Modern approaches to endovascular treatment of uterine leiomyoma

Individual features of the blood supply to the uterus and ovaries in 20-25% of cases cause failures in endovascular treatment of patients with uterine leiomyoma (ULM) and are forced to return to traditional surgical methods. The purpose of the study is to assess the possibilities of preventing iatrogenic complications of endovascular treatment of ULM through the use of separating occlusion of the uterine arteries, taking into account the characteristics of the blood supply to the uterus and ovaries. Materials and methods. The work is based on the analysis of the results. X-ray endovascular occlusion of the uterine arteries for ULM performed in 88 women aged 34-46 years (mean age 38.8 ± 2.5 years). The patients were divided into 2 groups: the 1st group comprised 65 patients without visible uterine-ovarian interarterial anastomoses. They performed standard embolization of the uterine arteries (EUA) using spherical PVA microemboli (COOK, USA), Embosphere (Merit Medical, USA) with a diameter of 500-700 microns. The second group consisted of 23 patients in whom utero-ovarian inter-arterial anastomoses were detected. In patients of this group, EUAs were produced with Embox cylindrical emboli (Plastis-M, Russia) with a length of 10 mm and a diameter of 500-700 μm, which occlude only the bed of the uterine arteries and are not capable of to overcome utero-ovarian inter-arterial anastomoses. In the 2nd group of EUA patients wore the character of occlusion, separating the uterine and ovarian arteries. The original EUA protocol was applied, which includes, in addition to the standard stages of selective arteriography of the uterine arteries, performing preliminary abdominal aortography to visualize the ovarian arteries and pelvic arteriography to assess pelvic vascular anatomy and identify utero-ovarian interarterial anastomoses. The results of the study. A total angiographic examination of the ovarian and uterine arteries, including a review angiography of the infrarenal section and bifurcation of the aorta, ileal vessels. In 23 (26.1%) patients with angiographic examination, uterine-ovarian arterio-arterial anastomoses. In 13 patients (56.5% of the detected anastomoses), these were type 1 anastomoses. In 10 patients (43.5% of the detected anastomoses), type 3 anastomoses were detected. Endovascular occlusion of the uterine arteries was performed in all patients. In 5 (7.69%) patients from the 1st group after EUA, amenorrhea occurred. In contrast, in all 23 patients from the 2nd group in the postembolization period, no observation of ovarian function was observed in any of the observations. Conclusion. For endovascular treatment of ULM in the presence of pronounced utero-ovarian interarterial anastomoses, the method of separating uterine artery occlusion is a safe and effective way to prevent ischemic damage to the ovaries.

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Prophylaxis of Ischemic Damage to the Ovaries, Taking Into Account Peculiarities of Blood Supply to the Uterus During Endovascular Treatment of Le Yo Fibroids

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2020-9-2-273-280 ◽

2020 ◽

Vol 9 (2) ◽

pp. 273-280

Author(s):

L. S. Kokov ◽

M. M. Damirov ◽

O. N. Oleinikova ◽

A. A. Medvedev ◽

G. Y. Belozyorov

Keyword(s):

Blood Supply ◽

Ovarian Tissue ◽

Vascular Anatomy ◽

Uterine Bleeding ◽

Ischemic Damage ◽

Infrarenal Aorta ◽

Uterine Arteries ◽

Group I ◽

Long Term Follow Up ◽

Group Ii

SUMMARY Uterine arteries embolization (UAE) is one of the modern trends in the treatment of uterine bleeding caused by uterine leiomyomas (UL). However, unfavourable results of this method of treatment are observed in 10–15% of cases. This is primarily concerned with the emerging ischemia of ovarian tissue after embolization.Material and methods Complex examination and treatment was performed in 48 patients admitted with UL complicated by the development of uterine bleeding. Patients with UL were divided into two groups. In the Group I of patients (n=29) standard embolization was performed, while the patients of the Group II (n=19) with diagnosed interarterial utero-ovarian anastomosis underwent separating technique of UA occlusion using different types of emboli.Results and discussion The features of the uterine blood supply in patients with UL were analyzed from the perspective of the effecacy and safety of endovascular intervention. A methodology of staged EUA was developed, which involved the staged aortography of the infrarenal aorta (for visualization of the ovarian arteries); pelvic arteriography (for evaluating the vascular anatomy of the pelvis and identifying utero-ovarian intearterial anastomoses); selective arteriography followed by UAE first with cylindrical emboli, and then with standard emboli in the form of microspheres. The application of the developed technique did not show dysfunction of the ovaries in both the short and long-term follow-up period up to 18 months in the Group II.Conclusion The separating UA occlusion is a safe and effective way of preventing ischemic damage in the presence of signoficant utero-ovarian inter-arterial nastomoses.

