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Rofo 2002; 174(10): 1227-1235
DOI: 10.1055/s-2002-34563
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Transarterielle Embolisation von Uterusmyomen - Eine neue Therapieoption bei symptomatischem Uterus myomatosus

Uterine Fibroid Embolization - a New Therapeutic Option for Symptomatic Leiomyomata of the UterusT.  J.  Kröncke1 , A.  Gauruder-Burmester1 , B.  Hamm1
  • 1Institut für Radiologie, Universitätsklinikum Charité, Campus Mitte, Humboldt-Universität zu Berlin
Prof. Dr. med. Paul Romaniuk zum 65. Geburtstag gewidmet
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Publication History

Publication Date:
10 October 2002 (online)

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Zusammenfassung

Die transarterielle Embolisation von Uterusmyomen ist eine neue minimal-invasive Therapie beim symptomatischen Uterus myomatosus und stellt eine gebärmuttererhaltende Behandlungsalternative zu den gynäkologisch-operativen Verfahren dar. Die bisher vorliegenden mittelfristigen Ergebnisse zeigen eine hohe klinische Erfolgsrate mit Verbesserung von myombedingten Blutungsbeschwerden in 80 - 100 %, Verbesserung der Beschwerden durch raumfordernde Wirkung der Leiomyome in 60 - 100 % der Fälle und Größenreduktion der Myomknoten um durchschnittlich 36 - 78 % bei geringer Komplikations- und Nebenwirkungsrate. In der vorliegenden Übersichtsarbeit soll anhand der aktuellen Literatur und eigener Erfahrungen eine Übersicht zu Indikationen und Kontraindikationen, Technik und Pathophysiologie der Embolisation, Materialauswahl, Ergebnissen und Komplikationen des Verfahrens gegeben werden.

Abstract

Uterine fibroid embolization (UFE) is a new minimal-invasive therapy for the treatment of symptomatic leiomyomata of the uterus and a uterine-sparing alternative to surgical procedures. Short-term and mid-term results indicate a high clinical success rate with improvement of fibroid-related bleeding symptoms in 80 - 100 % of cases, improvement of bulk symptoms in 60 - 100 % of cases and reduction in fibroid volume at an average of about 36 - 78 % combined with a low rate of complications and side effects. This review discusses indications and contraindications, technique and pathophysiology, choice of material, results and complications of UFE on the basis of the current literature and our own results.


Schlüsselwörter

Interventionelle Radiologie - Vaskuläre Interventionen - Embolisation - Uterus - Leiomyome

Key words

Interventional radiology - vascular interventions - embolization - uterus - leiomyomata

