Daca esti femeie ai un risc de 60% de a avea un fibrom! Medicii iti vor spune cu o probabilitate de 70% ca trebuie sa te operezi, ca uterul tau trebuie scos! Este aceasta singura solutie? Sau cea mai buna? Sigur nu! 80% din operatii pot fi evitate! Cum? Afla in aceasta prezentare!

1. Fibromul uterin
EMBOLIZARE SAU CHIRURGIE?
La ce riscuri ma expun?
Dr. Rares Nechifor - ARES Clinics, Bucuresti www.fibroidcenter.ro
office@drnechifor.ro

2. “ Intai cantareste consideratiile, apoi asuma-ti riscuri ”
–Helmuth Karl Bernhard von Moltke

3. 60%
dintre femei
au fibrom
70%
primesc recomandare
pentru Histerectomie doar 20%
au indicatie corecta
histerectomia!
80% dintre femei
nu primesc informatii
despre alternative!
30%
Histerectomie cu
scoaterea ovarelor 100%
infertilitate 60%
depresie
50%
menopauza
40%
afectare
viata sexuala
30%
complicatii
minore 7%
complicatii
majore
1
deces/zi
Din fericire,
90% dintre fibroame
se se pot trata mai bine!
Situatia actuala
Consecinte

4. Alternative
Histerectomie Miomectomie Embolizare
scoaterea
chirurgicala
a uterului
scoaterea
chirurgicala
a fibromului
inchiderea
vaselor de sange
ce hranesc fibroamele

5. Afirmatii despre embolizare
Este o procedura foarte dureroasa!
Se pot produce infectii grave ajungand pana la deces!
Nu este eficenta, fibroamele recidiveaza!
Nu elimina riscul de cancer!
Nu mai poti avea copii!

6. Sunt aceste afirmatii adevarate ?
Sa vedem!

7. “ Este o procedura dureroasa ? ”

8. Intensitatea si durata durerii
Chirurgie
1-2 saptamani
Embolizare 1-2 zile

9. “ Este o procedura dureroasa ? ”
Pacientele ce fac embolizare
au nevoie de jumatate din cantitatea
de medicamente pentru durere
primite de cele ce s-au operat!

10. “ Exista riscuri legate de anestezie ? ”

11. Riscul asociat anesteziei
Embolizare Chirurgie
0%
2%

12. “ Exista riscuri legate de anestezie ? ”
La embolizare nu se foloseste anestezia,
deci nu exista astfel de riscuri!
Toate interventiile chirurgicale necesita anestezie!
Cu riscurile asociate

13. “ Pot face o infectie grava ? ”

14. Riscul de infectie
2% 10%
Embolizare
Chirurgie

15. 5x
“ Pot face o infectie grava ? ”
Riscul de infectie pentru chirurgie
este de 5 ori mai mare
decat cel asociat embolizarii!

16. “ Fibroamele recidiveaza dupa tratament ? ”

17. Riscul de recidiva
2% 60%
Embolizare
Miomectomie

18. 30x
“ Fibroamele recidiveaza dupa tratament ? ”
Riscul de recidiva pentru miomectomie
este de 30 ori mai mare
decat cel asociat embolizarii!

19. “ Pot face cancer ? ”

20. Parkinson
Accident vascular
Riscul de cancer
Histerectomie totala
0,1%
Embolizare
Dementa
Fractura sold Infarct

21. 5x
“ Pot face cancer ? ”
Riscul de deces
este de 5 ori mai mare
atunci cand uterul si ovarele sunt scoase chirurgical!

22. “ Ce risc am sa devin infertila ? ”

23. Riscul de infertilitate
Embolizare / Miomectomie
0,1% 100%
Histerectomie
2%

24. 1x
“ Ce risc am sa devin infertila ? ”
Embolizarea si miomectomia
au acelasi risc, mic, de 2%
Prin scoaterea uterului
toate femeile devin infertile!

25. “ Pot intra la menopauza ? ”

26. Riscul de menopauza
Embolizare / Miomectomie
2% 50%
Histerectomie

27. 1x
“ Pot intra la menopauza ? ”
Embolizarea si miomectomia
au acelasi risc, mic, de 2%
Prin scoaterea uterului
jumatate dintre femei intra la menopauza!

