Fatal Sepsis after Uterine Artery Embolization with Microspheres

Blok, Sjoerd de; Vries, CS de; Prinssen, Helma M.; Blaauwgeers, Hans; Jorna-Meijer, Lorine B.

doi:10.1097/01.rvi.0000079988.80153.61

Cited by 112 publications

(46 citation statements)

References 18 publications

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“…25 Uterine artery embolization, which has shown good results, is also expensive and associated with risks. [26][27][28][29][30] Taking all of these aspects into consideration, sclerotherapy seems to be an advantageous method.…”

Section: Discussionmentioning

confidence: 99%

Midterm Outcome of Ultrasound-Guided Alcohol Gel Sclerotherapy for Symptomatic Leiomyoma

Pessoa

Gurgel

Ávila

et al. 2010

Journal of Ultrasound in Medicine

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AbbreviationsGnRH, gonadotropin-releasing hormone; UAE, uterine artery embolization eiomyoma, also known as a fibromyoma or fibroid, is a frequent gynecologic disorder affecting approximately 25% to 35% of women, especially black women, at some point in their lives. 1Although most patients are asymptomatic, the fact that about 50% have clinical symptoms explains the high number of hysterectomies performed all over the world (538,722 per year for benign disease in the United States in 2003).2 The main symptoms of leiomyoma include heavy menstrual bleeding, pelvic pain, abdominal swelling, intestinal, urinary, or venous pressure, and hemorrhagic vaginal discharge (bleeding between periods).3 In addition, myomas are considered infertility factors, although the mechanisms of this association have not been clarified. 4 Diagnosis has been facilitated in the past few years by dissemination of ultrasound techniques. The sensitivity and specificity of ultrasound for diagnosing leiomyomas are as high as 99% and 91%, respectively. L ArticleObjective. The purpose of this study was to describe the outcome of ultrasound-guided ethanol gel sclerotherapy of myomatous nodules 1 to 18 months after treatment. Methods. A total of 118 consecutive patients with a diagnosis of symptomatic leiomyomas referred for ethanol gel sclerotherapy were studied between November 2005 and July 2007. Clinical (self-administered symptom questionnaire) and ultrasound follow-ups were done 1 to 2, 6 to 8, and 12 to 18 months after the procedure. Results. The mean baseline volumes ± SD were 223.3 ± 158.3 cm 3 for the uterus and 68.4 ± 110.5 cm 3 for the dominant fibroid. The most common adverse reaction in the immediate postoperative period was pelvic pain in 27.1% of the patients, but 58.4% had no reactions. After 12 months, a 29.5% reduction in uterine volume was observed in 64.7% of the patients. A 55.5% reduction in dominant fibroid volume was observed in 82.8% of the patients. Pelvic pain improved in 29.8% of the sample, dysmenorrhea in 51.7%, and menstrual flow in 39%. Most patients (77%) reported being satisfied or very satisfied with the treatment. Conclusions. The results suggest that ethanol gel sclerotherapy is a safe, conservative alternative for treating symptomatic uterine leiomyomas. Further randomized studies are necessary to determine the suitability and indications of this procedure in comparison to other minimally invasive techniques.

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Section: Discussionmentioning

confidence: 99%

Midterm Outcome of Ultrasound-Guided Alcohol Gel Sclerotherapy for Symptomatic Leiomyoma

Pessoa

Gurgel

Ávila

et al. 2010

Journal of Ultrasound in Medicine

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“…Sepsis is more frequent when UAE is performed on a very large uterus; more than 20 cm in height, when a single fibroid is larger than 9 cm in diameter or when there is a large submucous fibroid (Aungst et al, 2004;Nikolic et al, 2004). Two deaths from uterine infection and overwhelming sepsis have also been reported after UAE (de Block et al, 2003;Vashist et al, 1999). Clinical experience and evidence from a case report (Vashist et al, 1999) suggest that infection may originate from the vagina and/or the urinary tract, which underlines the importance of preprocedure screening for genitourinary infection.…”

Section: Postprocedural Carementioning

confidence: 99%

“…There is also evidence that certain preexisting conditions, such as a coexistent adnexal pathology (Nikolic et al, 2004), and some minor post-procedure complications, in particular fibroid expulsion (Marret et al, 2004;Spies et al 2002b), are associated with a higher risk of infection. In addition to two deaths from septic shock (de Block et al, 2003;Vashist et al, 1999), other three deaths following UAE have thus far been reported, one from pulmonary embolism and two from uncertain causes (Worthington-Kirsch et al, 2005), in more than 100 000 procedures performed worldwide. If we assume that all these deaths were related to the procedure, the mortality risk would be 0.05:1000, which compares favourably with the estimated mortality rate of 0.38:1000 following hysterectomy for non-obstetric benign disease (Maresh et al, 2002;Siskin et al, 2002;Vashist et al, 1999).…”

Section: Postprocedural Carementioning

confidence: 99%

See 1 more Smart Citation

Is Embolization Equal to Hysterectomy in Treating Uterine Fibroids?

Strinić¹

2012

Hysterectomy

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“…The rare fatal complications reported have mostly been related to a combination of infection and lack of communication between the patient and treating physician leading to fatal septic shock. [38] 24/7 access to emergency gynaecological care after UAE is crucial. A follow-up telephone call after one week is standard in some institutions.…”

Section: Post-procedural Follow-up and Carementioning

confidence: 99%