Literatur

  • 1 Stewart E A. Uterine fibroids.  Lancet. 2001;  357 293-298
    CrossrefPubMedGoogle Scholar
  • 2 Farquhar C M, Steiner C A. Hysterectomy rates in the United States 1990 - 1997.  Obstet Gynecol. 2002;  99 229-234
    CrossrefPubMedGoogle Scholar
  • 3 Greenberg M D, Kazamel T I. Medical and socioeconomic impact of uterine fibroids.  Obstet Gynecol Clin North Am. 1995;  22 625-636
    PubMedGoogle Scholar
  • 4 Ravina J H, Herbreteau D, Ciraru-Vigneron N, Bouret J M, Houdart E, Aymard A, Merland J J. Arterial embolisation to treat uterine myomata.  Lancet. 1995;  346 671-672
    CrossrefPubMedGoogle Scholar
  • 5 Townsend D E, Sparkes R S, Baluda M C, McClelland G. Unicellular histogenesis of uterine leiomyomas as determined by electrophoresis by glucose-6-phosphate dehydrogenase.  Am J Obstet Gynecol. 1970;  107 1168-1173
    CrossrefPubMedGoogle Scholar
  • 6 Parker W H, Fu Y S, Berek J S. Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing leiomyoma.  Obstet Gynecol. 1994;  83 414-418
    PubMedGoogle Scholar
  • 7 McLucas B, Adler L, Perrella R. Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids.  J Am Coll Surg. 2001;  192 95-105
    CrossrefPubMedGoogle Scholar
  • 8 Goodwin S C, Walker W J. Uterine artery embolization for the treatment of uterine fibroids.  Curr Opin Obstet Gynecol. 1998;  10 315-320
    CrossrefPubMedGoogle Scholar
  • 9 Pelage J P, Le Dref O, Soyer P, Kardache M, Dahan H, Abitol M, Merland J J, Ravina J H, Rymer R. Fibroid-related menorrhagia: treatment with superselective embolization of the uterine arteries and midterm follow-up.  Radiology. 2000;  215 428-431
    CrossrefPubMedGoogle Scholar
  • 10 Belli A, Mehta H, Matson M. Uterine artery embolisation in the treatment of fibroids: complications requiring re-hospitalisation.  Cardiovasc Intervent Radiol. 2001;  24 S 141
    PubMedGoogle Scholar
  • 11 Siskin G P, Tublin M E, Stainken B F, Dowling K, Dolen E G. Uterine artery embolization for the treatment of adenomyosis: clinical response and evaluation with MR imaging.  Am J Roentgenol. 2001;  177 297-302
    PubMedGoogle Scholar
  • 12 Pelage J P, Le Dref O, Soyer P, Jacob D, Kardache M, Dahan H, Lassau J P, Rymer R. Arterial anatomy of the female genital tract: variations and relevance to transcatheter embolization of the uterus.  Am J Roentgenol. 1999;  172 989-994
    PubMedGoogle Scholar
  • 13 Chait A, Moltz A, Nelson J H. The collateral arterial circulation in pelvis. An angiographic study.  Am J Roentgenol radium Ther Nucl Med. 1968;  102 392-400
    PubMedGoogle Scholar
  • 14 Nikolic B, Spies J B, Campbell L, Walsh S, Abbara S, Lundsten M J. Uterine artery embolization: reduced radiation with refined technique.  J Vasc Interv Radiol. 2001;  12 39-44
    PubMedGoogle Scholar
  • 15 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 1167-1170
    PubMedGoogle Scholar
  • 16 Binkert C A, Andrews R T, Kaufman J A. Utility of nonselective abdominal aortography in demonstrating ovarian artery collaterals in patients undergoing uterine artery embolization for fibroids.  J Vasc Interv Radiol. 2001;  12 841-845
    CrossrefPubMedGoogle Scholar
  • 17 Pelage J P, Soyer P, Le Dref O, Dahan H, Coumbaras J, Kardache M, Rymer R. Uterine arteries: bilateral catheterization with a single femoral approach and a single 5-F catheter - technical note.  Radiology. 1999;  210 573-575
    PubMedGoogle Scholar
  • 18 Brunereau L, Herbreteau D, Gallas S, Cottier J P, Lebrun J L, Tranquart F, Fauchier F, Body G, Rouleau P. Uterine artery embolization in the primary treatment of uterine leiomyomas: technical features and prospective follow-up with clinical and sonographic examinations in 58 patients.  Am J Roentgenol. 2000;  175 1267-1272
    PubMedGoogle Scholar
  • 19 Nicholson A A, Ettles D E. Anatomic abnormalities at the origin of the uterine artery. A cause of failure and how to overcome it.  Cardiovasc Intervent Radiol. 2001;  24 S 141
    PubMedGoogle Scholar
  • 20 Spies J B, Benenati J F, Worthington-Kirsch R L, Pelage J P. Initial experience with use of tris-acryl gelatin microspheres for uterine artery embolization for leiomyomata.  J Vasc Interv Radiol. 2001;  12 1059-1063