28. “ Pot surveni complicatii ? ”

29. Riscul de complicatii majore
7%
Chirurgie
Embolizare
1%

30. 7x
“ Pot surveni complicatii ? ”
Interventiile chirurgicale produc
de 7 ori mai multe complicatii majore
decat embolizarea!

31. “ Imi pot pierde uterul ? ”

32. Riscul de scoatere a uterului
10%
Miomectomie
0,1%
Embolizare

33. Riscul de scoatere a uterului
100%
Histerectomie

34. 100x
“ Imi pot pierde uterul ? ”
Persoanele ce fac miomectomie
are un risc de 100 de ori mai mare
de a-si pierde uterul
fata de cele ce au facut embolizare

35. “ Alte organe pot fi afectate ? ”

36. Riscul de afectare a altor organe
Chirurgie
Plaman 5% Ureter
Embolizare
0,01% Vezica Intestine

37. 500x
“ Alte organe pot fi afectate ? ”
Persoanele ce sunt tratate chirurgical
are un risc de 500 de ori mai mare
de afectare a altor organe
fata de persoanele ce au facut embolizare

38. “ Sunt cazuri de deces ? ”

39. Riscul de deces
Embolizare
Chirurgie
1deces la 3 ani 1deces in fiecare zi
in lume in USA
(1/50.000 cazuri) (1/1.500 cazuri)

40. 50x
“ Sunt cazuri de deces ? ”
Persoanele ce sunt tratate chirurgical
are un risc de deces
de 50 de ori mai mare
fata de persoanele ce au facut embolizare

41. Alegerea pacientului
prin
Informare corecta si completa
Histerectomie
70%
Recomandarea
initiala a
medicului
Alegerea
pacientei
10%
cea mai veche metoda
cea mai folosita metoda
cea mai agresiva
cele mai multe complicatii
descurajata de ghidurile terapeutice

42. Alegerea pacientului
Miomectomie
30%
Recomandarea
initiala a
medicului
Alegerea
pacientei
15%
prin
Informare corecta si completa
mai dificila ca tehnica
putini medici pregatiti
mai putin agresiva
mai putine complicatii
inrficienta pentru polifibromatoza
rata mare de recidiva
incurajata de ghidurile terapeutice

43. Alegerea pacientului
Embolizare
cea mai putin agresiva
cele mai putine complicatii
posibila in 90% din cazuri
rezultate similare miomectomiei
incurajata de ghidurile terapeutice
30%
Recomandarea
initiala a
medicului
Alegerea
pacientei
60%
prin
Informare corecta si completa

44. FIBROID | CENTER
6000
cazuri
Cea mai mare experienta din Europa
Centru de Training International
www.fibroidcenter.ro
office@drnechifor.ro

45. FIBROID | CENTER
Prin Embolizare nu au mai fost necesare
24000
zile de spitalizare
1000 de ani
de concediu medical
www.fibroidcenter.ro
office@drnechifor.ro

46. FIBROID | CENTER
Prin Embolizare am evitat
3000
cazuri de
menopauza precoce
500
infectii
300
complicatii majore
6
decese
www.fibroidcenter.ro
office@drnechifor.ro

