Uterine artery embolization (UAE ) for uterine fibroids - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Gynecology

Uterine artery embolization - a minimally invasive intervention in which an artery through a puncture in the thigh in the blood vessels that feed the fibroids, particles are introduced special medical grade plastic - polyvinyl alcohol (PVA), completely stopping the blood flow in them.Used embolization drug is absolutely safe, biologically inert and can not cause allergic reactions.Furthermore, necessary for EMA prepatata negligible amount, usually not more than 500 mg.

On vessels healthy myometrium embolization has virtually no impact, which is due to their structural features (blood supply to the units is carried out so-called perifibroidnogo plexus - the vasculature surrounding the myoma on the periphery) and the technique of intervention.After the cessation of blood supply to the muscle cells that form the fibroids are killed.Within a few weeks is their replacement by connective tissue (fibrosis), which leads to significant reduction and / or disappearance of fibroids and its manifestations.Thus, so

on after ESA fibroids as such no longer remains - it remains a connective tissue in its place.Then, in the process of "sucking" the tissue is a significant reduction and / or complete disappearance of nodes, fibroid symptoms disappear.

In most cases (about 98%) after embolization any additional treatment for uterine fibroids is not required.

Pros and cons of EMA

  • EMA - minimally invasive and relatively safe method of treatment does not require anesthesia.
  • intervention is highly effective and the likelihood of recurrence of fibroids is minimal (as opposed to myomectomy, for which the likelihood of recurrence of up to 30-40%) ..
  • There is an immediate improvement in symptoms.
  • not require a long hospital stay, usually gostpitalizatsiya just 1 day.
  • low probability of complications, provided a good skill of the surgeon.According to comparative studies, the risk of any complications is 20 times lower than that for all variants of surgical treatment of fibroids.
  • uterus is not removed.
  • retain the ability to bear children.

BUT: in contrast to the equipment needed for laparoscopic surgery, angiography devices are very expensive, so not every hospital can afford them.In addition, Russia has very few experienced endovascular surgeons, and other doctors can not spend EMA.

Another negative - X-rays used in the UAE.However autographic feature of modern machines is the use of low-dose radiation.The average radiation dose received by a patient in the course of embolization does not exceed the dose received during a diagnostic x-rays (chest x-ray).

Another drawback of the method.If the open operation is always possible to take a biopsy of the tissue, which is removed, and explore it, while embolization, unfortunately, this is impossible.However, this disadvantage offset by performing diagnostic angiographic study prior therapeutic manipulation.Benign and malignant tumor vasculature have a different picture.Therefore, on the basis of diagnostic angiographic data doctor can decide what is the matter.

Preparations for ESA

Typically, embolization is performed on the day of admission.On this day, it is recommended to refrain from breakfast, as well as prior to any surgery.During the procedure, performed puncture of an artery at the top of the right thigh, so you must pre-shave the groin and thigh on the right.Before the procedure is assigned an injection of sedative drug.On both feet doctor will put bandages.After the procedure, bandages need to be worn for 5-7 days.Then, accompanied by a gynecologist patient is sent to the department radiologists on foot or by wheelchair.

EMA

procedure Uterine artery embolization is performed in a specially equipped rentgenooperatsionnoy.The operating unit is equipped with angiographic, allowing the surgeon to control the x-ray mode of manipulation inside the blood sosudov.Embolizatsiyu perform endovascular surgeons - specialists who are highly qualified vascular surgeons and extensive experience with complex angiographic equipment.

Before operation endovascular surgeon asks the patient several questions (about the individual tolerance of drugs, etc.).The patient is placed on a special angiographic table.The veins on the inner side of the arm is installed thin catheter for IVs and administering drugs.Before the procedure, endovascular surgeon will treat the right thigh and the abdomen with antiseptic and will cover special sterile drapes.Then conducted a local anesthetic solution of novocaine or lidocaine for painless puncture of the right common femoral artery.Through a small (1.5 mm) skin piercing thin catheter (1.2 mm) is inserted into the upper part of the thigh in an artery which is under the control of X-ray television carried directly into the uterine arteries.

