Uterine artery embolization: A review of current concepts

Keung, Jonathan; Spies, James B.; Caridi, T.

doi:10.1016/j.bpobgyn.2017.09.003

Cited by 99 publications

(75 citation statements)

References 41 publications

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“…Additionally, UAE has been described to slightly reduce fertility and pregnancy rate which was possibly secondary to ovarian failure resulting from nontarget ovarian embolization via ovarian arteryto-uterine artery anastomoses [14][15][16]. In the present study, when selective embolization of uterine arteries and collaterals was performed, absorbable and large diameter embolic agents were used, so as to preserve the uterine and avoid nontarget embolization of ovarian arteries as much as possible.…”

Section: Discussionmentioning

confidence: 95%

Role of collateral embolization in addition to uterine artery embolization followed by hysteroscopic curettage for the management of cesarean scar pregnancy

Zhang

Tanida

et al. 2019

Preprint

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The aim of this study was to assess the feasibility, safety and outcome of the embolization of non-gonadal collateral supplying gestational sac (GS) in addition to uterine artery embolization (UAE), followed by hysteroscopic curettage for the management of cesarean scar pregnancy (CSP). Methods: A retrospective study was undertaken from January 2012 to September 2018 in 24 CSP patients in whom non-gonadal collaterals supplying GS were identified by arterial angiography performed immediately after UAE. These patients underwent attempt collateral embolization in addition to UAE, followed by hysteroscopic curettage for the management of CSP. The 24 patients were divided into two groups based on whether they underwent technically successful collateral embolization (UAE-SCE group) or failed collateral embolization (UAE-FCE group) in addition to UAE. The baseline characteristics and clinical outcomes including time for serum β-human chorionic gonadotropin (β-hCG) levels normalization, blood loss, secondary anemia, and pelvic pain were compared between the two groups. The paired t test and Man Whitney test were used for comparisons of discrete and numerical variables, respectively. Results: Collateral embolization was techinically successful in 16 (66.7%, 16/24) patients and failed in the other 8 (33.3%, 8/24) patients. There were no significant differences between the two groups in baseline characteristics. The mean blood loss and secondary anemia in the UAE-SCE group were significantly less than UAE-FCE group. No significant difference was found between the two groups in the mean time for β-hCG levels normalization and pelvic pain. Conclusions: During the management of UAE combined with hysteroscopic curettage for CSP, additional embolization of non-gonadal collateral supplying GS during UAE is feasible and safe in patients with non-gonadal collateral supplying GS, and the additional embolization of the collateral may reduce blood bloss related to hysteroscopic curettage.

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Section: Discussionmentioning

confidence: 95%

Role of collateral embolization in addition to uterine artery embolization followed by hysteroscopic curettage for the management of cesarean scar pregnancy

Zhang

Tanida

et al. 2019

Preprint

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“…A limited number of studies have been published concerning adverse events after using UAE for the treatment of PAS disorder; 29 however, larger experience concerning morbidity after UAE procedure has been accumulated regarding the treatment of uterine fibroids 30‐33 . In 2014, a Cochrane summary reported that UAE is associated with higher rates of minor short‐term and long‐term complications, more unscheduled readmissions after discharge, and an increased surgical re‐intervention rate 30 .…”

Section: Discussionmentioning

confidence: 99%

Cesarean delivery with and without uterine artery embolization for the management of placenta accreta spectrum disorder—A comparative study

Mohr–Sasson

Hochman

Anteby

et al. 2020

Acta Obstet Gynecol Scand

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Introduction The aim of this study is to compare immediate and long‐term obstetrical outcomes of patients who underwent cesarean delivery with and without uterine artery embolization (UAE) for the management of placenta accreta spectrum disorder. Material and methods A retrospective case control study including all pregnant women admitted to a single tertiary medical center between December 2001 and May 2018 with a diagnosis of placenta accreta spectrum disorder, who underwent cesarean delivery with and without UAE. Groups were compared for maternal characteristics, operative management, postoperative complication rate and long‐term outcomes. Follow up on future obstetrical outcomes was conducted via telephone questionnaire. Non‐parametric statistics were used. Results During the study period, 272 women met the inclusion criteria: 64 (23.53%) and 208 (76.47%) underwent preservative cesarean section with and without UAE, respectively. UAE procedure was associated with a longer operative time (82.5 [68‐110] vs 50.5 [39‐77] minutes; P = .001), and higher blood loss (2000 (1500‐3000) vs 1000 (600‐2000) mL; P = .001). Hysterectomy rate was comparable between the groups (9 [14%] vs 35 [16.82%]; P = .88); however, multivariate logistic regression analysis found UAE to be an independent factor associated with lower hysterectomy rate (P = .02). Postoperative complications were more frequent in the UAE group. Follow up was achieved in 29 (59.18%) and 72 (51.79%) of the women with and without UAE, respectively (P = .36). No differences were found in rate of abortions, pregnancy and deliveries between the groups. Conclusions Cesarean delivery using UAE in placenta accreta spectrum disorder is associated with a higher rate of operative and postoperative complications. Nevertheless, in cases of severe adherence of the placenta, embolization reduces the need for hysterectomy, allowing future fertility.

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“…Uterine artery embolization (UAE) is a well-established uterine preserving and minimally invasive therapy for symptomatic fibroids. There is strong evidence for safety and efficacy, with low rates of complications [9] [10]. Although in the past, UAE was avoided in large leiomyomas, recent studies have demonstrated its safety for masses over 10 cm [9].…”

Section: Discussionmentioning

confidence: 99%

Huge Intravaginal Pedunculated Fibroid Embolization and Resectoscopy—A Case Report and Review of Literature

Hirides¹,

Michalis²,

Athanasios³

et al. 2019

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Background: Submucosal fibroids account for approximately 15-20 percent of total fibroids. Rarely, they prolapse. Common size is 2-6 cm, because larger fibroids are unlikely to fit through the cervix. Larger fibroids are associated with significant bleeding and pose a surgical challenge. Case Presentation: We present a 38-year-old woman nulliparous with an intravaginal pedunculated fibroid, 12 cm in diameter. She presented with metrorrhagia and an intense malodorous vaginal discharge, irresponsive to oral therapy. The patient had a history of resectoscopic fibroid enucleation, 7 months earlier, followed by insertion of an (intra-uterine device) IUD. There was no uterine prolapse. Management involved bilateral uterine artery embolization, followed by hysteroscopic excision with rigid resectoscope. The fibroid was "delivered" transvaginally intact. The uterus was preserved. The IUD was partly buried within the mass. Blood loss was negligible. Patient recovery was quick and uneventful. At 6-months follow up, pelvic anatomy has been restored. Conclusion: Large pedunculated fibroids are very rare. Embolization of uterine arteries has proven a valuable tool in challenging gynecologic operations. In our case, not only it prevented massive bleeding during excision, but also allowed a fertility-sparing minimally invasive management.

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Uterine artery embolization: A review of current concepts

Cited by 99 publications

References 41 publications

Role of collateral embolization in addition to uterine artery embolization followed by hysteroscopic curettage for the management of cesarean scar pregnancy

Role of collateral embolization in addition to uterine artery embolization followed by hysteroscopic curettage for the management of cesarean scar pregnancy

Cesarean delivery with and without uterine artery embolization for the management of placenta accreta spectrum disorder—A comparative study

Huge Intravaginal Pedunculated Fibroid Embolization and Resectoscopy—A Case Report and Review of Literature

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