47. FIBROID | CENTER
www.fibroidcenter.ro
office@drnechifor.ro

48. VA MULTUMESC!
Dr. Rares Nechifor - ARES Clinics, Bucuresti
www.fibroidcenter.ro
office@drnechifor.ro

49. Bibiliografie (http://www.fibroidcenter.ro/#!dovezi-stiintifice/c1gly)
COMMITTEE OPINION
.UMBERs!PRIL
Committee on Gynecologic Practice
This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should
not be construed as dictating an exclusive course of treatment or procedure to be followed.
Management of Acute Abnormal Uterine Bleeding in
Nonpregnant Reproductive-Aged Women
ABSTRACT: Initial evaluation of the patient with acute abnormal uterine bleeding should include a prompt
assessment for signs of hypovolemia and potential hemodynamic instability. After initial assessment and stabi-lization,
the etiologies of acute abnormal uterine bleeding should be classified using the PALM–COEIN system.
Medical management should be the initial treatment for most patients, if clinically appropriate. Options include
intravenous conjugated equine estrogen, multi-dose regimens of combined oral contraceptives or oral progestins,
and tranexamic acid. Decisions should be based on the patient’s medical history and contraindications to therapies.
Surgical management should be considered for patients who are not clinically stable, are not suitable for medical
management, or have failed to respond appropriately to medical management. The choice of surgical manage-ment
should be based on the patient’s underlying medical conditions, underlying pathology, and desire for future
fertility. Once the acute bleeding episode has been controlled, transitioning the patient to long-term maintenance
therapy is recommended.
Abnormal uterine bleeding (AUB) may be acute or
chronic and is defined as bleeding from the uterine cor-pus
that is abnormal in regularity, volume, frequency, or
duration and occurs in the absence of pregnancy (1, 2).
Acute AUB refers to an episode of heavy bleeding that,
in the opinion of the clinician, is of sufficient quantity to
require immediate intervention to prevent further blood
loss (1). Acute AUB may occur spontaneously or within
the context of chronic AUB (abnormal uterine bleeding
present for most of the previous 6 months). The general
process for evaluating patients who present with acute
AUB can be approached in three stages: 1) assessing rap-idly
the clinical picture to determine patient acuity, 2)
determining most likely etiology of the bleeding, and 3)
choosing the most appropriate treatment for the patient.
Assessment of the Patient With Acute
Abnormal Uterine Bleeding
Initial evaluation of the patient with acute AUB should
include a prompt assessment for signs of hypovolemia
and potential hemodynamic instability. If the patient is
hemodynamically unstable or has signs of hypovolemia,
intravenous access with a single or two large bore intra-venous
lines should be initiated rapidly as should the
preparation for blood transfusion and clotting factor
replacements. After the initial assessment and stabili-zation,
the next step is to evaluate for the most likely
etiology of acute AUB so that the most appropriate and
effective treatment strategy to control the bleeding can
be chosen.
Etiologies of Acute Abnormal Uterine
Bleeding
The etiologies of acute AUB, which can be multifacto-rial,
are the same as the etiologies of chronic AUB. The
Menstrual Disorders Working Group of the International
Federation of Gynecology and Obstetrics proposed a
classification system and standardized terminology for
the etiologies of the symptoms of AUB, which has been
approved by the International Federation of Gynecology
and Obstetrics’ executive board and supported by the
American College of Obstetricians and Gynecologists (1,
2). With this system, the etiologies of AUB are class-ified
as “related to uterine structural abnormalities” and
“unrelated to uterine structural abnormalities” and cat-egorized
following the acronym PALM–COEIN: Polyp,
The American College of
Obstetricians and Gynecologists
WOMEN’S HEALTH CARE PHYSICIANS
Close window
Guideline Title
Alternatives to hysterectomy in the management of leiomyomas.
Bibliographic Source(s)
American College of Obstetricians and Gynecologists (ACOG). Alternatives to hysterectomy in the management of leiomyomas.
Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2008 Aug. 14 p. (ACOG practice bulletin; no. 96). [117
references]
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: American College of Obstetricians and Gynecologists (ACOG). Surgical alternatives to
