Preliminary Experience with Uterine Artery Embolization for Uterine Fibroids

Goodwin, Scott C.; Vedantham, Suresh; McLucas, Bruce; Forno, Alice E.; Perrella, R R

doi:10.1016/s1051-0443(97)70603-1

Cited by 321 publications

(89 citation statements)

References 14 publications

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“…In the past, embolization was used to reduce pelvic bleeding 132. Only since 1995 has UAE been seen as a potential treatment for menorrhagia related to uterine fibroids 133,134. In essence, it involves the placement of an angiographic catheter into the uterine arteries via a common femoral artery approach and injection of embolic agents (in most cases, polyvinyl alcohol particles or trisacryl gelatin microspheres) into both uterine arteries until the flow becomes sluggish (Figure 5).…”

Section: Managementmentioning

confidence: 99%

Uterine fibroids: current perspectives

Khan¹,

Shehmar²,

Gupta³

2014

IJWH

307

252

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Uterine fibroids are a major cause of morbidity in women of a reproductive age (and sometimes even after menopause). There are several factors that are attributed to underlie the development and incidence of these common tumors, but this further corroborates their relatively unknown etiology. The most likely presentation of fibroids is by their effect on the woman’s menstrual cycle or pelvic pressure symptoms. Leiomyosarcoma is a very rare entity that should be suspected in postmenopausal women with fibroid growth (and no concurrent hormone replacement therapy). The gold standard diagnostic modality for uterine fibroids appears to be gray-scale ultrasonography, with magnetic resonance imaging being a close second option in complex clinical circumstances. The management of uterine fibroids can be approached medically, surgically, and even by minimal access techniques. The recent introduction of selective progesterone receptor modulators (SPRMs) and aromatase inhibitors has added more armamentarium to the medical options of treatment. Uterine artery embolization (UAE) has now been well-recognized as a uterine-sparing (fertility-preserving) method of treating fibroids. More recently, the introduction of ultrasound waves (MRgFUS) or radiofrequency (VizAblate™ and Acessa™) for uterine fibroid ablation has added to the options of minimal access treatment. More definite surgery in the form of myomectomy or hysterectomy can be performed via the minimal access or open route methods. Our article seeks to review the already established information on uterine fibroids with added emphasis on contemporary knowledge.

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Section: Managementmentioning

confidence: 99%

Uterine fibroids: current perspectives

Khan¹,

Shehmar²,

Gupta³

2014

IJWH

307

252

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“…A possible explanation could be that remaining vasculature facilitates UF recurrence, which might be a technically reasonable benefit of UAE over MRgHIFU. Based on the principle of devascularization, UAE is known to effectively reduce heavy bleeding symptoms (19, 20). But aiming at UF infarction also implies a threshold tumor volume for successful and realistic UAE treatment, which is reported to be relatively small at 66.0 cm 3 (21, 22).…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Quantitative Assessment of Lesion Response to MR-guided High-Intensity Focused Ultrasound Treatment of Uterine Fibroids

et al. 2015

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Rationale and Objectives To investigate the response after MR-guided high-intensity focused ultrasound (MRgHIFU) treatment of uterine fibroids (UF) using a 3D quantification of total and enhancing lesion volume (TLV, ELV) on contrast-enhanced MRI (ceMRI) scans. Methods and Materials In a total of 24 patients, ceMRI scans were obtained at baseline and 24 hrs, 6, 12 and 24 months after MRgHIFU treatment. The dominant lesion was assessed using a semi-automatic quantitative 3D segmentation technique. Agreement between software-assisted and manual measurements was then analyzed using a linear regression model. Patients were classified as responders (R) or non-responders (NR) based on their symptom report after 6 months. Statistical analysis included the paired t-test and Mann-Whitney-test. Results Preprocedurally, the median TLV and ELV were 263.74cm3 (30.45–689.56cm3) and 210.13cm3 (14.43–689.53cm3), respectively. The 6-month follow-up demonstrated a reduction of TLV in 21 patients (87.5%) with a median TLV of 171.7cm3 (8.5–791.2cm3) (p<.0001). TLV remained stable with significant differences compared to baseline (p<.001 and p=.047 after 12 and 24 months). A reduction of ELV was apparent in 16 patients (66.6%) with a median ELV of 158.91cm3 (8.55–779.61cm3) after 6 months (p=.065). 3D quantification and manual measurements showed strong intermethod-agreement for fibroid volumes (R2=.889 and R2=.917) but greater discrepancy for enhancement calculations (R2=.659 and R2=.419) at baseline and 6 mo. No significant differences in TLV or ELV were observed between clinical R (n=15) and NR (n=3). Conclusion The 3D assessment has proven feasible and accurate in the quantification of fibroid response to MRgHIFU. Contrary to ELV, changes in TLV may be representative of the clinical outcome.

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“…Myomas are benign and their mortality rate is very low (17). The treatment guidelines for uterine myomas vary depending on assessment, medical treatments of myolysis, selective artery occlusion, and surgical alternatives including myomectomy and hysterectomy (18)(19)(20)(21). Concerning the method of conservative management with gonadotropin releasing hormone agonist, it is effective in reducing the myoma volume (50%) but may lead to menopausal symptoms (22,23).…”

Section: Discussionmentioning

confidence: 99%

Assessment of the feasibility of bipolar coagulation use to reduce hemorrhage in myomectomy performed by minilaparotomy

Liberis¹,

Tsikouras²,

Ammari³

et al. 2010

Minimally Invasive Therapy & Allied Technologies

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The major problem with myomectomy is excessive bleeding from increased uterine blood supply, and this can be a life-threatening condition and prolong postoperative stay. The aim of our study was to evaluate our experience in symptomatic myoma excision with bipolar electrode by mini-laparotomy; we compared 67 procedures with bipolar electrode, in normal saline as distension fluid, to 42 cases performed with unipolar electrode. All participants were pre-menopausal women who had symptomatic myomas

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Preliminary Experience with Uterine Artery Embolization for Uterine Fibroids

Cited by 321 publications

References 14 publications

Uterine fibroids: current perspectives

Uterine fibroids: current perspectives

Three-Dimensional Quantitative Assessment of Lesion Response to MR-guided High-Intensity Focused Ultrasound Treatment of Uterine Fibroids

Assessment of the feasibility of bipolar coagulation use to reduce hemorrhage in myomectomy performed by minilaparotomy

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