When to Consider Ovarian Artery Embolization in UAE
The ovarian artery is a major collateral pathway to the uterus and may act as a source of fibroid perfusion. This chapter gives an overview about the ovarian artery anatomy, imaging techniques to visualize collateral arterial supply to uterine fibroids, t
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Contents
Abstract
The ovarian artery is a major collateral pathway to the uterus and may act as a source of fibroid perfusion. This chapter gives an overview about the ovarian artery anatomy, imaging techniques to visualize collateral arterial supply to uterine fibroids, the technique of ovarian artery embolization (OAE) as well as the risks and benefits of supplemental OAE in the setting of uterine fibroid embolization.
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Introduction..........................................................................
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Anatomy of the Ovarian Artery ........................................
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Classification of the Uterine-to-Ovarian Artery Anastomoses .........................................................................
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Uterine Artery-to-Ovarian Artery Anastomoses, Ovarian Perfusion, and Function in the Setting of UAE..........................................................
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Imaging of the Ovarian Artery and Indication for Ovarian Artery Embolization......................................
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Technical Aspects ................................................................
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Clinical Outcome After Ovarian Artery Embolization............................................................
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References......................................................................................
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Uterine artery embolization (UAE) has become an accepted treatment option in patients suffering from symptomatic uterine leiomyomata (fibroids) with a high clinical success rate. Among other causes, incomplete devascularisation of uterine fibroids is considered to be an important negative prognostic factor for the long-term clinical outcome of the procedure (Pelage et al. 2004; Kroencke et al. 2006). Collateral arterial supply to uterine fibroids has been identified as a relevant cause for incomplete fibroid infarction and subsequent clinical failure (Nikolic et al. 1999; Matson et al. 2000). The ovarian arteries represent the major collateral pathway to the uterus with significant supply to uterine leiomyomata in up to 6 % of patients undergoing UAE for symptomatic fibroids according to the literature (White et al. 2007). In addition, the connection between the uterine and ovarian artery circulation, known as the uterine-ovarian anastomoses, represents a potential pathway for nontarget embolization of the ovary during UAE. Furthermore, supplemental ovarian artery embolization (OAE) has been advocated in selected cases of ovarian artery collateral supply to ensure complete fibroid infarction of targeted fibroids. Knowledge about the anatomy of the ovarian artery and recognition of this collateral pathway including types of uterine-to-ovarian artery anastomoses as well as knowledge about the technique, benefits,
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T. J. Kröncke (&) Klinik für Diagnostische und Interventionelle, Radiologie und Neuroradiologie, Klinikum Augsburg, Stenglinstr. 2, D-86156 Augsburg, Germany e-mail: [email protected]
Introduction
J. Reidy et al. (eds.), Radiological Interventions in Obstetrics and
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