Uterine artery embolization using progressively larger calibrated gelatin sponge particles

Purpose To assess the effectiveness and safety of uterine artery embolization (UAE) using progressively larger calibrated gelatin sponge particles for symptomatic uterine fibroids. Material and methods Thirty patients with symptomatic uterine fibroids underwent UAE. Calibrated gelatin sponge particles were used in all patients, beginning with 355-500?μm particles, progressively increasing to 500-710?μm and finally to 710-1000?μm particles. Changes in tumor, uterine volume, and tumor infarction rate were assessed using pelvic magnetic resonance imaging (MRI). The level of complication, improvement of clinical symptoms, and Uterine Fibroid Symptom and Quality of Life (UFS-QOL) score were assessed. Results MR imaging revealed the mean largest tumor volume reduction was 56.23?±?16.25% at three months and 72.61?±?14.47% at 12 months after the procedure. 100% infarction of the dominant fibroids was 91.27?±?5.02% at three months and 96?±?5.20% at 12 months after the procedure. Menorrhagia improved markedly in all 23 patients. Bulk-related symptoms improved in 12 (92.30%) of 13 patients. The baseline UFS-QOL score was 43.13 and improved to 11.88 (p?<?0.001). No major complications were observed. Conclusion UAE using progressively larger calibrated gelatin sponge particles is an effective and safe treatment for symptomatic uterine fibroids.     

静脉自控镇痛泵在子宫肌瘤栓塞治疗中的应用

目的 总结在子宫动脉栓塞治疗子宫肌瘤时,使用静脉自控镇痛泵对预防术中及术后疼痛及介入相关指标临床疗效和经验.方法 109例子宫肌瘤行双侧子宫动脉栓塞的病例,采用碘油平阳霉素乳剂加明胶海绵颗粒为栓塞材料,其中80例使用静脉自控镇痛泵,另29例使用利多卡因100 mg（2 ml）加生理盐水4.0 ml稀释成6.0 ml,患者疼痛不适时由导管注入,必要时加肌肉注射度冷丁50 mg.记录栓塞治疗中及治疗后患者急性缺血反应和症状.结果 与未使用静脉自控镇痛泵的病例相比,使用静脉自控镇痛泵患者术中及术后疼痛症状明显减轻,镇痛效果达85 %（68/80例）,与常规镇痛存在显著差异性.结论 子宫动脉栓塞治疗子宫肌瘤时使用静脉自控镇痛泵可以显著减轻常规栓塞治疗时的疼痛症状,是一种操作简单,效果好的方法,可推进子宫肌瘤动脉栓塞术的广泛应用.     

Uterine artery embolization as a treatment for symptomatic uterine fibroids: a review of literature and case report

PURPOSE: To provide a case presentation and review of the literature on uterine artery embolization (UAE) as a treatment alternative for symptomatic uterine fibroids and to guide the nurse practitioner (NP) in patient selection, education, and periprocedural management of patients undergoing this procedure. DATA SOURCES: Research articles, clinical articles, and case studies pertaining to UAE. CONCLUSIONS: UAE is a safe, well tolerated, and effective nonsurgical treatment option for symptomatic uterine fibroids. This uterus-sparing procedure has low complication rates with excellent clinical outcomes and high patient satisfaction rates. The majority of women who undergo UAE report marked reduction in the severity of fibroid specific symptoms and significant improvement in their quality of life. Uterine fibroids are common in women and often produce symptoms that have a negative impact on quality of life. IMPLICATIONS FOR PRACTICE: The NP is instrumental in identifying which patients may be appropriate candidates for UAE, educating them about the risks and benefits of the procedure, and managing these patients before and after the procedure.     

Uterine artery embolization for fibroids

UAE is an alternative to surgery for treatment of uterine fibroids that uses injections of small plastic or gelatin beads to thrombose fibroid vessels arising from the uterine artery. Clinical studies have reported less menorrhagia and pelvic pain in patients who have undergone the procedure. After embolization, many patients experience pain requiring an overnight hospital stay and administration of parenteral opioids. UAE is generally not recommended for women who have not completed childbearing.     

