Uterine Artery Embolization for Leiomyomas and Adenomyosis: A Pictorial Essay Based on Our Experience from 1300 Cases

Abstract

Since its introduction in 1995, uterine artery embolization (UAE) has become an established option for the treatment of leiomyomas. Identification of a leiomyoma using arteriography improves the ability to perform effective UAE. UAE is not contraindicated in a pedunculated subserosal leiomyoma. UAE in a cervical leiomyoma remains a challenging procedure. A leiomyoma with high signal intensity on T2-weighted imaging responds well to UAE, but a malignancy with similar radiological features should not be misdiagnosed as a leiomyoma. Administration of gonadotropin-releasing hormone agonists before UAE is useful in selected patients and is not a contraindication for the procedure. The risk of subsequent re-intervention 5 years after UAE is approximately 10%, which represents an acceptable profile. UAE for adenomyosis is challenging; initial embolization using small particles can achieve better success than that by using larger particles. An intravenous injection of dexamethasone prior to UAE, followed by a patient-controlled analgesia pump and intra-arterial administration of lidocaine after the procedure, are useful techniques to control pain. Dexmedetomidine is an excellent supplemental sedative, showing a fentanyl-sparing effect without causing respiratory depression. UAE for symptomatic leiomyoma is safe and can be an alternative to surgery in most patients with a low risk of re-intervention.

Sedation With Dexmedetomidine During Lymphangiography and Thoracic Duct Embolization in an Elderly Man

“…DEX has a mild analgesic effect mediated by the α2-adrenergic receptor [ 5 - 6 ]; however, additional analgesics may be required for IR associated with pain, such as uterine arterial embolization. DEX and analgesics are used in combination during embolization [ 7 ]. In such cases, considering that analgesics also have some sedative effects, the characteristics of DEX, which are “conscious sedation” and “co-operative sedation,” may not be clearly demonstrated [ 8 ].…”

Uterine Artery Embolization with Small-Sized Particles for the Treatment of Symptomatic Adenomyosis: A 42-Month Clinical Follow-Up

“…It is reasonable to assume that smaller-sized particles may induce larger ischemia with a more distal penetration into the lesions, leading to higher infarction and better clinical outcomes. 12 Small-sized PVA particles have been reported as safe for UAE without untargeted embolization by Kim et al 13 In the study, UAE with the “1-2-3 protocol” (small PVA particles measuring 150–250 µm were used at the beginning of embolization, followed by 250–355 µm and 355–500 µm particles) resulted in more than 80% of patients with complete necrosis of AD and a lower recurrence rate of symptoms. As in the Kim et al 13 and de Bruijn et al 9 studies, there were no deaths or other complications after UAE in this study.…”

Recent Progress in Advanced Hydrogel‐Based Embolic Agents: From Rational Design Strategies to Improved Endovascular Embolization

“…Due to the maneuverability, low costs, few complications, and high efficacy, the TAE procedure is considered a practical and effective method for treating a variety of diseases such as acute hemorrhage, [1,2] aneurysms, [3,4] arteriovenous malformation (AVM), [5][6][7] and benign/malignant tumors. [8][9][10][11] To meet the wide range of clinical scenarios, a diverse of embolic materials, such as embolic particulates, liquid embolic agents, and metallic coils, are currently clinically available. Specifically, the choice of embolic materials is dependent on a case-by-case basis and influences the overall performance and outcomes of TAE.…”