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Endovascular occlusion of uterine arteries in the treatment of symptomatic uterine leiomyoma

Journal of Clinical Medicine of Kazakhstan ◽

10.23950/1812-2892-jcmk-00478 ◽

2017 ◽

Vol 3 (45 special issue) ◽

pp. 11-13

Author(s):

Abishev Bakhyt ◽

Rakhimzhanova Raushan ◽

Tazhibaeyv Dulat

Keyword(s):

Uterine Leiomyoma ◽

Uterine Arteries ◽

Endovascular Occlusion

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Vascular Supply of the Human Spiral Ganglion: Novel Three-Dimensional Analysis Using Synchrotron Phase-Contrast Imaging and Histology

Scientific Reports ◽

10.1038/s41598-020-62653-0 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 2

Author(s):

Xueshuang Mei ◽

Rudolf Glueckert ◽

Annelies Schrott-Fischer ◽

Hao Li ◽

Hanif M. Ladak ◽

...

Keyword(s):

Blood Supply ◽

Phase Contrast ◽

Spiral Ganglion ◽

Three Dimensional ◽

Vascular Anatomy ◽

Helical Structure ◽

Vascular Supply ◽

Phase Contrast Imaging ◽

Contrast Imaging ◽

Temporal Bones

AbstractHuman spiral ganglion (HSG) cell bodies located in the bony cochlea depend on a rich vascular supply to maintain excitability. These neurons are targeted by cochlear implantation (CI) to treat deafness, and their viability is critical to ensure successful clinical outcomes. The blood supply of the HSG is difficult to study due to its helical structure and encasement in hard bone. The objective of this study was to present the first three-dimensional (3D) reconstruction and analysis of the HSG blood supply using synchrotron radiation phase-contrast imaging (SR-PCI) in combination with histological analyses of archival human cochlear sections. Twenty-six human temporal bones underwent SR-PCI. Data were processed using volume-rendering software, and a representative three-dimensional (3D) model was created to allow visualization of the vascular anatomy. Histologic analysis was used to verify the segmentations. Results revealed that the HSG is supplied by radial vascular twigs which are separate from the rest of the inner ear and encased in bone. Unlike with most organs, the arteries and veins in the human cochlea do not follow the same conduits. There is a dual venous outflow and a modiolar arterial supply. This organization may explain why the HSG may endure even in cases of advanced cochlear pathology.

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Endovascular Occlusion of the Posterior Cerebral Artery in the Treatment of P2 Ruptured Aneurysms

Interventional Neuroradiology ◽

10.1177/159101990701300202 ◽

2007 ◽

Vol 13 (2) ◽

pp. 127-132 ◽

Cited By ~ 7

Author(s):

E. Cotroneo ◽

R. Gigli ◽

G. Guglielmi

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Parent Vessel ◽

Ruptured Aneurysms ◽

Endovascular Occlusion ◽

Platinum Coils

Four cases of posterior cerebral artery (PCA) aneurysms are described. The aneurysms were located at the P2 segment of PCA. All cases presented with a subarachnoid hemorrhage (SAH). Endovascular treatment was performed, with occlusion of the aneurysm and parent vessel, using platinum coils. Two patients developed a homonymus lateral hemianopia after treatment.

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Cutaneous Vascular Anatomy of Pectoral Skin Flaps

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947308200512 ◽

1973 ◽

Vol 82 (5) ◽

pp. 691-695

Author(s):

Thomas C. Calcaterra ◽

Edward F. Cherney ◽

Mohammed Saffouri

Keyword(s):

Head And Neck ◽

Blood Supply ◽

Surgical Therapy ◽

Vascular Anatomy ◽

Skin Flaps ◽

Flap Necrosis ◽

Arterial Blood Supply ◽

Pedicled Flaps ◽

Arterial Blood ◽

Flap Viability

The need for nondelayed skin flaps from the chest for postoperative reconstruction and repair has increased considerably since the advent of combined irradiation and surgical therapy for treatment of cancer of the head and neck. Survival of these pedicled flaps is of paramount concern to the surgeon, as flap necrosis can be catastrophic for the patient. Many parameters have been evaluated to predict flap viability, but recent studies strongly suggest that the arterial blood supply of the pedicle is the most important factor in the success of immediate transposition. A study was performed in 19 cadavers to delineate the cutaneous vascular anatomy of the chest in order to determine precisely where the perforating vessels of the thorax and shoulders supply the pedicle region of medially-based and laterally-based pectoral flaps. On the basis of this study, modification of the design of these flaps is recommended.

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Evaluation of the immediate and long-term results of endovascular treatment of ruptured vertebrobasilar artery aneurysms in an acute period of hemorrhage

Russian journal of neurosurgery ◽

10.17650/1683-3295-2018-20-4-31-37 ◽

2019 ◽

Vol 20 (4) ◽

pp. 31-37

Author(s):