    PubMedGoogle Scholar
  • 21 Pelage J P, Beregi J, LeDref O, Nonent M, Robert Y H, Rymer R. Uterine artery embolization for fibroids using a different end-point for embolization: preliminary results using calibrated microspheres.  Radiology. 2001;  221 (P) 356
    PubMedGoogle Scholar
  • 22 Andersen P E, Lund N, Justesen P, Munk T, Elle B, Floridon C. Uterine artery embolization of symptomatic uterine fibroids. Initial success and short-term results.  Acta Radiol. 2001;  42 234-238
    PubMedGoogle Scholar
  • 23 Andrews R T, Bromley P J, Pfister M E. Successful embolization of collaterals from the ovarian artery during uterine artery embolization for fibroids: a case report.  J Vasc Interv Radiol. 2000;  11 607-610
    PubMedGoogle Scholar
  • 24 Pelage J. Ovarian artery supply of uterine fibroids as a cause of treatment failure after uterine artery embolization: a case report (letter, comment).  J Vasc Interv Radiol. 1999;  11 535
    PubMedGoogle Scholar
  • 25 Sampson J. The blood supply of uterine leiomyomata.  Am J Clin Pathol. 1912;  94 435-438
    PubMedGoogle Scholar
  • 26 Casey R, Rogers P A, Vollenhoven B J. An immunohistochemical analysis of fibroid vasculature.  Hum Reprod. 2000;  15 1469-1475
    CrossrefPubMedGoogle Scholar
  • 27 deSouza N M, Williams A D. Uterine Arterial Embolization for Leiomyomas: Perfusion and Volume Changes at MR Imaging and Relation to Clinical Outcome.  Radiology. 2002;  222 367-374
    CrossrefPubMedGoogle Scholar
  • 28 Katsumori T, Nakajima K, Hanada Y. MR imaging of a uterine myoma after embolization.  Am J Roentgenol. 1999;  172 248-249
    PubMedGoogle Scholar
  • 29 McCluggage W G, Ellis P K, McClure N, Walker W J, Jackson P A, Manek S. Pathologic features of uterine leiomyomas following uterine artery embolization.  Int J Gynecol Pathol. 2000;  19 342-347
    PubMedGoogle Scholar
  • 30 Katsumori T, Nakajima K, Mihara T, Takuhiro M. Uterine artery embolization using gelatin sponge particles alone for symptomatic uterine fibroids: midterm results.  Am J Roentgenol. 2002;  178 135-139
    PubMedGoogle Scholar
  • 31 Lee P, Chang Y, Yoon J. Preliminary experience with uterine artery ligation for symptomatic uterine leiomyomas.  J Am Assoc Gynecol Laparosc. 1999;  6 S 27-28
    PubMedGoogle Scholar
  • 32 Liu W M, Ng H T, Wu Y C, Yen Y K, Yuan C C. Laparoscopic bipolar coagulation of uterine vessels: a new method for treating symptomatic fibroids.  Fertil Steril. 2001;  75 417-422
    CrossrefPubMedGoogle Scholar
  • 33 Hutchins F L, Worthington-Kirsch R. Embolotherapy for myoma induced menorrhagia.  Obstet Gynecol Clin North Am. 2000;  27 397-405
    CrossrefPubMedGoogle Scholar
  • 34 Spies J B, Ascher S A, Roth A R, Kim J, Levy E B, Gomez-Jorge J. Uterine artery embolization for leiomyomata.  Obstet Gynecol. 2001;  98 29-34
    CrossrefPubMedGoogle Scholar
  • 35 Worthington-Kirsch R, Fueredi G, Goodwin S, Machan L, Niedzwiecki G, Reidy J, Spies J, Walker W. Polyvinyl alcohol particle size for uterine artery embolization.  Radiology. 2001;  218 605-606
    PubMedGoogle Scholar
  • 36 Bendszus M, Klein R, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L. Efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles in the preoperative embolization of meningiomas.  Am J Neuroradiol. 2000;  21 255-261
    PubMedGoogle Scholar
  • 37 Deredeyn C P, Graves V B, Salamat M S, Rappe A. Collagen-coated acrylic microspheres for embolotherapy: in vivo and in vitro characteristics.  Am J Neuroradiol. 1997;  18 647-653
    PubMedGoogle Scholar
  • 38 Davidson G S, Terbrugge K G. Histologic long-term follow-up after embolization with polyvinyl alcohol particles.  Am J Neuroradiol. 1995;  16 843-846
    PubMedGoogle Scholar
  • 39 Bradley E A, Reidy J F, Forman R G, Jarosz J, Braude P R. Transcatheter uterine artery embolisation to treat large uterine fibroids.  Br J Obstet Gynaecol. 1008;  105 235-240
    PubMedGoogle Scholar
  • 40 Günther R, Klose K, Thelen M, Jacobi G. Superselektive Embolisation mit Gewebekleber im Urogenitaltrakt.  Fortschr Röntgenstr. 1981;  134 536-539
