Endovascular surgery in gynecology

Abstract

Endovascular surgery has presented a high evolution since 1960 with Charles Dotter, who changed the concept of catheter utilization as a mean to diagnose and introduce therapeutic in interventionist vascular environment. The first reports of bleeding control of gastrointestinal and transluminal angioplasty input the development of new techniques for endovascular access, and new materials use, such as microcatheters and embolic agents, become this procedure effective and viable for treatment of several pathologies. The embolization of several organs of human body is a procedure carried out for more than 30 years all over the world showing safety, efficacy and of simple execution. In obstetrics and gynecology, particularly, the first reports refer to pelvic hemorrhage control of varied etiology, including pelvic trauma, bladder and gynecology neoplasia, anteriovenous fistulas and puerperal hemorrhages. The embolization of uterine myoma appears in the 1990's as an alternative for treat of uterine leiomyoma, and a number of studies try to clarify the risks and benefits of this procedure. It is a multidisciplinary technique, with diagnostic and indication performed by gynecologist and the procedure done by interventional vascular radiologist. This review is a critical analysis of interventionist vascular radiologic methods and its main therapeutic indications in gynecology.

Interventional radiology and endovascular surgery in the treatment of ectopic pregnancies

“…The advent of interventional radiology enabled striking advances in diagnosis and treatment of a variety of conditions, particularly in obstetrics and gynecology throughout minimally invasive percutaneous techniques, without general anesthesia, shorter period of hospitalization, low morbidity and preservation of the uterus. ( 1 , 2 )…”

“…In the field of obstetrics, notable advances include temporary hypogastric artery occlusion for management of placenta accrete, embolization arteriovenous fistulae followed by curettage and management of complicated intrauterine and extrauterine ectopic pregnancies. ( 1 - 3 ) The incidence of ectopic pregnancy is 2%, and most of implants occur in the fallopian tubes (90%). ( 3 )…”

“…Thus arose the endovascular interventional radiology technique known as intra-arterial chemoembolization, which combines selective, in locus delivery of high concentrations of chemotherapeutic agents – with minimal systemic effects – and the additional effects of embolization. ( 1 , 5 )…”

“…O advento da radiologia intervencionista possibilitou avanços impressionantes no diagnóstico e no tratamento de uma variedade de condições, particularmente no domínio da obstetrícia e da ginecologia, por meio de técnicas percutâneas minimamente invasivas, sem anestesia geral, com menor tempo de internação hospitalar, baixa morbidade e preservação do útero. ( 1 , 2 )…”

“…No campo da obstetrícia, avanços notáveis incluem oclusão da artéria hipogástrica temporária para placenta acreta, embolização de fístulas arteriovenosas, seguida de curetagem e manejo de gravidez intrauterinas complicadas e prenhezes ectópicas extrauterina. ( 1 - 3 ) A incidência de gravidez ectópica é de 2%, sendo que a maioria dos implantes ocorre nas trompas de falópio (90%). ( 3 )…”