The Role of a Repeat UAE Procedure
Patients who have been treated for fibroid disease by embolotherapy occasionally may not experience satisfactory symptom relief. Others, who initially do have relief from their fibroid-related symptoms may have those symptoms recur. Causes for clinical fa
- PDF / 389,131 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 36 Downloads / 239 Views
Contents 1
Abstract
Patients who have been treated for fibroid disease by embolotherapy occasionally may not experience satisfactory symptom relief. Others, who initially do have relief from their fibroid-related symptoms may have those symptoms recur. Causes for clinical failure and symptom recurrence include incomplete fibroid infarction and interval growth of new fibroids. Many of these patients will respond to repeat embolization.
Introduction.......................................................................... 109
2 Indications for Repeat UAE .............................................. 109 2.1 Scenario 1: Early Failure of UAE ........................................ 110 2.2 Scenario 2: Late Failure of Symptom Control..................... 111 3
Technique for Repeat UAE ................................................ 112
4
Results of Repeat UAE ....................................................... 113
5
Conclusion ............................................................................ 113
References...................................................................................... 113
1
Introduction
Ideally, a Uterine Artery Embolization (UAE) procedure should cause complete or near complete infarction of all detectable fibroids (Katsumori et al. 2008). While patients with less than complete fibroid infarction may experience relief from symptoms in the short or medium term (Abramowitz et al. 2009), the risk of symptom recurrence in these patients is higher than for those who had more extensive infarction (Pelage et al. 2004; Kroenke et al. 2010). Unfortunately, embolotherapy does not change the pathology that leads to the formation of fibroids. Women may well go on to develop new symptomatic fibroids, even after the most thorough of embolizations. If a woman fails to respond to embolization or develops recurrent symptoms, one must consider whether or not a repeat embolization would be useful.
2
R. L. Worthington-Kirsch (&) 42 Rosedale Road, Wynnewood, PA 19096, USA e-mail: [email protected]
Indications for Repeat UAE
There are two clinical scenarios that can lead to a repeat UAE. Both situations pose different questions, which are largely answered by imaging. The procedure of choice is contrast-enhanced MRI of the pelvis (Table 1).
J. Reidy et al. (eds.), Radiological Interventions in Obstetrics and Gynaecology, Medical Radiology. Diagnostic Imaging, DOI: 10.1007/174_2012_595, Springer Berlin Heidelberg 2014 Published Online: 23 May 2014
109
110
R. L. Worthington-Kirsch
Table 1 Repeat UAE decision algorithm
2.1
Scenario 1: Early Failure of UAE
Vignette—LK is a 43-year-old woman who works as a college professor. She has a 10-year history of increasing menorrhagia and pressure symptoms. Physical examination and MRI show an 18–20-week uterus almost completely occupied by 2 or 3 large fibroids which show homogeneous global enhancement. Endometrial biopsy is benign. At UAE both uterine arteries were catheterized and embolized with a total of 12 ml of calibrated
Data Loading...