子宫动脉栓塞术治疗子宫肌瘤的疗效及其对卵巢功能的影响

目的探讨子宫动脉栓塞术(UAE)治疗子宫肌瘤的疗效及安全性。方法对122例子宫肌瘤患者行UAE治疗,按肌瘤大小分为两组,随访观察肌瘤体积变化与原有症状的改善情况;其中35例监测血中卵巢激素的水平,评价内分泌功能改变。结果117例患者行双侧栓塞,5例行单侧栓塞。110例症状性患者的改善率为87.8%(96例)。栓塞后,小肌瘤组平均肌瘤缩小率要高于大肌瘤组,但两者间无明显统计学差异,且这种差异又有随着时间缩小的趋势。术后无患者出现闭经,栓塞前后激素水平无显著变化。结论行UAE治疗子宫肌瘤,近期疗效明显,且对卵巢内分泌功能无影响。     

Anti-Müllerian hormone levels before and after uterine artery embolization

Objective: To determine the effects of uterine artery embolization (UAE) on ovarian reserve as measured by Anti-Müllerian hormone (AMH) levels.

Material and methods: Non-randomized, observational study of 89 women 23–40 years of age who received UAE. Control hormone levels were measured prior to UAE and the first post-embolization measurement was taken at various times post-procedure (mean?=?190?±?229 days).

Results: Historical work verified by our earlier work has shown that AMH levels decline with age. Regression analysis allows us to determine whether UAE contributes to a greater decline in AMH values over that naturally occurring with aging. The effect of the procedure was found to contribute no deleterious effect to the natural decline in AMH levels. In addition, multiple blood draws were obtained from 32 patients up to 47 months post-UAE. Regression studies with these patients as their own controls showed no long-term diminishment of ovarian reserve due to the UAE procedure.

Conclusions: Earlier reported data are consistent with larger sample size. UAE does not affect ovarian reserve in women <40 as evidenced by no significant change in AMH levels after embolization. Women who are of reproductive age and have uterine fibroids can consider UAE without concern for adverse effects on their fertility.     

子宫动脉栓塞术治疗子宫肌瘤35例分析

目的探讨子宫动脉栓塞术治疗子宫肌瘤的疗效。方法对35例子宫肌瘤患者采用Seldinger技术,经皮股动脉穿刺双侧子宫动脉插管栓塞治疗子宫肌瘤。结果栓塞治疗后子宫肌瘤血供被完全阻断,治疗后3～12个月随访结果表示栓塞治疗后子宫及肌瘤体积呈进行性缩小,临床症状明显改善,以月经改善最明显。结论子宫动脉栓塞术治疗子宫肌瘤是一种安全、有效、微创的新方法。     

Retrograde embolization technique of the right gastric artery during the implantation of port-catheter system for hepatic arterial infusion chemotherapy

ObjectiveThis study aimed to introduce and evaluate a new embolization technique for the right gastric artery (RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy (HAIC).MethodsFrom January 2013 to January 2017, 159 patients with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system. In 86 of these patients (56 men; aged 28–88 years; mean: 60.6 ​± ​12.0 years), in whom the RGA was obvious on arteriography, embolization of RGA was attempted using microcoils to protect the gastric mucosa during HAIC. In the first phase (first three years), antegrade embolization of the RGA using a 2.7 Fr microcatheter was performed in 55 patients. In the second phase (next two years), embolization of the RGA was attempted by combining antegrade embolization and retrograde embolization through the left gastric artery (LGA) in 31 patients. The success rates and the incidence of acute gastroduodenal mucosal toxicity (AGMT) in these two groups were compared.ResultsThe total success rate of the RGA embolization was 70.9%. The success rate was 83.9% in 31 patients who underwent combined antegrade and retrograde embolization, which was significantly higher than that of antegrade embolization alone (63.6%) performed in 55 patients (p ​= ​0.047). No complications related to embolization of RGA were documented. The incidence of AGMT was 29.1% (16/55) in patients in the first phase, which was significantly higher than that in the patients in the second phase (9.7%, 3/31) (p ​= ​0.037).ConclusionA combination of retrograde embolization via LGA could increase the success rates of RGA embolization and reduce the incidence of AGMT after HAIC.     

