Structural changes in uterine tissues after uterine artery embolization in patients with leiomyoma complicated by uterine bleeding

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (1) ◽  
pp. 78-82
Author(s):  
G P Titova ◽  
M M Damirov ◽  
L S Kokov ◽  
O N Oleynikova ◽  
G E Belozerov
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Structural Changes ◽  
Morphological Changes ◽  
Uterine Bleeding ◽  
Small Scale ◽  
Artery Embolization ◽  
Vessel Occlusion ◽  
Uterine Arteries ◽  
Uterine Tumors

Uterine leiomyoma (UL) is often complicated by the development of uterine bleeding. In urgent gynecology for the implementation of endovascular hemostasis, uterine artery embolization (UAE) is used. Performing UAE allows to stop and/or significantly reduce the intensity of bleeding and prepare a patient for surgical intervention. At the same time, the morphological changes that occur in uterine tissues in operated UL patients after performing the UAE are not studied. The aim was to study the peculiarities of pathomorphological changes in uterine tumors and tissues in operated UL patients complicated by uterine bleeding after performing UAE. Material and methods. The results of morphological changes appearing in tumors and tissues of the uterus in 39 operated UL patients, who were used for stopping uterine bleeding, were analyzed. Results. After applying different types of embolizing agents in macroscopic study of the uterus, signs of ischemia of its tissues were revealed, and the most pronounced disorders were detected in the UL nodes. Morphologically it was established that UAE microemboli resulted in vessel occlusion with increasing thrombosis in their distal sections. UAE was not accompanied by occlusal occlusion of the arteries and resulted in small-scale necrosis of the tumor with complete regeneration of the endometrium. Conclusions. The results of the morphological study showed that after the UAE was performed, the myomatous nodes underwent dystrophic, necrobiotic and necrotic changes. Depending on the nature of occlusion of the uterine arteries, various variants of necrosis (scale and completeness of the process) developed in the tumor tissue, which was aseptic in nature.

scholarly journals Successful repeated uterine artery embolization in postpartum hemorrhage with disseminated intravascular coagulation: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shunya Sugai ◽  
Taro Nonaka ◽  
Kana Tamegai ◽  
Tatsuhiko Sato ◽  
Kazufumi Haino ◽  
...  
Keyword(s):  
Risk Factor ◽  
Disseminated Intravascular Coagulation ◽  
Postpartum Hemorrhage ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Placenta Previa ◽  
Blood Transfusions ◽  
Artery Embolization ◽  
Intravascular Coagulation ◽  
Uterine Arteries

Abstract Background Postpartum hemorrhage (PPH) is a potentially fatal condition requiring urgent and appropriate intervention. Uterine artery embolization (UAE) has a high hemostatic capacity for PPH, but it may fail. Disseminated intravascular coagulation (DIC) has been reported as a risk factor associated with the failure of UAE. Case presentation A 37-year-old primigravida with dichorionic diamniotic twins and placenta previa underwent cesarean section. The blood loss during surgery was 4950 mL. Hemostasis was achieved using an intrauterine balloon tamponade device. However, she lost a further 2400 mL of blood 5 h after surgery. We embolized both uterine arteries using gelatin sponges and confirmed hemostasis. She was suffering from DIC and received ample blood transfusions. However, a further 1300 mL of blood was lost 18 h after surgery and we performed repeated UAE, with complete recanalization of the uterine arteries on both sides and re-embolization with gelatin sponges. Her DIC was treated successfully by blood transfusions at this time, and she showed no further bleeding after the repeated UAE. Conclusions DIC is a risk factor for the failure of UAE. Repeated UAE may be effective after sufficient improvement of the hematological status in patients with PPH and DIC.

scholarly journals Uterine Artery Embolization End Points and Collateral Circulation: Value of Intra-Procedural Non-Contrast Cone Beam CT

2021 ◽  
Vol 9 (3) ◽  
Author(s):  
Jaron Tepper ◽  
Jacob Cynamon
Keyword(s):  
Blood Supply ◽  
Collateral Circulation ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Cone Beam Ct ◽  
Uterine Fibroids ◽  
Cone Beam ◽  
Artery Embolization ◽  
Embolic Material ◽  
Uterine Arteries

Uterine artery embolization (UAE) is a well-accepted treatment for symptomatic uterine fibroids, but endpoints of UAE remain controversial. This is of significant concern as incomplete embolization can lead to treatment failure, necessitating repeat embolization or alternative treatments such as hysterectomy. Multiple potential causes of UAE failure have been described including failure to catheterize one or both of the uterine arteries, uterine artery spasm, clumping of embolic material and collateral blood supply vascularizing the fibroids. In this review, we discuss potential approaches to identifying collateral blood supply to the uterus and suggest that intra-procedural non-contrast cone beam CT provides unique advantages to addressing this issue.