    PubMedGoogle Scholar
  • 41 Ravina J, Merland J, Herbetreau D, Houdart E, Bouret J, Madelenat P. Embolisation pré-opératoire des fibromes utérins.  Presse Med. 1994;  23 1540
    PubMedGoogle Scholar
  • 42 Goodwin S C, Vedantham S, McLucas B, Forno A E, Perrella R. Preliminary experience with uterine artery embolization for uterine fibroids.  J Vasc Interv Radiol. 1997;  8 517-526
    CrossrefPubMedGoogle Scholar
  • 43 Ravina J H, Bouret J M, Ciraru-Vigneron N, Repiquet D, Herbreteau D, Aymard A, le Dreff O, Merland J J, Ferrand J. Recourse to particular arterial embolization in the treatment of some uterine leiomyoma.  Bull Acad Natl Med. 1997;  181 233-246
    PubMedGoogle Scholar
  • 44 Worthington-Kirsch R L, Popky G L, Hutchins F L. Uterine arterial embolization for the management of leiomyomas: quality-of-life assessment and clinical response.  Radiology. 1998;  208 625-629
    CrossrefPubMedGoogle Scholar
  • 45 Spies J B, Scialli A R, Jha R C, Imaoka I, Ascher S M, Fraga V M, Barth K H. Initial results from uterine fibroid embolization for symptomatic leiomyomata.  J Vasc Interv Radiol. 1999;  10 1149-1157
    CrossrefPubMedGoogle Scholar
  • 46 Burn P, McCall J, Chinn R, Healy J. Embolization of uterine fibroids.  Br J Radiol. 1999;  72 159-161
    PubMedGoogle Scholar
  • 47 Hutchins F L, Worthington-Kirsch R, Berkowitz R P. Selective uterine artery embolization as primary treatment for symptomatic leiomyomata uteri.  J Am Assoc Gynecol Laparosc. 1999;  6 279-284
    CrossrefPubMedGoogle Scholar
  • 48 Siskin G P, Stainken B F, Dowling K, Meo P, Ahn J, Dohlen E G. Outpatient uterine artery embolization for symptomatic uterine fibroids: experience in 49 patients.  J Vasc Interv Radiol. 2000;  11 305-311
    CrossrefPubMedGoogle Scholar
  • 49 Matson M, Nicholson A, Belli A M. Anastomoses of the ovarian and uterine arteries: a potential pitfall and cause of failure of uterine embolization.  Cardiovasc Intervent Radiol. 2000;  23 393-396
    CrossrefPubMedGoogle Scholar
  • 50 Andrews R T, Bromley P J, Pfister M E. Successful embolization of collaterals from the ovarian artery during uterine artery embolization for fibroids: a case report.  J Vasc Interv Radiol. 2000;  11 607-610
    PubMedGoogle Scholar
  • 51 Binkert C A, Andrews R T, Kaufman J A. Utility of nonselective abdominal aortography in demonstrating ovarian artery collaterals in patients undergoing uterine artery embolization for fibroids.  J Vasc Interv Radiol. 2001;  12 841-845
    CrossrefPubMedGoogle Scholar
  • 52 Nikolic B, Abbara S, Levy E, Imaoka I, Lundsten L, Jha R C, Spies J B. Influence of radiographic technique and equipment on obsorbed ovarian dose associated with uterine artery embolization.  J Vasc Interv Radiol. 2000;  11 1173-1178
    PubMedGoogle Scholar
  • 53 Rasuli P, Lavoie C, Hammond I, French G J. Uterine artery embolization for fibroids: measurement of radiation dose.  Radiology. 1999;  213 (P) 133
    PubMedGoogle Scholar
  • 54 Chrisman H B, Saker M B, Ruy R K, Nemcek A A, Gerbie M V, Milad M P, Smith S J, Sewall L E, Omary R A, Vogelzang R L. The impact of uterine fibroid embolization on resumption of menses and ovarian function.  J Vasc Interv Radiol. 2000;  11 699-703
    CrossrefPubMedGoogle Scholar
  • 55 Spies J B, Roth A R, Gonsalves S M, Murphy-Skrzyniarz K M. Ovarian function after uterine artery embolization for leiomyomata: assessment with use of serum follicle stimulating hormone assay.  J Vasc Interv Radiol. 2001;  12 437-442
    CrossrefPubMedGoogle Scholar
  • 56 Vashisht A, Studd J, Carey A, Burn P. Fatal septicaemia after fibroid embolisation.  Lancet. 1999;  354 307-308
    PubMedGoogle Scholar
  • 57 Godfrey C D, Zbella E A. Uterine necrosis after uterine artery embolization for leiomyoma.  Obstet Gynecol. 2001;  98 950-952
    CrossrefPubMedGoogle Scholar

Dr. med. Thomas J. Kröncke

Institut für Radiologie, Universitätsklinikum Charité, Campus Mitte,
Humboldt-Universität zu Berlin

Schumannstraße 20/21

10117 Berlin

Phone: + 49/30/450/527194

Email: thomas.kroencke@charite.de