Then, just under fluoroscopy, the catheter is introduced through tiny particles embolization of the drug, which cover the blood vessels that feed the fibroids.Embolization particles are generally administered alternately in the right and left uterine arteries.

procedure lasts from 10 minutes to 2.5 hours EMA depending on the variant of origin of the uterine artery and the surgeon's experience.But usually it does not exceed the duration of 20 minutes.

puncture the artery, through anesthesia, causes little or no sensation.In the course of the procedure EMA may periodic appearance of a feeling of warmth, light burning in the lower abdomen, lower back - this action is a contrast agent that introduces the surgeon for vascular imaging.

After embolization, the doctor removes the catheter from the femoral artery, and within 15-25 minutes, pressing his fingers to the place of puncture to avoid the formation of a bruise (hematoma).Then, on the right thigh superimposed compressive bandage.From this point on for 10-12 hours can not bend his right leg.Pressure bandage is removed after 2-3 hours.

After EMA (postembolizatsionny period)

After embolization you on a gurney transported back to the ward.At the puncture site for one hour impose ice.Perhaps for a few hours it will set dropper.After 1-2 hours after the procedure, there are quite strong nagging pains in the lower abdomen.These feelings are a consequence of ischemia (fasting) fibroid cells.Pain lasted for several hours and adequately cropped painkillers.

In addition, in the first days after the EMA temperature may rise to subfibrilnyh numbers - 37-37,5.Possible weakness, malaise, nausea.However, all of these symptoms, a syndrome known as postembolizatsionny, speed not pose a threat to health and does not relate to the complications of UAE.

Usually these symptoms disappear the next day.Usually 1-3 days after UAE patients sent home.Even after 7-10 days, it is recommended to avoid physical activity.Extract available the very next day after the procedure.

results of uterine artery embolization

most active reduction of myoma continues in the first 6 months after UAE, but also in the future to maintain the momentum to decrease.On average, to 1 year after embolization of fibroids decreased by 4 times, and the size of the uterus normalized.In some cases, some fibroids (especially located close to the uterus) are separated from the uterine wall and out in a natural way (there is a "expulsion" of fibroids).This beneficial effect, resulting in the rapid recovery of the uterus structure.In 99% of patients return to normal menstruation, reduces the amount of menstrual bleeding.Symptoms of compression diminish and disappear in 92-97% of patients soon after the EMA treatment.
No risk of disease recurrence after intervention is an important feature of the UAE.This is due to the fact that when EMA effect occurs in all nodes regardless of their size.In general, more than 98% of patients not added after EMA treatment of uterine fibroids is required even in the long term.

Side effects and complications of uterine artery embolization

embolization of uterine fibroids - a fairly safe procedure, the risk of complications is ten times lower than after surgical treatment.Unfortunately, some gynecologists do not have the opportunity to use any other methods of treatment of uterine fibroids in addition to surgery patients often scare a lot of complications after embolization.This is fundamentally wrong and is a deliberate introduction of the patients misleading.

The most common problem after UAE is the formation of a hematoma (bruise) on the thigh artery at the site of puncture.This complication does not usually require additional treatment and extends within 1-2 weeks.

Not more than 3% of patients in the first 3-6 months after embolization of uterine fibroids may impair the regularity of the menstrual cycle or transient (temporary) amenorrhea.

more unpleasant complication EMA - infection.This is no more than one patient out of 200. The infection is usually treated successfully with antibiotics, but in rare cases may require performing a hysterectomy.

And another theoretically possible complication EMA - hit embolic particles in other vascular beds, which is very unacceptable and threatens the patient's life.

At the same likelihood of developing complications that may require a return to surgery, is less than one case per 600-800 EMA.

EMA and pregnancy

Embolization does not preclude the ability of women to bear children.It is obvious that after a hysterectomy about childbirth are not talking, but even after myomectomy infertility is often associated with the formation of adhesions in the uterus and around it.Therefore, EMA - the method of choice for women with fibroids who are planning a pregnancy.

bear pregnancy after uterine artery embolization is possible, but the risk of termination of pregnancy in the case of very large at any stage.And during childbirth, the postpartum period is a certain complication.

is not recommended in pregnancy planning periods up to a year after the embolization - is reduction units and uterine contractions.High risk of miscarriage.