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DOI: 10.1055/s-0028-1102997
Uterine Artery Embolization in the Management of Symptomatic Uterine Fibroids: An Overview of Complications and Follow-up
Publikationsverlauf
Publikationsdatum:
15. Dezember 2008 (online)
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ABSTRACT
Uterine artery embolization (UAE) evolved as a treatment for symptomatic uterine fibroids in the early 1990s, after initially being used as a temporizing measure prior to hysterectomy or myomectomy. Since that time, over 100,000 UAEs have been performed. Technical success rates have been quoted ranging from 94 to 99%. The overall incidence of major complications associated with the procedure is low, the majority of which can be prevented. Knowledge of the potential complications and the measures that can be taken to avoid these complications is essential. Furthermore, because UAE is a relatively new procedure, no standardized recommendations for patient follow-up exist. Common practice for patient follow-up includes both clinic visits at increasing time intervals postprocedure, as well as telephone follow-up, and imaging follow-up when necessary. As symptomatic improvement is subjective, some institutions have developed standardized questionnaires to better assess patient improvement postprocedure. Aggressive pain control is a crucial component of follow-up, as uncontrolled pain can result in readmission and patient dissatisfaction.
KEYWORDS
Uterine artery embolization - fibroids - leiomyomata
REFERENCES
- 1 Goodwin S C, Wong G C. Uterine artery embolization for uterine fibroids: a radiologist's perspective. Clin Obstet Gynecol. 2001; 44(2) 412-424
- 2 Ravina J H, Herbetreau D, Ciraru-Vigneron N et al.. Arterial embolization to treat uterine myomata. Lancet. 1995; 346 671-672
- 3 Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists . ACOG Committee Opinion: uterine artery embolization. Obstet Gynecol. 2004; 103 403-404
- 4 Hehenkamp W J, Volkers N A, Donderwinkel P F et al.. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): Peri- and postprocedural results from a randomized control trial. Am J Obstet Gynecol. 2005; 193 1618-1629
- 5 Andersen P E, Lund N, Justesen P et al.. Uterine artery embolization of symptomatic uterine fibroids. Acta Radiol. 2001; 42 234-238
- 6 Dutton S, Hirst A, McPherson K, Nicholson T, Maresh M A. UK Multicentre retrospective cohort study comparing hysterectomy and uterine artery embolization for the treatment of symptomatic uterine fibroids (HOPEFUL study): main results on medium term safety and efficacy. BJOG. 2007; 114 1340-1351
- 7 Edwards R D, Moss J G, Lumsden M A et al.. Uterine artery embolization versus surgery for symptomatic uterine fibroids. The REST investigators. N Engl J Med. 2007; 356 360-370
- 8 Shashoua A R, Stringer N H, Pearlman J B, Behmaram B, Stringer E A. Ischemic uterine rupture and hysterectomy 3 months after uterine artery embolization. J Am Assoc Gynecol Laparosc. 2002; 9 217-220
- 9 Ryan J M. Misinterpretation of postembolization syndrome after conservative treatment of fibroids. J Vasc Interv Radiol. 2004; 15 99-100
- 10 McLucas B, Adler L, Perrella R et al.. Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids. J Am Coll Surg. 2001; 192 195-105
- 11 Siskin G P, Stainken B F, Dowling K et al.. Outpatient uterine artery embolization for symptomatic uterine fibroids: experience in 49 patients. J Vasc Interv Radiol. 2000; 11(3) 305-311
- 12 Pinto I et al.. Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment: a prospective, randomized, and controlled clinical trial. Radiology. 2003; 226 425-431
- 13 Goodwin S C, Walker W J. Uterine artery embolization for the treatment of uterine fibroids. Curr Opin Obstet Gynecol. 1998; 10 315-320
- 14 Ahmad A, Qadan L, Hassan N, Najarian K. Uterine artery embolization treatment of uterine fibroids: effect on ovarian function in younger women. J Vasc Interv Radiol. 2002; 13 1017-1020
- 15 Mara M, Maskova J, Fucikova Z et al.. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol. 2008; 31 73-85
- 16 Banu N S, Gaze D C, Bruce H et al.. Markers of muscle ischemia, necrosis and inflammation following uterine artery embolization in the treatment of symptomatic uterine fibroids. Am J Obstet Gynecol. 2007; 196 213e.1-213e.5
- 17 Dubreuil-Chambardel L. Traité des Variations du System Artériel Variations des Artères du Pelvis et du Membre Inferieur. Paris; Masson et Cie 1925
- 18 Lai A C, Goodwin S C, Bonilla S M et al.. Sexual dysfunction after uterine artery embolization. J Vasc Interv Radiol. 2000; 11 755-758
- 19 Nikolic B, Spies J B, Lundstein M et al.. Patient radiation dose associated with uterine artery embolization (UAE) for leiomyomas. Radiology. 2000; 214(1) 121-125
- 20 White A M, Banovac F, Spies J B. Patient radiation exposure during uterine fibroid embolization and the dose attributable to aortography. J Vasc Interv Radiol. 2007; 18 573-576
- 21 Klein A, Schwartz M. Uterine artery embolization for treatment of uterine fibroids: an outpatient procedure. Am J Obstet Gynecol. 2001; 184 1556-1563
- 22 Siskin G P, Shlansky-Goldberg R D, Goodwin S C et al.. A prospective multi-center comparative study between myomectomy and uterine artery embolization with polyvinyl alcohol microspheres: long term clinical outcomes in patients with symptomatic uterine fibroids. J Vasc Interv Radiol. 2006; 17 1287-1295
- 23 Spies J B, Coyne K, Guaou Guaou N et al.. The UFS-QOL, a new disease-specific symptom and health related quality of life questionnaire for leiomyomata. Obstet Gynecol. 2002; 99 290-300
- 24 Pelage J P, Guaou N G, Jha R C et al.. Uterine fibroid tumors: long-term MR imaging outcome after embolization. Radiology. 2004; 230 803-809
- 25 Toor S S, Tan K T, Simons M E et al.. Clinical failure after uterine artery embolization: evaluation of patient and MR imaging characteristics. J Vasc Interv Radiol. 2008; 19 662-667
- 26 Nikolic B, Spies J B, Abbara S, Goodwin S C. Ovarian artery supply of uterine fibroids as a cause of treatment failure after uterine artery embolization: a case report. J Vasc Interv Radiol. 1999; 10(9) 1167-1170
Tami C CarrilloM.D.
Department of Radiology, University of Illinois at Chicago Hospital
M/C 960, 1740 West Taylor, Chicago, IL 60612
eMail: tcchope@gmail.com