hysterectomy in the management of leiomyomas. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2000
May. 10 p. (ACOG practice bulletin; no. 16). [64 references]
The American College of Obstetricians and Gynecologists (ACOG) reaffirmed the currency of this guideline in 2012.
Scope
Disease/Condition(s)
Uterine leiomyomas (fibroids)
Guideline Category
Evaluation
Management
Treatment
Clinical Specialty
Obstetrics and Gynecology
Surgery
Intended Users
Physicians
Guideline Objective(s)
To aid practitioners in making decisions about appropriate obstetric and gynecologic care
To review the literature about medical and surgical alternatives to hysterectomy and to offer treatment recommendations
Target Population
Women with uterine leiomyomas
Interventions and Practices Considered
Treatment/Management
Surgical Alternatives to Hysterectomy
1. Abdominal myomectomy
2. Laparoscopic myomectomy
3. Hysteroscopic myomectomy
4. Uterine artery embolization
5. Magnetic resonance imaging-guided focused ultrasound surgery (considered, but not specifically recommended)
Adjunctive Medical Treatment
1. Preoperative adjuvant therapy: gonadotropin-releasing hormone agonists (GnRH)
2. Intraoperative adjuvant therapy: vasopressin infiltration into the myometrium
3. Medications considered but not specifically recommended:
Contraceptive steroids and nonsteroidal anti-inflammatory drugs
Aromatase inhibitors
Progesterone modulators
Major Outcomes Considered
Morbidity and mortality
Recurrence of leiomyomas
Risk of follow-up treatment, including unplanned hysterectomy
Methodology
Methods Used to Collect/Select the Evidence
fAQ
FREQUENTLY ASKED QUESTIONS
FAQ074
GYNECOLOGIC PROBLEMS
The American College of
Obstetricians and Gynecologists
Uterine Fibroids
• What are uterine fibroids?
• Who is most likely to have fibroids?
• What are symptoms of fibroids?
• What complications can occur with fibroids?
• How are fibroids diagnosed?
• When is treatment necessary for fibroids?
• Can medication be used to treat fibroids?
• What types of surgery may be done to treat fibroids?
• Are there other treatments besides medication and surgery?
• Glossary
What are uterine fibroids?
Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus. They also are called
leiomyomas or myomas. The size, shape, and location of fibroids can vary greatly. They may be present inside the uterus,
on its outer surface or within its wall, or attached to it by a stem-like structure. A woman may have only one fibroid or many
of varying sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number
of years.
Fibroid outside the uterus
attached by a stem
Fibroid within the inside
layer of the uterine wall
Fibroid within
uterine wall
Fibroid within the outside
layer of the uterine wall
Fibroids may be attached to the outside of the uterus or be located inside the uterus or uterine wall.
Who is most likely to have fibroids?
Fibroids are most common in women aged 30–40 years, but they can occur at any age. Fibroids occur more often in
African American women than in white women. They also seem to occur at a younger age and grow more quickly in African
American women.
What are symptoms of fibroids?
Fibroids may have the following symptoms:
• Changes in menstruation
Human Reproduction Vol.16, No.7 pp. 1473–1478, 2001
Morbidity of 10 110 hysterectomies by type of approach
Juha Ma¨kinen1,8, Jari Johansson2, Candido Toma´s2, Eija Toma´s3, Pentti K.Heinonen3,
Timo Laatikainen4, Minna Kauko5, Anna-Mari Heikkinen6 and Jari Sjo¨berg7
1Department of Obstetrics and Gynecology, Turku University Hospital, FIN-20520 Turku, 2Department of Obstetrics and
Gynecology, Oulu University Hospital, P.O.Box 22, FIN-90221 Oulu, 3Department of Obstetrics and Gynecology, Tampere
University Hospital, P.O.Box 2000, Fin-33521 Tampere, 4Department of Obstetrics and Gynecology, Helsinki City Maternity
Hospital, Sofialehdonkatu 5 A, 00610 Helsinki, 5Department of Obstetrics and Gynecology, North Carelia Central Hospital,
Tikkama¨entie 16, 80210 Joensuu, 6Department of Obstetrics and Gynecology, Kuopio University Hospital, P.O.Box 1777, FIN-70211
Kuopio, 7Department of Obstetrics and Gynecology, Helsinki University Hospital, Haartmaninkatu 2, FIN-00290 Helsinki, Finland
8To whom correspondence should be addressed. E-mail: juha.makinen@tyks.fi
BACKGROUND: Since the late 1980s, the option of laparoscopic hysterectomy has raised questions about the most
suitable approach to hysterectomy. METHODS: To evaluate the influence of the type of approach, in causing or
avoiding certain complaints in hysterectomies a prospective nationwide study was conducted comprising all