子宫动脉栓塞治疗子宫肌瘤的初步研究

目的 评价经导管子宫动脉栓塞法对子宫肌瘤的治疗作用。方法 28例病人（年龄36－48岁，平均41岁），有子宫肌瘤，顽固性阴道出血和腹痛，用PVA微粒行子宫动脉栓塞。术后3－12个月（平均5月）通过调查评估临床症状的改善。术前和术后3个月CT测量子宫和主要肿块的大小。结果 所有28例病人在技术上均成功栓塞。28名患中18名完成了调查表，显示症状明显好转的15例，无症状改善的1例，CT检查证实子宫体积和主要瘤体均大幅度缩小（平均缩小40％－65％）。结论 子宫动脉栓塞是一种很有希望的治疗子宫肌瘤导致的经血过多和盆腔疼痛的有效方法之一。     

介入栓塞联合中医消癥汤治疗子宫肌瘤的临床研究

目的：评价选择性子宫动脉栓塞术（UAE）联合中药自拟消癥汤治疗子宫肌瘤的临床疗效.材料与方法：经超声或CT或MR确诊子宫肌瘤68例随机分为治疗组34例,经UAE联合中药自拟消癥汤治疗;对照组34例,单纯采用UAE治疗.结果：治疗组在减少月经量、缩短月经期、增加血红蛋白、减少子宫肌瘤平均体积上明显优于对照组（P＜0.05）.结论：UAE联合中药自拟消癥汤治疗子宫肌瘤,疗效确切,值得临床推广应用.     

介入栓塞术、手术及高强度聚焦超声治疗子宫肌瘤的网状Meta分析

目的运用网状评价方法评价子宫动脉栓塞术(uterine artery embolization,UAE)、手术及高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗子宫肌瘤的安全性和有效性。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、WanFang Data和CNKI数据库,搜集有关UAE、外科手术、HIFU治疗子宫肌瘤的安全性和有效性评价的研究,检索时限均从2000年1月至2019年8月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,运用ADDIS 1.16.8软件和Stata 14软件进行网状Meta分析。结果共纳入11个研究(22篇文献),包括3469例患者。定性分析结果显示:与手术相比,UAE和HIFU患者术后1年生存质量较高,且UAE高于HIFU。网状Meta分析结果显示HIFU治疗子宫肌瘤术后1年内主要并发症发生率最低,UAE治疗次之,手术治疗最高;使用HIFU和UAE治疗患者住院时间及恢复时间较手术治疗短;但手术治疗后进一步干预率均低于UAE和HIFU治疗。结论UAE治疗子宫肌瘤术后1年生存质量最高。与手术相比,HIFU和UAE具有安全性好、住院时间短、康复快等优点,但两者有需要再次接受治疗的风险。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。     

Uterine Artery Embolization: Background Review,Patient Management,and Endovascular Treatment

Uterine fibroids, also called leiomyomas, are a common benign pelvic neoplasm that affects a large population of women. Symptoms caused by fibroids include excessive uterine bleeding, pelvic pain, fertility issues, and fatigue. Uterine artery embolization (UAE) is one of many different treatments used to reduce the symptomatic burden of fibroids by effectively reducing the blood supply to the fibroid, thus yielding symptomatic relief. Many studies have compared the effectiveness of UAE with the gold standard hysterectomy or gold standard alternative myomectomy, with strong results favoring UAE as a safe and effective treatment of fibroids. The literature shows that the less-invasive UAE also allows for shorter hospital stays, shorter recovery time, and less major complications than hysterectomy. The procedure involves a multidisciplinary preoperative approach with careful review of the imaging by the interventional radiologist. Many patients only require one overnight stay after the procedure, mainly to ensure adequate pain control. Overall, UAE serves as a less-invasive, safe, and effective option as a treatment modality for uterine fibroids.     