E. O. Ivankova ◽

V. V. Darvin ◽

M. A. Bessmertnykh

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Vegetative State ◽

Good Condition ◽

Artery Aneurysm ◽

Long Term Results ◽

Study Objective ◽

Acute Period ◽

Endovascular Occlusion ◽

Vertebrobasilar Artery

The study objective is to evaluate the results of endovascular treatment of patients with subarachnoid hemorrhage due to rupture of the vertebrobasilar artery aneurysm.Materials and methods. From 2011 to 2017, 26 patients underwent endovascular occlusion of the ruptured vertebrobasilar artery aneurysm in an acute period of hemorrhage in Surgut Clinical Hospital for Traumatology.Results. Endovascular interventions were performed in 1–14 days after the episode of the primary subarachnoid hemorrhage. Among the patients 53.8 % were in good condition at admission (Hunt–Hess grade I–II), 46.2 % had moderate and severe neurologic disability (Hunt–Hess grade III–IV). A good and satisfactory degree of aneurysm occlusion was achieved in 18 (69.3 %). Favorable outcome (modified Rankin Scale (mRS) 0–2) was achieved in 21 (80.7 %); 1 (3.7 %) had severe disability (mRS 4), 2 (7.8 %) – vegetative state (mRS 5). Lethal outcome (mRS 6) occurred in 2 (7.8 %). Unfavorable outcomes were caused by a severe vasospasm.Conclusions. Endovascular occlusion of vertebrobasilar artery aneurysms in the acute period of hemorrhage is an effective and safe method of treatment in patients with Hunt–Hess grade I–IV.

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The Intraosseous Blood Supply of the Fifth Metatarsal: Implications for Proximal Fracture Healing

Foot & Ankle ◽

10.1177/107110079201300306 ◽

1992 ◽

Vol 13 (3) ◽

pp. 143-152 ◽

Cited By ~ 175

Author(s):

Judith W. Smith ◽

Steven P. Arnoczky ◽

Alexander Hersh

Keyword(s):

Fracture Healing ◽

Blood Supply ◽

Vascular Anatomy ◽

Delayed Union ◽

Nonoperative Treatment ◽

Anatomical Location ◽

Nutrient Artery ◽

India Ink ◽

Increased Risk ◽

Fresh Frozen

Fractures of the proximal fifth metatarsal can be divided into two distinct groups based on anatomical location and clinical course. Fractures of the tuberosity often heal well with nonoperative treatment, whereas fractures occurring in the proximal diaphysis (up to 1.5 cm distal to the tuberosity) have significantly increased risk for delayed union or nonunion. It is the purpose of this paper to describe the intraosseous vascular anatomy of the fifth metatarsal, and the clinical implications for basilar fracture healing. Ten fresh-frozen amputation or cadaver specimens were studied following arterial injection with India ink or barium sulfate suspension. The intraosseous blood supply to the fifth metatarsal tuberosity arose from numerous metaphyseal vessels penetrating the nonarticular surfaces of the tuberosity in a random, radiate pattern. The blood supply to the proximal diaphysis was derived primarily from the nutrient artery, which gave rise to longitudinal intramedullary branches. The arterial supply to the tuberosity joined the supply of the proximal diaphysis in the area just distal to the tuberosity, corresponding to the region of poor prognosis for fracture healing. This suggests that a relative lack of blood supply following a proximal diaphyseal fracture may contribute to delayed union and nonunion.

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Vascular anatomy of the pronator quadratus muscle-bone flap: A justification for its use with a distally based blood supply

The Journal Of Hand Surgery ◽

10.1016/s0363-5023(09)90027-2 ◽

1990 ◽

Vol 15 (4) ◽

pp. 630-636 ◽

Cited By ~ 43

Author(s):

Santosh Rath ◽

L.K. Hung ◽

P.C. Leung

Keyword(s):

Blood Supply ◽

Vascular Anatomy ◽

Bone Flap ◽

Pronator Quadratus ◽

Distally Based ◽

Pronator Quadratus Muscle

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Endovascular Treatment of Ruptured Dissecting Posterior Inferior Cerebellar Artery Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991201800410 ◽

2012 ◽

Vol 18 (4) ◽

pp. 442-448 ◽

Cited By ~ 13

Author(s):

I. Ioannidis ◽

N. Nasis ◽

A. Andreou

Keyword(s):

Endovascular Treatment ◽

Medical Center ◽

Posterior Inferior Cerebellar Artery ◽

Vascular Anatomy ◽

Parent Artery ◽

Parent Vessel ◽

Cerebellar Artery ◽

Clinical Records ◽

Dissecting Aneurysms

Dissecting aneurysms of the posterior inferior cerebellar artery (PICA) distal to its origin from vertebral artery (VA) are very rare. Although rare, they associated with a high risk of rebleeding and they present a therapeutic challenge. This study reviewed the clinical presentations, angiographic characteristics of dissecting aneurysms of the PICA and to assess the clinical and angiographic outcomes of patients who underwent endovascular treatment. Ten patients with ten dissecting aneurysms who underwent endovascular treatment were identified in the clinical records of a single medical center from January 2000 to December 2010. The mean follow-up duration was 2.8 years. All patients presented with subarachnoid hemorrhage (SAH). They all underwent endovascular treatment, which included occlusion of the dissected segment and the parent artery after detailed angiographic evaluation of the vascular anatomy, and test occlusion of the PICA. In all patients the endovascular treatment was successfully completed without procedure related complications. Long-term follow-up studies in seven out of ten patients showed complete occlusion of the aneurysm with no new neurologic deficits. The clinical outcome was good in eight cases, whereas two patients with poor clinical condition at admission died during their initial hospital stay. Endovascular occlusion of the parent vessel and the dissected segment is relatively safe treatment option for dissecting aneurysms of the PICA distal to its origin.

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