Uterine Fibroid Embolization

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Uterine Fibroid Embolization

  1. 1. Uterine Fibroid EmbolizationUterine Fibroid Embolization Renan Uflacker, M.D.Renan Uflacker, M.D. Interventional RadiologyInterventional Radiology Medical University of South CarolinaMedical University of South Carolina Charleston, SCCharleston, SC
  2. 2. Uterine FibroidsUterine Fibroids • At least 25% of women will develop fibroids in the uterus • 40% of all women over 35 have fibroids • Most fibroids do not require treatment • Most common symptoms are – Excessive menstrual bleeding (heavy bleeding anemia) – Pain (Pelvic discomfort) – Heaviness – Infertility (difficulty getting or staying pregnant) – Compressive symptoms (rectum, bladder) • Painful or difficult bowel movements • Frequent urination
  3. 3. Uterine FibroidsUterine Fibroids • Cause unknown • Usually occur just before menopause • May be related to estrogen levels • Most common benign tumor in women • Black women more vulnerable • Most common cause of hysterectomy
  4. 4. Uterine FibroidsUterine Fibroids • Differential diagnosis – Adenomyosis – Ovarian Cysts – Uterine Carcinoma
  5. 5. Uterine FibroidsUterine Fibroids • Available treatments – Myomectomy – Myolysis – Hormonal treatment • If above treatments fail or are not feasible – Hysterectomy • New less invasive treatment – Uterine artery embolization
  6. 6. • Potential problems with hysterectomy • Post hysterectomy depression (?) • Lack of interest in sex (7%) (not significant) • Lack of enjoyment of sex (1%)
  7. 7. Uterine FibroidsUterine Fibroids • UAE is a fundamentally different treatment for fibroids • Minimally invasive • Low complication rates • Effective • Repeatable if necessary • Uses proved technique of embolization, available for more than 30 years
  8. 8. Uterine Artery EmbolizationUterine Artery Embolization • Uterine artery embolization (UAE) as a primary form of therapy was reported by Ravina in 1995 • 16 patients were treated • Polyvinyl alcohol particles used as embolic agent • Mean FU 20 months • Symptoms resolved in 11 of 16 patients • 3 partially improved • 2 failures (1 hysterectomy @ 6 weeks, 1 myomectomy @ 6 months Ravina et al. Lancet 1995
  9. 9. PVA 300-500 microns
  10. 10. •Fibroids die (caseous necrosis) •Then scar down (hyaline sclerosis) and shrink
  11. 11. Uterine Artery EmbolizationUterine Artery Embolization • SCVIR (SIR) survey in October 2000: • 2741 Institutions were surveyed, 330 Institutions responded • Aggregate caseload of the institutions was 542 procedures per month • 10,501 - UAE performed world-wide • 8,644 - UAE performed in USA • 40 (0.03%) complications resulting in additional surgery within 30 days of the procedure • 1 (0.009%) death CIRREF Fibroid Registry 2000
  12. 12. Uterine Artery EmbolizationUterine Artery Embolization • The procedure got a boost from a large multicenter prospective study involving 555 patients in Canada • Median uterine fibroid size was reduced by 35% • Dominant fibroid size was reduced by 42% • 83% reduction in menorrhagia • 77% reduction in dysmenorrhea • 86% reduction in urinary frequency Pron et al Fertility & Sterility, 2003
  13. 13. Uterine Artery EmbolizationUterine Artery Embolization • Severe bleeding was controlled, even in women with large uteri and minimal initial volume reductions • UAE reduced the average menstrual duration from 7.6 to 5.4 days • 17 pregnancies were observed • Major complications occurred in 1% of the cases Pron et al Fertility & Sterility, 2003
  14. 14. Uterine Artery Embolization
  15. 15. Uterine Fibroid Embolization

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