Ovarian reserve after fibroid embolization in premenopausal women

Objective: To investigate the effect of uterine artery embolization (UAE) for fibroids on ovarian pool of premenopausal women.

Study design: Prospective case control study.

Material and methods: One-hundred and twenty premenopausal women, aged between 40 and 50?years, who underwent UAE for symptomatic uterine fibroids and the same number of women, aged between 40 and 50?years, with symptomatic uterine fibroids, who were not offered treatment were recruited for this study. Hormonal status and ovarian reserve were evaluated by means of anti-Müllerian hormone (AMH) and follicle stimulating hormone (FSH) pre-procedural, three months, six months and 12?months after UAE.

Results: No statistically significant decrease was noted in AMH values 12?months post procedure and no statistical significant alterations in AMH values between the two groups.

Conclusions: Even though the study results may not be able to confirm the preservation of ovarian reserve and normal menstruation after UAE in premenopausal women, it should be considered as a friendly to normal menstruation treatment option of symptomatic fibroids.     

经导管子宫动脉灌注化疗序贯栓塞术治疗异位妊娠

目的 探讨经子宫动脉灌注化疗序贯栓塞术在治疗异位妊娠中的价值。 方法 对65例异位妊娠患者行超选择性双侧子宫动脉插管,灌注氨甲蝶呤,后用聚乙烯醇颗粒栓塞双侧子宫动脉,l周后行刮宫手术。 结果 65例患者均成功接受双侧子宫动脉灌注化疗栓塞术,术后l周行刮宫术,手术顺利。 结论 子宫动脉灌注化疗序贯栓塞术是保守治疗异位妊娠的一种安全、有效的微创方法。     

MRI对子宫动脉栓塞术治疗子宫肌瘤的价值

目的 观察经动脉导管子宫动脉栓塞术(UAE)治疗前后子宫肌瘤MRI表现,评估MRI对UAE治疗子宫肌瘤的价值。 方法 对40例接受UAE治疗的子宫肌瘤患者,分别于UAE治疗前及治疗后行MR检查,观察子宫肌瘤UAE前后的MRI信号及体积的变化情况。 结果 40例患者中共发现75个子宫肌瘤,其中肌壁间型60个(80.0%),浆膜下型12个(16.0%),黏膜下型3个(4.0%)。UAE治疗前,75个子宫肌瘤中56个(74.7%)T2^*     

Effects of TGF-β on uterine fibroids of women of childbearing age and uterine artery embolization

Purpose: To evaluate the effects of transforming growth factor-β (TGF-β) on uterine fibroids of women of childbearing age and uterine artery embolization (UAE) using Embosphere microspheres.

Material and methods: A total of 128 eligible women were randomly divided into an experimental group and a control group (n?=?64) who received UAE using Embosphere microspheres and panhysterectomy, respectively. Another 128 healthy women receiving physical examination in the same period were also enrolled. Serum TGF-β levels were detected by enzyme-linked immunosorbent assay (ELISA). Serum TGF-β level, size of uterine fibroid and prognosis were followed up.

Results: The serum TGF-β level of patients was significantly higher than that of healthy subjects. After treatment, the red blood cell counts and hemoglobin levels of the two patient groups significantly increased compared with those before (p?p?p?Conclusion: With the uterus retained, the therapeutic effect of UAE was similar to that of panhysterectomy. TGF-β expression level was associated with growth of uterine fibroid in women of childbearing age, which can be used as a target for treatment.     