hysterectomies for benign disease performed in Finland during 1996. The primary outcomes of interest were the
operation-related morbidity, common surgical details and post-operative complications. RESULTS: A total of 10 110
hysterectomies, including 5875 abdominal, 1801 vaginal and 2434 laparoscopic operations showed a low rate of
overall complications, 17.2, 23.3 and 19.0% respectively. Infections were the most common complications with
incidences of 10.5, 13.0 and 9.0% in the abdominal, vaginal and laparoscopic group respectively. The most severe
type of haemorrhagic events occurred in 2.1, 3.1 and 2.7% in the abdominal, vaginal and laparoscopic group
respectively. Ureter injuries were predominant in laparoscopic group [relative risk (RR) 7.2 compared with
abdominal] whereas bowel injuries were most common in vaginal group (RR 2.5 compared with abdominal).
Surgeons who had performed 30 laparoscopic hysterectomies had a significantly lower incidence of ureter and
bladder injuries (0.5 and 0.8% respectively) than those who had performed ≤30 operations (2.2 and 2.0%
respectively). A decreasing trend of bowel complications was also seen with increasing experience in vaginal
hysterectomies. CONCLUSIONS: This large-scale observational study on hysterectomies provides novel information
on operation-related morbidity of abdominal, vaginal or laparoscopic approach. The results support the importance
of the experience of the surgeon in reducing severe complications, especially in laparoscopic and vaginal
hysterectomies.
Key words: complication/epidemiology/gynaecology/hysterectomy/laparoscopy
Introduction et al., 1992; Liu, 1992; Kovac, 1995; Weber and Lee, 1996).
Hysterectomy is the most common major gynaecological There are, however, some concerns related to the costs and the
operation in the world. For benign indications many countries morbidity of the approach (Summitt et al., 1992; Kovac, 1995;
have favoured either the abdominal (Nathorst-Boos et al., Weber and Lee, 1996). In general, the results of these studies
1992; Hall et al., 1998; Harkki-Siren et al., 1998) or the have a limited value because they are retrospective and include
vaginal approach (Querleu et al., 1993; Kovac, 1995). These only a small number of patients. Furthermore, they have been
traditions have prevailed unaltered throughout decades. How- performedmainly by expert surgeons or done during the learning
ever, since the late 1980s, the new option of laparoscopic curve of the new procedure (Garry, 1998). In order to increase
hysterectomy (Reich et al., 1989) has raised questions about the power of the observational studies on morbidity in large
the most suitable type of approach (Stovall and Summitt, 1996; numbers of patients, a prospective evaluation was conducted of
Kadar et al., 1997; Osborne, 1997; Porges, 1997) all hysterectomies performed for benign indications during 1996
The newlaparoscopic technique has been assessed against the in the whole of Finland.
other techniques by observational patient series, case-controlled
trials and also by randomized controlled trials. The advantage Materials and methods
of the laparoscopic approach has been mainly associated with a From January 1 to December 31, 1996, the information on all
short hospital stay and a quick convalescence (Garcia Padial hysterectomies performed for benign disease in Finland was registered
© European Society of Human Reproduction and Embryology 1473
International Journal of Women’s Health Dovepress
Embolization of uterine fibroids from the point
of view of the gynecologist: pros and cons
International Journal of Women’s Health 2014:6 623–629
open access to scientific and medical research
R E V I EW
© 2014 Mara and Kubinova. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0)
License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further
permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on
how to request permission may be found at: http://www.dovepress.com/permissions.php
Michal Mara
Kristyna Kubinova
Department of Obstetrics and
Gynecology, General Faculty Hospital
and First Medical Faculty of Charles
University, Prague, Czech Republic
Correspondence: Michal Mara
Department of Obstetrics and
Gynecology, General Faculty Hospital,
Apolinarska 18, Prague 2, Czech Republic
Tel 42 07 2396 8944
Fax 42 02 2496 7474
Email michal@drmara.cz
submit your manuscript | www.dovepress.com
Dovepress
623
Open Access Full Text Article
http://dx.doi.org/10.2147/IJWH.S43591
Abstract: Uterine artery embolization (UAE) is a minimally invasive procedure with large
