IS Case 53: Uterine Artery Embolization
Imaging Sciences URMC 2008
Publication Date: 2009-05-19
History
Patient is a 43-year-old female with menorrhagia and uterine fibroids seen on MRI now presenting for uterine artery embolization.
Findings
Multiple leiomyomata (fibroids) are seen on MRI images before uterine artery embolization. Pre-embolization digitally subtracted fluoroscopic images demonstrate the contrast-enhanced bilateral uterine arteries. Post-embolization digitally subtracted images demonstrate occlusion of the bilateral uterine arteries beyond their small ovarian branches.
Diagnosis
Discussion
Uterine artery embolization (UAE) is only indicated for patients with symptomatic uterine leiomyomata. Symptoms commonly caused by leiomyomata include heavy menstrual bleeding, pain and bulk-related symptoms. Absolute contraindications include viable pregnancy, active infection and leiomyomata when leiomyosarcoma or other gynecologic malignancy is present unless being performed palliatively or as an adjunct before surgery.
A single femoral access site for UAE is most common. Occlusion of all arteries supplying the uterine leiomyomata is needed for successful treatment of leiomyomata. Large leiomyomata may have collateral supply from the ovarian arteries or via adhesions from nearby structures. These vessels should be treated to increase the success of UAE. The necessity and effects of potential embolization of the ovarian artery can significantly impair ovarian function and should be discussed with and consented to by the patient.
The level of arterial occlusion in UAE is not too distal nor proximal, in the perforating branches. This is accomplished with particulate agents, such as polyvinyl alcohol, tris-acryl gelatin microspheres and gelatin sponge particles. The size of polyvinyl alcohol particles used is 500 to 900 microns.
UAE with polyvinyl alcohol or gelatin sponge particles is continued until total occlusion of arterial flow is attained in the main uterine artery. UAE with gelatin microspheres is discontinued when the branches of the uterine arteries penetrating the leiomyoma are occluded, even with significant antegrade flow in the main uterine artery and its proximal branches.
References
- Andrews RT, Spies JB, Sacks D, et al. Patient care and uterine artery embolization for leiomyomata. J Vasc Interv Radiol. 2004 Feb;15(2 Pt 1):115-20. [PMID: 14963177]
- Kandarpa K, Aruny JE. Handbook of Interventional Radiologic Procedures. New York: Lippincott, Williams & Wilkins, 2002.
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