aim of this article is to review the current knowledge of fibroid heterogeneity and to identify key areas where fibroid heterogeneity should be taken into consideration both clinically and when designing research protocols. Uterine leiomyomata display significant and well-documented heterogeneity in symptoms, diagnostic imaging appearance, pathology, genetic background and therapeutic requirements. Additional research is needed to better understand fibroid heterogeneity as it relates to pathogenesis, molecular targets for potential new therapies, patient symptoms and, ultimately, treatment. To this list should also be added heterogeneity of genetics, lifestyle and individual clinical characteristics of the fibroid. Increasingly, an understanding of uterine leiomyoma heterogeneity will be of importance for clinicians who see patients with this common and costly disease.
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Affiliation(s)
- Dong Zhao
- Department of Minimally Invasive Gynecological Surgery, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200040, PR China
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Ito N, Natimatsu Y, Tsukada J, Sato A, Hasegawa I, Lin BL. Two cases of postmyomectomy pseudoaneurysm treated by transarterial embolization. Cardiovasc Intervent Radiol 2013; 36:1681-1685. [PMID: 23354964 DOI: 10.1007/s00270-013-0551-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 12/07/2012] [Indexed: 11/30/2022]
Abstract
Pseudoaneurysm resulting from hysteroscopic myomectomy is a rare clinical situation, and interventional radiologists are not traditionally involved in the management. To our knowledge, endovascular treatment of a pseudoaneurysm resulting from hysteroscopic myomectomy has not yet been reported in the English-language literature. Here, two such cases are reported, including one of a woman who later became pregnant. The case is unique because little is known about the influence of unilateral coil embolization of the uterine artery on fertility.
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Affiliation(s)
- Nobutake Ito
- Department of Diagnostic Radiology, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Yoshiaki Natimatsu
- Department of Diagnostic Radiology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kanagawa, 210-0013, Japan
| | - Jitsuro Tsukada
- Department of Diagnostic Radiology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kanagawa, 210-0013, Japan
| | - Akihiro Sato
- Department of Diagnostic Radiology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kanagawa, 210-0013, Japan
| | - Ichiro Hasegawa
- Department of Diagnostic Radiology, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kanagawa, 210-0013, Japan
| | - Bao-Liang Lin
- Department of Gynecologic Endoscopy, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kanagawa, 210-0013, Japan
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8
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O'Driscoll D, Malone DE, Johnston C. Your Patient Has Symptomatic Fibroids and Would like to Have a Baby: What Treatment Should you Advise? Can Assoc Radiol J 2012; 63:2-4. [DOI: 10.1016/j.carj.2010.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 08/02/2010] [Accepted: 08/03/2010] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Dermot E. Malone
- University College Dublin, St Vincent's University Hospital, Elm Park, Dublin, Ireland
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9
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Subsequent pregnancy after two uterine artery embolizations. Arch Gynecol Obstet 2011; 285:1189-90. [PMID: 22042167 DOI: 10.1007/s00404-011-2129-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/18/2011] [Indexed: 10/16/2022]
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10
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Vo NJ, Andrews RT. Uterine artery embolization: a safe and effective, minimally invasive, uterine-sparing treatment option for symptomatic fibroids. Semin Intervent Radiol 2011; 25:252-60. [PMID: 21326515 DOI: 10.1055/s-0028-1085923] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Leiomyomas (or fibroids) are exceedingly common lesions. The indications to initiate treatment are based on the symptoms that can arise from their presence. In general, medical therapy should be considered the first line of treatment. Currently, the treatment of fibroids is in evolution. Since uterine artery embolization (UAE) was first described by Ravina et al in 1995, it has been shown to be a safe, efficacious, and cost-effective alternative to traditional surgical options, with data from long-term studies now available. Appropriate patient evaluation and selection are vital; the ideal candidate is one who is premenopausal, has symptomatic fibroids resistant to medical therapy, no longer desires fertility, and wishes to maintain her uterus. Uterine artery embolization is primarily an angiographic procedure, but periprocedural clinical management is critical for patient satisfaction. This article discusses the various embolic materials that are commonly used and available for UAE; understanding the technical nuances is critical for long-term success.