Uterine Fibroids

2021 ◽  
Author(s):  
Kari Plewniak ◽  
Hye-Chun Hur
Keyword(s):  
Key Words ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Treatment Options ◽  
Uterine Fibroids ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Hormonal Status ◽  
Artery Embolization ◽  
Medical Comorbidities

Uterine fibroids may be present in up to 80% of women and are the most common benign indication for hysterectomy. Symptoms related to fibroids can vary tremendously and depend on the number, size, and location of fibroids, as well as the patient’s hormonal status. Several different treatment options are available for fibroids. A variety of factors, such as a patient’s symptoms, age, reproductive goals, and medical comorbidities, help determine which treatment is best for each patient.  This review contains 11 figures, 4 tables and 55 references Key Words: abnormal uterine bleeding, fibroids, FIGO fibroid classification, hysterectomy, leiomyoma, myomectomy, uterine artery embolization

Role of Uterine Artery Embolization in Management of Uterine Lesions with Abnormal Uterine Bleeding

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 27-27
Author(s):  
MF Hammad ◽  
MS Alwaraky ◽  
MA Maaly ◽  
MA Kamel ◽  
HA Hamza
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Clinical Success ◽  
Venous Malformation ◽  
Treatment Options ◽  
Clinical Success Rate ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Artery Embolization ◽  
High Level

Introduction: Abnormal uterine bleeding is one of the most frequent gynecological and obstetrics problems. Till the recent decades, myomectomy and hysterectomy were the only treatment options available to control uterine bleeding regardless the morbidity and mortality. Over the past decade, uterine artery embolization (UAE) has become a popular alternative treatment. Our study aim is to evaluate the efficacy of UAE for the treatment of uterine bleeding of different etiologies as Fibroids & uterine arterio-venous malformation (AVM). Material & Methods: Thirty patients were enrolled in the study: 28 patients with fibroids & 2 patients with AVM, all underwent UAE by PVA for fibroid & Hystroacryl with lipidol & coils for AVM. Bleeding as an end point was Followed up for 6 months. Results: Cessation of bleeding with no recurrence through the 6 months of follow up. UAE significantly decreased the bleeding towels from 4.4 to 2 towels after 6 months. As well, the menstrual duration was reduced from 7.6 to 4.4 days (p < 0.05*). Hemoglobin level was boosted from 10.7 to 11.4 gm/dl after 6 months (p=0.001*). As well, the fibroid size was significantly reduced from 314.7 to 70.4 cm3 after 6 months (p < 0.05*). The AVM cases have completely recovered & one of them got pregnant with delivery of normal fetus with no reported complication. The majority of our patients showed high level of satisfaction with the obtained outcomes. Conclusion: UAE, either unilateral or bilateral, is a safe and effective technique for management of abnormal uterine bleeding of fibroids & AVM origin. A high clinical success rate and fibroid volume with the mean menstrual duration& amount reduction can be achieved.

scholarly journals Repeated broad ligament hematomas managed by uterine artery embolization: time to execute

2019 ◽  
Vol 8 (8) ◽  
pp. 3417
Author(s):  
Subrat Panda ◽  
Nalini Sharma ◽  
Pranjal Phukan
Keyword(s):  
Complication Rate ◽  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Effective Interaction ◽  
Broad Ligament ◽  
Arterial Embolization ◽  
Clinical Effectiveness ◽  
Artery Embolization ◽  
Uterine Arteries ◽  
Obstetric Haemorrhage

Selective arterial embolization (SAE) of the uterine arteries is an alternative to surgery when medical management fails in cases of intractable posrtpartum haemorrhage. It is highly efficacious with low complication rate. Here we report a case of repeated broad ligament haematoma managed by selective uterine artery embolization. Present case 28year old P4L4 was referred from a district hospital as post LSCS case with broad ligament haematoma. Patients general condition was very poor at the time of admission. She underwent laparotomy twice and finally uterine artery embolization for repeated broad ligament haematoma and responded. Massive obstetric haemorrhage remains a significant cause of maternal morbidity and mortality. The threshold for uterine artery embolization (UAE) in women with obstetric haemorrhage should be low, as it is coupled with a high clinical effectiveness rate, low complication rate and preservation of fertility. However, it requires an infrastructure, multidisciplinary approach, as well as speedy and effective interaction between various specialties.

scholarly journals Ruptured pyomyoma – Rare complication of post-uterine artery embolization: A case report

2021 ◽  
Vol 11 ◽  
pp. 67
Author(s):  
Sai Swarupa Reddy Vulasala ◽  
Dheeraj Reddy Gopireddy ◽  
Khaled Mohamed ◽  
Chandana Lall
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Rare Complication ◽  
Invasive Procedure ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Vascular Supply ◽  
High Morbidity ◽  
Artery Embolization ◽  
Uterine Arteries

Leiomyomas, also termed as fibroids, are benign smooth, muscle neoplasms seen in 70–80% of women by the age of 50 years. Uterine artery embolization (UAE) is a minimally invasive procedure that involves cessation of vascular supply to the fibroids, by infusion of gelatinous microspheres into the uterine arteries. Pyomyoma is a suppurative leiomyoma, secondary to infection of necrotic tissue. It is an infrequent complication of uterine artery embolization (UAE). Pyomyoma can lead to sepsis, peritonitis, and respiratory distress syndrome resulting in high morbidity and mortality. Due to its rarity, high suspicion is crucial in the diagnosis, and prompt treatment is recommended to reduce mortality. Ultrasound, computed tomography, and magnetic resonance imaging assist in diagnosis. We present a case of a 44-year-old woman with ruptured pyomyoma, following an UAE intervention. The patient was treated with total abdominal hysterectomy and salpingo-oophorectomy along with peritoneal irrigation and drainage.

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