Uterine Artery Embolization
This section provides a comprehensive procedural report for uterine artery embolization procedure with up-to-date explanatory notes, synopsis of the indications and contraindications, and potential complications in an organized and practical format.
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INTRODUCTION First reported in the late 1990s and derived from interventions to reduce posttraumatic or postpartum pelvic hemorrhage; transcatheter embolization of the uterine arteries for the management of uterine fibroids has become a widely accepted substitute to hysterectomy and myomectomy, especially in patients who desire fertility or are high-risk candidates for surgery. The procedure is associated with a high success rate primarily for the treatment of symptomatic leiomyomas, with symptoms including bleeding and pelvic pain, and also has been reported in the management of symptomatic adenomyosis. Transcatheter embolization generally has a low rate of postprocedural complications and has been associated with high patient satisfaction rates.
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– Mass effect on the urinary bladder with associated urinary frequency – Constipation • Less commonly, adenomyosis with associated bleeding and pain
COMMON CONTRAINDICATIONS [1–3] • • • • • • • • •
History of reaction to contrast media Uncorrectable coagulopathy Impaired renal function Pregnancy Gynecologic malignancy Active pelvic inflammatory disease Endometritis Prior pelvic radiation Connective tissue disease
COMMON INDICATIONS [1–3]
POSSIBLE COMPLICATIONS [1–3]
• Symptomatic uterine leiomyomas: – Severe bleeding and secondary anemia – Pelvic pain and pressure symptoms
General (angiography-related) complications: • Access site complications (e.g., hematoma, retroperitoneal hemorrhage, arterial injury/pseudoaneurysm/arteriovenous fistula, thrombosis) • Contrast-induced allergic reaction • Contrast-induced nephropathy • Catheter or guidewire breakage • Risks related to any minimally invasive procedure performed under conscious sedation (e.g., allergy to medications)
S. Semaan (&) Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574, USA e-mail: [email protected]
© Springer International Publishing Switzerland 2016 B. Taslakian et al. (eds.), Procedural Dictations in Image-Guided Intervention, DOI 10.1007/978-3-319-40845-3_115
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Procedure-specific complications: • Amenorrhea • Vaginal discharge • Fibroid expulsion • Pelvic pain • Fever and chills
PREPROCEDURAL ASSESSMENT AND PLANNING [4–6] • History, indications, and physical examination (Appendix 1 in Chap. 149) • Evaluation of diagnostic imaging studies: Pelvic ultrasound to assess uterine volume and size of fibroid(s), pelvic MRI with Gadolinium • Periprocedural management of coagulation status (Appendices 2 in Chap. 150 and 3 in Chap. 151) • Antibiotic prophylaxis: Recommended, but no consensus for first choice. Common antibiotics used include: 1 g cefazolin IV, 2 g ampicillin IV, 900 mg clindamycin plus 1.5 mg/kg gentamicin IV, 1.5–3 g ampicillin/sulbactam [4] (Appendices 4 in Chap. 152 and 5 in Chap. 153) • Imaging modality for guidance: Fluoroscopy ± ultrasound (to guide arterial puncture in difficult cases and obese patients) • Positioning of the patient: Supine
PROCEDURE NOTE Procedure: Uterine artery embolization Staff: [_]
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