Complications of Fibroid Embolisation
Uterine artery embolisation (UAE) is a well-established procedure in the treatment of uterine fibroids. It is a safe procedure in experienced hands, but is not without serious complications. As our experience with the procedure has grown, our understandin
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Contents
Abstract
1
Introduction..........................................................................
75
2
Overall Complication Rates ...............................................
76
3
Complications of Angiography ..........................................
76
4
Non-target Embolisation .....................................................
77
5
Post-embolisation Syndrome ..............................................
78
6
Pelvic Infection and Sepsis .................................................
78
7
Fibroid Passage ....................................................................
79
8
Ovarian Failure ...................................................................
79
9
Pregnancy After Embolisation...........................................
81
10
Deep Vein Thrombosis and Pulmonary Embolism .........
81
11
Radiation Protection............................................................
81
12
Miscellaneous........................................................................
82
13
Death .....................................................................................
82
14
Conclusion ............................................................................
82
References......................................................................................
82
Uterine artery embolisation (UAE) is a well-established procedure in the treatment of uterine fibroids. It is a safe procedure in experienced hands, but is not without serious complications. As our experience with the procedure has grown, our understanding of the nature and timing of these complications has also improved. A large number of observational studies and comparative studies of UAE versus surgery have reported a range of complication rates. Two large multicentre registries with the largest patient cohorts have also presented their data on adverse events. These complications are classified according to the Society of Interventional Radiology (SIR) guidelines and the evidence for each category is presented in this chapter. It is important to understand the causes of these adverse events and to maintain awareness during and after UAE, in order to ensure prompt diagnosis and appropriate management should they occur.
1
J.-Y. Chun (&) A.-M. Belli Department of Radiology, St George’s Hospital, Ground Floor, St James Wing, Blackshaw Road, London, SW17 0QT, UK e-mail: [email protected]
Introduction
As experience with uterine artery embolisation (UAE) has increased, our understanding of the nature and timing of complications has improved. Whereas most complications related to surgery are expected within 30 days and often before the patient has been discharged, complications associated with UAE may be delayed for months. Therefore, it is important for clinicians and patients to be aware of this difference in timeframe. The EMMY trial reported that the majority of UAE complications occurred following discharge, within the first 6 weeks (Volkers et al. 2006). Another large series reported up t
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