Clinical experience of using the technique of uterine artery embolization in the treatment of submucous uterine fibroids in the Vidar Medical Center, Vinnytsia (2008–2022)

Abstract

Myoma of the uterus is a benign neoplasm. The technique of uterine artery embolization (UAE) is used to treat uterine fibroids and is highly effective. The principle of embolization is based on the fact that all blood vessels that supply the uterus end in the endometrium.During UAE small parts are injected – emboli, which are spread along these vessels with the blood flow. In the vessels of the myoma the emboli cannot pass through the capsule of the myoma, so they block the vessels that supply it with blood. This leads to the cessation of blood supply to myomatous nodes, and subsequently there is a decrease in the size of these nodes, on average by 50–60% during the year, with a gradual decrease during the following years of life.This minimally invasive procedure is performed under local anesthesia – after femoral artery puncture, with X-ray control of angiography and intraoperative assessment of blood flow in fibroid nodes using ultrasound (US).Over 15 years of work, 1,400 UAE operations of uterine fibroids have been performed, of which more than 70 cases are UAE of submucosal myomas. Later, when the clinical picture of expulsion of these submucosal nodes appeared, transvaginal myomectomy was performed. Such a combined technique demonstrated high efficiency.The article describes clinical cases of patients who received treatment of large submucosal myoma by the UAE method followed by transvaginal myomectomy of the nascent node. In total, 5 clinical cases are described, the results of ultrasound, macropreparations, and colposcopic images are presented. A clinical case of a uterine myoma, the size of which corresponded to 21 weeks of pregnancy and a volume of 1500 cm3, is presented: after the above complex treatment method the volume of the uterus decreased according to ultrasound examination to 122 cm3. Also, a clinical case of a patient with uterine myoma, massive bleeding, whose hemoglobin level was 67 g/l is described. The patient was performed by UAE followed by transvaginal myomectomy for expulsion of the submucosal node.So, the described complex method of treatment of submucous uterine fibroids demonstrated high efficiency of clinical results.