Uterine Artery Embolization Indications and Contraindications
Uterine artery embolization (UAE) has become accepted as an effective therapy for most women with symptomatic fibroids (ACOG Practice Bulletin 2008 ). And while the vast majority of patients would be well treated with embolization, the decision as to whet
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Contents
Abstract
1 Basic Considerations in UAE Patient Selection............... 1.1 History and Physical Examination........................................ 1.2 Imaging ..................................................................................
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2 2.1 2.2 2.3 2.4
Indications ............................................................................ Heavy Menstrual Bleeding.................................................... Pelvic Pain and Pressure ....................................................... Urinary Symptoms................................................................. Asymptomatic Fibroids .........................................................
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3 3.1 3.2 3.3 3.4 3.5
Contraindications................................................................. Practice Guidelines................................................................ Pregnancy............................................................................... Suspected Uterine or Adnexal Malignancy.......................... Contrast Allergy .................................................................... Pelvic Infection......................................................................
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4
Medical Conditions Requiring Caution ............................
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5 5.1 5.2 5.3 5.4
Anatomic Considerations in Patient Selection................. Large Uteri............................................................................. Large Dominant Fibroid........................................................ Pedunculated Serosal Fibroids with Narrow Attachment .... Cervical Fibroids ...................................................................
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6
Gynecologic Co-Morbidities ...............................................
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7
Summary...............................................................................
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References......................................................................................
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J. B. Spies (&) Department of Radiology, Georgetown University Hospital, CG201 3800 Reservoir Road NW, Washington, DC 20007-2113, USA e-mail: [email protected]
Uterine artery embolization (UAE) has become accepted as an effective therapy for most women with symptomatic fibroids (ACOG Practice Bulletin 2008). And while the vast majority of patients would be well treated with embolization, the decision as to whether it is the best choice for any individual patient requires a consideration of the extent of the fibroids and also patient-related factors, such as interest in future childbearing, preferences toward surgery, and the relative risks of differing therapies for individual patients. Therefore, the decision as to whether UAE is appropriate for a patient is based on a multilayered consideration of factors. This chapter will review what is known about the patient selection for UAE, including the indications and contraindications of the procedure, as well as medical conditions in which patient care may be a particular challenge. W
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