Downloaded 252 times
More Related Content
Similar to Uterine artery embolisation
Uterine artery embolisation
- 1.
- 2. • Asymptomatic • Heavyuterine bleeding • Pain • Dyspareunia • Pressure symptoms Uterine Leiomyomas - Fibroids • Benign monoclonal tumours • 9% of women < 44 years old • 40% of women > 40 years old
- 4. • Myomectomy • 35,000a year (US) • Hysterectomy – 300,000 a year (US) NICE: Symptomatic Fibroid(s) >3cm: • Gonadotrophin releasing hormone (GnRH) analogue • Uterine artery embolisation
- 6. Uterine artery embolisation •Day case • Sedation – Diazemuls (5mg/min IV infusion) • Analgesia - Paracetamol (500mg IV) • Local anaesthesia - Lidocaine • Morphine (5mg IV) • Metoclopramide (10mg IV)
- 7.
- 10. •Polyvinyl alcohol (PVA) particles •Trisacrylgelatin microspheres •Gelatin sponge •Preferential flow to fibroid vessels
- 13. Evidence Base • Introducedin 1997 • 4 RCTs (n= 403) • 1 Comparative study • 3 Case series • UK registry (n= 1387) • US registry (n= 2112)
- 14. • SymptomsSymptoms improvedin 85 – 95% of patients • 30 – 48% decrease in fibroid volumefibroid volume (all studies) • Improved quality of lifequality of life 39/100 (US registry n=2112) • 91% would recommendrecommend to a friend (HOPEFUL n=649) • 90% < 2 nights2 nights in hospital (Gabriel-Cox n=562) Efficacy
- 15. Complications Procedure •Early: 6.9% (Maran=58) •1st month: 20.7% (Mara n=58) •1 year: 17.6% (HOPEFUL 649) Non target emboli •Amenorrhea •Buttock/Bladder •1 death (Goodwin 2009) Failure •11% required further treatment (UK registry n= 1387) Fertility •27 women •37 pregnancies •19 live births (HOPEFUL n= 649)
- 18. References • Dutton S,Hirst A, McPherson K, et al. (2007) A UK multicentre retrospective cohort study comparing hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids (HOPEFUL study): main results on medium-term safety and efficacy. BJOG 114: 1340–51. • Edwards RD, Moss JG, Lumsden MA, et al. (2007) Uterine-artery embolization versus surgery for symptomatic uterine fibroids. New England Journal of Medicine 356: 360–70. • Gabriel-Cox K, Jacobson GF, Armstrong MA, et al. (2007) Predictors of hysterectomy after uterine artery embolization for leiomyoma. American Journal of Obstetrics & Gynecology 196: 588.e1–588.e6. • Goodwin SC, Spies JB, Worthington-Kirsch R, et al. (2008) Uterine artery embolization for treatment of leiomyomata. Obstetrics & Gynecology 111; 22–33. • Goodwin, S.C. & Spies, J.B. (2009) Uterine Fibroid Embolization. The New England Journal of Medicine. 361:690-697 • Gupta, J.K., Sinah, A., Lumsden, M.A. & Hickey, M. (2009) Cochrane Review – Uterine artery embolization for symptomatic fibroids. The cochrane collaboration. • Hirst A, Dutton S, Wu O, et al. (2008) A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids. The HOPEFUL study. Health Technology Assessment 12 (5).
- 19. References • Mara M,Maskova J, Fucikova Z, et al. (2008) Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovascular & Interventional Radiology 31: 73–85. • Marshall LM, Spiegelman D, Barbieri RL, Manson JE, Colditz GA, Willett WC, et al.Variation in the incidence of uterine leiomyoma among pre menopausal women by age and race. Obstetrics & Gynecology 1997;90:967–73. • Moss JG, Lumsden MA, Murray GD, et al. (2010) Long term (3-5 year) follow up and MRI imaging of the REST trial cohort. Unpublished personal communication. • O’Grady EA, Moss JG, Belli AM, et al. (2009) UK uterine artery embolisation for fibroids registry 2003–2008. The British Society of Interventional Radiology. • Spies JB, Bruno J, Czeyda-Pommersheim F, et al. (2005) Long-term outcome of uterine artery embolization of leiomyomata. Obstetrics & Gynecology 106: 933–9. • Volkers NA, Hehenkamp WJK, Birnie E, et al. (2007) Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years’ outcome from the randomized EMMY trial. American Journal of Obstetrics & Gynecology 196: 519.e1–519.e11. • Walker WJ, McDowell SJ. (2006) Pregnancy after uterine artery embolization for leiomyomata: a series of 56 completed pregnancies. American Journal of Obstetrics & Gynecology 195: 1266–71.
Editor's Notes
- #3 Affected by sex steroid hormones – don’t see in children and tend to regress after the menopause Nurses health study 2 incidence rates confirmed by USS or hysterectomy Heavy bleeding in turn causesiron deficiency anaemia Heavy bleeding especially if fibroid is growing into endometrial cavity and increasing surface area
- #5 Symptomatic fibroids – due to the fibroid itself or related eg anaemia/hydronephrosis from ureteric obstruction Hysterectomies for fibroids cost $1.5 billion in 2000 in US UAE originally devised to reduce bleeding due to post partum haemorrhage
- #6 Perfusion from ovarian artery Additional supply from ovarian artery is seen in 5 – 10% of cases Anastamoses between left and right uterine arteries occurs in 10% Treated fibroids shrink over several months to a year
- #11 PVA is suspended in contrast so you can see where it is going
- #14 Pinto n = 57, UAE Vs Hysterectomy EMMY n = 177, UAE Vs Hysterectomy Mara n = 63, UAE Vs Myomectomy REST n = 106 UAE Vs Surgery
- #15 Symptoms include menorrhagia, pelvic pain Improved quality of life according to UFS-QOL questionnaire HRQoL score) EMMY trial (RCT) showed mean hospital stay for UAE was 2.7 days Vs 5.1 days for hysterectomy)
- #16 Post procedural pain, post embolisation syndrome, Fibroid infection 5.9% Almost all who have permanant amenorrhea are perimenopausal Non target embolisation death – uterine arteriovenous shunting and a patent foramen ovale Further treatment – 3% hysterectomy, 1% Myomectomy, 5% repeat UAE (UK registry 1387) Fertility. Number of women that became pregnant only represented 8.5% of those that expressed a possible wish to become pregnant. In US study, 30% of those attempting to become pregnant became pregnant. Of these, 58% had a successful outcome
- #17 Fibroid reduction – evidence of fibroid on USS after 1 year HOPEFUL Drawbacks to UAE – larger single fibroids show less improvement – may not be the case, morphological considerations – broad ligament, cervical or narrow based pedunculated fibroids. Little evidence to support this Contraindications pregnancy, Pelvic cancer, infection (2) Mara (2008)
- #18 Fibroid reduction – evidence of fibroid on USS after 1 year HOPEFUL Drawbacks to UAE – larger single fibroids show less improvement – may not be the case, morphological considerations – broad ligament, cervical or narrow based pedunculated fibroids. Little evidence to support this Contraindications pregnancy, Pelvic cancer, infection (2) Mara (2008)