symptomatic potential in treatment of women with uterine leiomyomas. Due to specificities of
this method and possible complications the appropriate indication is crucial. Patient’ symptoms,
age, plans for pregnancy, and surgical and reproductive history play a major role in decision-making
regarding appropriate subjects for UAE. Close cooperation between the gynecologist
and the interventional radiologist is necessary. UAE is usually offered as an alternative to
surgical treatment. In patients with no fertility plans, it is a less invasive option than abdominal
hysterectomy, with a comparable effect on fibroid-related symptoms and quality of life. The
need for reintervention is markedly greater in patients after UAE (up to 35% within 5 years)
than after hysterectomy. Women with large symptomatic fibroids wishing to retain the uterus
and ineligible for minimally invasive (laparoscopic or vaginal) hysterectomy are good candidates
for UAE. However, studies comparing UAE with minimally invasive hysterectomy are lacking.
Use of UAE in younger women desiring pregnancy is more controversial, mainly because of
the significant risk of miscarriage (as high as 64% in some studies) as well as the increased
risk of other complications of pregnancy, such as preterm delivery, abnormal placentation, and
post-partum hemorrhage. The risk of infertility or subfertility following UAE is unknown. Even
poor candidates for myomectomy should be carefully selected for UAE after counseling about
all possible adverse effects on fertility. Good prospective studies focused on fertility comparing
UAE with no treatment or with myomectomy are needed but would be ethically questionable.
This review summarizes the current knowledge regarding the benefits and potential risks of
UAE from the point of view of the gynecologist, who should be responsible for proper indica-tion
of this treatment.
Keywords: benefits, hysterectomy, myomectomy, risks, uterine artery embolization, uterine
fibroid
Introduction
Uterine artery embolization (UAE) is a radiologic catheterization procedure
traditionally used for intractable oncogynecologic or obstetric uterine bleeding, and
was first described as a potential treatment for uterine fibroids in 1995.1–3 Since then,
and in spite of skepticism and resistance on the part of many gynecologists, UAE has
become more or less established in the spectrum of uterus-sparing treatments for uterine
leiomyoma throughout the world, especially in developed countries.4–7
Premenopausal women aged 35–50 years with symptomatic uterine fibroids are the
most likely candidates for UAE.8 However, there are still unanswered questions and
controversies regarding UAE and these problems do not arise only from the different
viewing angle and rivalry between gynecologists and interventional radiologists.
The Appropriateness of Recommendations for
Hysterectomy
MICHAEL S. BRODER, MD, DAVID E. KANOUSE, PhD, BRIAN S. MITTMAN, PhD,
AND STEVEN J. BERNSTEIN, MD, MPH
Objective: To evaluate the appropriateness of recommenda-tions
for hysterectomies done for nonemergency and non-oncologic
indications.
Methods: We assessed the appropriateness of recommen-dations
for hysterectomy for 497 women who had the oper-ation
between August 1993 and July 1995 in one of nine
capitated medical groups in Southern California. Appropri-ateness
was assessed using two sets of criteria, the first
developed by a multispecialty expert physician panel using
the RAND/University of California–Los Angeles appropri-ateness
method, and the second consisting of the ACOG
criteria sets for hysterectomies. The main outcome measure
was the appropriateness of recommendation for hysterec-tomy,
based on expert panel ratings and ACOG criteria sets.
Results: The most common indications for hysterectomy
were leiomyomata (60% of hysterectomies), pelvic relaxation
(11%), pain (9%), and bleeding (8%). Three hundred sixty-seven
(70%) of the hysterectomies did not meet the level of
care recommended by the expert panel and were judged to
be recommended inappropriately. ACOG criteria sets were
applicable to 71 women, and 54 (76%) did not meet ACOG
criteria for hysterectomy. The most common reasons recom-mendations
for hysterectomies considered inappropriate
were lack of adequate diagnostic evaluation and failure to
try alternative treatments before hysterectomy.
Conclusion: Hysterectomy is often recommended for indi-cations
judged inappropriate. Patients and physicians
should work together to ensure that proper diagnostic eval-uation
has been done and appropriate treatments considered
before hysterectomy is recommended. (Obstet Gynecol 2000;