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Affiliation(s)
- Nghia-Jack Vo
- Department of Radiology, Section of Vascular and Interventional Radiology University of Washington, Seattle, Washington
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Garza-Leal JG, Toub D, León IH, Saenz LC, Uecker D, Munrow M, King D, Bajor J, Coad J. Transcervical, intrauterine ultrasound-guided radiofrequency ablation of uterine fibroids with the VizAblate System: safety, tolerability, and ablation results in a closed abdomen setting. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10397-010-0655-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Stokes LS, Wallace MJ, Godwin RB, Kundu S, Cardella JF. Quality Improvement Guidelines for Uterine Artery Embolization for Symptomatic Leiomyomas. J Vasc Interv Radiol 2010; 21:1153-63. [DOI: 10.1016/j.jvir.2010.03.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 03/01/2010] [Accepted: 03/13/2010] [Indexed: 11/26/2022] Open
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13
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The role of interventional radiology in obstetric hemorrhage. Cardiovasc Intervent Radiol 2010; 33:887-95. [PMID: 20464555 DOI: 10.1007/s00270-010-9864-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 01/20/2010] [Indexed: 12/12/2022]
Abstract
Obstetric hemorrhage remains a major cause of maternal morbidity and mortality worldwide. Traditionally, in cases of obstetric hemorrhage refractory to conservative treatment, obstetricians have resorted to major surgery with the associated risks of general anesthesia, laparotomy, and, in the case of hysterectomy, loss of fertility. Over the past two decades, the role of pelvic arterial embolization has evolved from a novel treatment option to playing a key role in the management of obstetric hemorrhage. To date, interventional radiology offers a minimally invasive, fertility-preserving alternative to conventional surgical treatment. We review current literature regarding the role of interventional radiology in postpartum hemorrhage, abnormal placentation, abortion, and cervical ectopic pregnancy. We discuss techniques, success rates, and complications.
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Intramyometrial ectopic pregnancy in an ICSI patient following uterine artery embolization. Reprod Biomed Online 2010; 20:831-5. [PMID: 20382082 DOI: 10.1016/j.rbmo.2010.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 07/29/2009] [Accepted: 01/25/2010] [Indexed: 12/26/2022]
Abstract
Myometrial pregnancy represents a rare subtype of ectopic pregnancy. A history of uterine artery embolization (UAE) because of symptomatic uterine fibroids, and assisted reproductive treatment may predispose to this unusual implantation site. A 40-year-old woman with a history of uterine fibroids underwent a transfer of two embryos after intracytoplasmic sperm injection treatment. The combined findings on transvaginal ultrasound scan, pelvic magnetic resonance imaging scan, suction curettage, diagnostic hysteroscopy and laparoscopy were compatible with a diagnosis of ectopic pregnancy within the myometrium, at the site of a necrotized intramyometrial fibroid following UAE. Treatment with systemic methotrexate resulted in successful resolution of this ectopic pregnancy. In conclusion, this study reports a pregnancy within a previously necrotized fibroid. Findings suggest that in patients with a history of UAE for the treatment of uterine fibroids and who subsequently undergo assisted reproductive treatment, the risk of an ectopic pregnancy within the myometrium has to be considered.
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Bradley LD. Uterine fibroid embolization: a viable alternative to hysterectomy. Am J Obstet Gynecol 2009; 201:127-35. [PMID: 19646564 DOI: 10.1016/j.ajog.2009.01.031] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 12/18/2008] [Accepted: 01/16/2009] [Indexed: 11/30/2022]
Abstract
Benign uterine fibroids, or leiomyomas, are the most common tumors found in gynecologic practice. Symptomatic fibroids present with menorrhagia, pelvic pain, leukorrhea, pressure and bloating, increased abdominal girth, and severe dysmenorrhea. Traditional treatment has relied on surgery because long-term medical therapies have demonstrated only minimal response. Uterine fibroid embolization (UFE) using particulate emboli to occlude the uterine arteries, thereby disrupting the blood supply to fibroids and leading to devascularization and infarction, has been reported to be effective in alleviating fibroid-related symptoms. UFE is a safe, effective, and durable nonsurgical alternative to hysterectomy.
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Affiliation(s)
- Linda D Bradley
- Department Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
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Wang PH, Liu WM, Fuh JL, Chao HT, Yuan CC, Chao KC. Symptomatic myoma treated with laparoscopic uterine vessel occlusion and subsequent immediate myomectomy: which is the optimal surgical approach? Fertil Steril 2009; 92:762-9. [DOI: 10.1016/j.fertnstert.2008.06.038] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 05/21/2008] [Accepted: 06/23/2008] [Indexed: 11/26/2022]
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Wang LM, Wang PH, Chen CL, Au HK, Yen YK, Liu WM. Uterine preservation in a woman with spontaneous uterine rupture secondary to placenta percreta on the posterior wall: A case report. J Obstet Gynaecol Res 2009; 35:379-84. [DOI: 10.1111/j.1447-0756.2008.00936.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Laparoscopic Uterine Vessel Occlusion in the Treatment of Women with Symptomatic Uterine Myomas with and without Adding Laparoscopic Myomectomy: 4-Year Results. J Minim Invasive Gynecol 2008; 15:712-8. [DOI: 10.1016/j.jmig.2008.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 07/29/2008] [Accepted: 08/01/2008] [Indexed: 11/19/2022]
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Successful use of uterine artery embolisation to treat placenta increta in the first trimester. Arch Gynecol Obstet 2008; 279:713-5. [DOI: 10.1007/s00404-008-0789-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2008] [Accepted: 08/25/2008] [Indexed: 10/21/2022]
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21
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