Anti Müllerian hormone levels before and after uterine artery embolization: A preliminary report

Objective: To determine the effects of uterine artery embolization on Anti-Müllerian hormone levels for women under 40 years of age. Material and methods: Non-randomized, observational study of women under 40 years of age and who received UAE. Twenty-seven women under the age of 40 who underwent UAE were included in the study. Hormone levels were measured prior to UAE, and at least six months post UAE. Results: Statistical analysis from a paired t-test showed that the AMH levels pre- and post-embolization of these women fell within the normal range. The average AMH level prior to embolization was 2.54 ± 3.99 ng/mL. The mean AMH concentration after embolization was 2.33 ± 2.70 ng/mL. The average change in AMH levels between pre-and post-embolization was -0.21 ± 1.08 ng/mL. There is no statistically significant difference between the pre- and post- UAE AMH levels (95% CI -0.64 to 0.22, p=0.32). Conclusion: UAE does not affect ovarian reserve in women under 40 as evidenced by no significant change in AMH levels before and after embolization. Women who are of reproductive age and have fibroids can consider UAE without concern for adverse effects on their fertility.     

经阴道三维彩色多普勒超声在子宫动脉栓塞术治疗子宫肌瘤的价值

目的 探讨经阴道三维彩色多普勒超声在子宫动脉栓塞术治疗子宫肌瘤的应用价值.方法 经阴道三维彩色多普勒超声检查子宫动脉栓塞术前患者47例,观察肌瘤位置、内部回声及血流.术后6个月观察肌瘤的体积变化,分析其与术前肌瘤位置、内部回声及血流的关系.结果 术后肌瘤体积的缩小程度与术前肌瘤位置、内部回声及血流有关.术前应用三维血管透明成像技术重建子宫肌瘤供血血管对子宫动脉栓塞术有一定指导作用.结论 经阴道三维彩色多普勒超声的图像清晰直观、空间关系明确、立体感强及测量瘤体体积准确,同时可以清晰显示肌瘤内外的立体血流分布情况,弥补二维超声的不足,能为子宫动脉栓塞术前提供有价值的信息.     

Mid-term outcomes of left subclavian artery revascularization with Castor stent graft in treatment of type B aortic dissection in left subclavian artery

BackgroundHere we analyzed mid-term data of thoracic endovascular aneurysm repair (TEVAR) surgery with Castor single-branched stent graft placement for the management of Stanford type B aortic dissection (STBAD) involving the left subclavian artery (LSA).MethodsBetween April 2014 and February 2019, 32 patients with STBAD involving a Castor single-branched stent graft were included. We analyzed their outcomes, including technical success rate (TSR), surgical duration (SD), presence of ischemia, perioperative complications, LSA patency, and survival rate (SR), using computed tomography angiography and clinical evaluation during mid-term follow-up.ResultsThe mean patient age was 54.63 ​± ​12.37 years (range, 36–83 years). The TSR was 96.88% (n ​= ​31/32). The mean SD was 87.44 ​± ​10.89 with a mean contrast volume of 125.31 ​± ​19.30 ​mL. No neurological complications or deaths occurred during the study period. The patients had a mean hospital stay of 7.84 ​± ​3.20 days. At a mean follow-up of 68.78 ​± ​11.26 months, four non-aortic deaths (12.5%) were observed. The LSA patency rate was 100% (n ​= ​28/28). There was only one case of type I endoleak immediately after surgery (3.12%) (type I from LSA). However, none of the patients experienced type II endoleaks, and there were no cases of retrograde type A aortic dissection or stent graft-driven new distal entry. Finally, all patients exhibited good LSA patency.ConclusionTEVAR using a Castor single-branched stent graft may be a highly feasible and efficient procedure for the management of STBAD involving the LSA.     

Spectrum of imaging findings on MRI and CT after uterine artery embolization

Uterine artery embolization (UAE) is an effective treatment for symptomatic uterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis, and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a sign of infection. The MRI and CT appearances vary depending upon the time interval after UAE and success of the procedure. Radiologists should be familiar with the range of post-UAE appearances on MRI and CT to better aid clinicians in correct diagnosis and treatment. The main purpose of this pictorial review is to identify the spectrum of findings on MRI and CT performed after UAE, to illustrate UAE-associated common and uncommon MRI and CT appearances and discuss post-UAE complications that require urgent medical or surgical intervention.