95:199 –205. © 2000 by The American College of Obstetri-cians
and Gynecologists.)
Several studies suggested that physicians might use
surgical procedures inappropriately, with some pa-tients
not receiving necessary care and others exposed
to unwarranted risk.1,2 To improve the quality of pa-tient
care, there has been a concerted effort to develop
guidelines and other criteria for physician practice. An
equivalent effort to implement and disseminate those
guidelines has been lacking.
The Agency for Health Care Policy and Research, a
branch of the US Department of Health and Human
Services, sponsored a series of studies to improve the
process. One of those studies, the Women’s Health and
Hysterectomy Project, is designed to develop and dis-seminate
recommendations for hysterectomy. We chose
to focus this project on hysterectomy because it is the
second most common major operation women have
and there are significant concerns among researchers
and the public that it might be overused.3–5 In this
study, we report the appropriateness of recommenda-tions
for hysterectomies in a cohort of women at nine
Southern California managed-care organizations before
the dissemination of clinical recommendations on use
of hysterectomy.
Methods
We measured appropriateness of recommendations for
hysterectomy using two sets of criteria: 1) a set devel-oped
for the Women’s Health and Hysterectomy Project
by an expert panel using the RAND/University of
Southern California–Los Angeles appropriateness
method, and 2) three recent ACOG criteria sets de-
From the Department of Obstetrics and Gynecology, University of
California, Los Angeles, RAND, Santa Monica, and Veterans Admin-istration
Medical Affairs, Sepulveda, California; the Veterans Affairs
Medical Center, and the Departments of Medicine and Health Manage-ment
and Policy, University of Michigan, Ann Arbor, Michigan.
Funded in part by grant no. R18HS07095 from the Agency for Health
Care Policy and Research, and in part by the Robert Wood Johnson
Clinical Scholars Program.
The views expressed herein are those of the authors and do not
necessarily reflect those of the Agency for Health Care Policy and
Research or the Robert Wood Johnson Foundation.
The authors thank the members of the expert panel (Bruce Bagley,
Constance Bohon, Vivian Dickerson, Karen Freund, Joseph Gambone,
Frank Ling, Anne Moulton, Herbert Peterson, and Marian Swinker) for
their assistance in developing the ratings, and Stanley Zinberg of ACOG
for assistance with revising the criteria.
VOL. 95, NO. 2, FEBRUARY 2000 0029-7844/00/$20.00 199
PII S0029-7844(99)00519-0
1
ABHI• AdvaMed • AMO •AntiCoagulation Europe • ARMA • Arrhythmia Alliance •
Arthritis Care • Atrial Fibrillation Association • BD • Bladder and Bowel Foundation •
Boston Scientific • British Cardiac Patients Association • C R Bard • Cardiomyopathy
Association • Convatec • Eucomed • FABLE• FEmISA • Heart Research UK • ICD
Group • INPUT • International Alliance of Patients' Organizations • IST Information
and Support • JDRF• Johnson Johnson • Lindsay Leg Club • Medtronic • National
Rheumatoid Arthritis Society • Pelvic Pain Support Network • Roche Diagnostics •
SADS UK • St Jude Medical • STARS • Stryker • The Circulation Foundation •The
Patients Association • Transplant Support Network • Zimmer
YouUr First ChoicE
Patient Information and Choice – UFE Patient Survey
YouUr First ChoicE: An On-Line Survey of Women with Fibroids, the Information, Choice and
Access They Had to Uterine Artery/Fibroid Embolisation and Alternatives to Hysterectomy for the
Treatment of Fibroids
Title of Report: YouUr First ChoicE: Patient Information and Choice A UFE Patient Survey - An On-Line
Survey of Women with Fibroids, the Information, Choice and Access They Had to Uterine
Artery/Fibroid Embolisation and Alternatives to Hysterectomy for the Treatment of Fibroids
Key words: UFE, UAE, embolisation, uterine artery embolisation, uterine fibroid embolisation,
embolization, uterine fibroids, patients, choice, information; NICE Guidance.
1. BACKGROUND
Fibroids are a major public health issue affecting up to 80% of women, with 20% requiring treatment
for symptoms such as heavy and painful periods, bulk symptoms and infertility. Sixty percent of all
hysterectomies (approximately 39,000 p.a. in total) carried out in the NHS in England are for fibroids.
More are carried out in the private sector.
Uterine Fibroid/Artery Embolisation [UFE or UAE] is a newer medical technology, started in the
1980s in France. It is an interventional radiology treatment for symptomatic fibroids, which is much
less invasive than the standard treatment - abdominal hysterectomy, allows women to maintain
their fertility (and to become pregnant) and return to work/normal life much quicker. It has been
shown to be safe and effective by two NICE Interventional Procedures Reviews and it is
recommended in NICE Clinical Guidelines on Heavy Menstrual Bleeding ‘07 as a first line treatment
for women with symptomatic fibroids over 3cm, wishing to retain their uterus. NICE Guidelines also
state that women should be offered this treatment, as well as hysterectomy and myomectomy. UFE
is also much less expensive to both women and the NHS.
Despite NICE Guidelines many women are still contacting FEmISA asking how to access UFE and/or
alternatives to hysterectomy and are still not being told about or offered UFE or other alternatives to
hysterectomy.
FEmISA and the Medical Technology Group (FEmISA is a member) has therefore asked women to
complete this on-line survey on what treatments they were offered and told about for their
symptomatic fibroids. The survey ran from March to September 2011 and FEmISA is grateful to
Woman’s Hour for highlighting these issues and all the women for taking the time to complete the
survey.
Complications of Uterine Fibroid
Embolization
Brian E. Schirf, M.D.,1 Robert L. Vogelzang, M.D.,1
and Howard B. Chrisman, M.D., M.B.A.1
ABSTRACT
Uterine fibroid embolization (UFE) is an increasingly popular, minimally invasive
treatment option for women with symptomatic fibroid disease. UFE therapy in qualified
hands is an effective, well-tolerated procedure that offers relief of fibroid symptoms with a
low risk of complications. In the acute postprocedural period, immediate complications
may relate to vascular access, thromboembolic events, infection, and pain management.
Reported major complications include but are not limited to pulmonary embolus, uterine
ischemia, necrosis, sepsis, and death. Non-life-threatening complications include altered
ovarian and sexual function, subcutaneous tissue necrosis, expulsion of fibroid tissue, and
treatment failure. Awareness of the known complications of UFE may allow more rapid
diagnosis and effective therapeutic responses to complications when they occur.
KEYWORDS: Fibroids, complications, embolization
Objectives: Upon completion of this article, the reader should be able to discuss the avoidance, detection, and management of both
procedural and delayed complications associated with uterine fibroid embolization.
Accreditation: Tufts University School ofMedicine (TUSM) is accredited by the Accreditation Council for ContinuingMedical Education
to provide continuing medical education for physicians.
Credit: TUSM designates this educational activity for a maximum of 1 Category 1 credit toward the AMA Physicians Recognition Award.
Each physician should claim only those credits that he/she actually spent in the activity.
Uterine fibroid embolization (UFE) is an in-creasingly
popular minimally invasive treatment option
for women with symptomatic fibroid disease. UFE
therapy in qualified hands is an effective, well-tolerated
procedure that offers relief of fibroid symptoms with a
low risk of complications. The Society of Interventional
Radiology Reporting Standards for Uterine Artery
Embolization for the Treatment of Uterine Leiomyo-mata
recommends that complications be categorized as
related to: ‘‘angiography, pelvic infection, ischemia,
post-embolization syndrome (prolonged admission, re-admission,
or escalation of care), ovarian failure, sexual
dysfunction, fibroid tissue passage requiring interven-tion,
non-gynecologic embolization (bowel, buttock,
nerves, etc.), radiation injury, adverse drug reaction,
pulmonary embolism, and other.’’1 Complications are
further defined as minor or major events within each
category1 with major events resulting in an unplanned
increased level of care or prolonged hospitalization.
Overall, major complications typically occur in fewer
1Department of Radiology, Northwestern University, Chicago,
Illinois.
Address for correspondence and reprint requests: Howard B.
Chrisman, M.D., M.B.A., Vice Chairman, Clinical Operations,
Department of Radiology, NUMS, 676 N. St. Claire Avenue, Suite
800, Chicago, IL 60611.
Complications in Interventional Radiology; Guest Editor, Jonathan
Lorenz, M.D.
Semin Intervent Radiol 2006;23:143–149. Copyright # 2006 by
Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York,
NY 10001, USA. Tel: +1(212) 584-4662.
DOI 10.1055/s-2006-941444. ISSN 0739-9529.
143
www.fibroidcenter.ro
office@drnechifor.ro