Postembolization Problems and Management

Abstract

Many problems, ranging from mild to severe, may arise postembolization that can be reduced or prevented if properly managed. During the early post-procedure period many patients may experience groin , buttock , and leg pains that may range from a minor hematoma , to pseudo aneurysm , to arterial obstruction resulting in thrombosis. Postembolization fever may be the result of either postembolization syndrome or bacterial infection. Generally prophylactic antibiotics are given to prevent bacterial infection and infection is generally associated with late onset fevers and increasing pain. The rate of hysterectomy following embolization is 3 %, possibly occurring as a result of unilateral embolization, collateral blood supply to the fibroids resulting in failure, or incomplete embolization. Patients who do not experience symptom relief, have extreme postembolization symptoms, or experience severe infections or septicemia may also undergo hysterectomy. Myomata that do undergo necrosis may be passed if small enough, or patients may receive a myomectomy to remove prolapsed myomata. Early onset of menopause post-UAE is more likely in women over 40, and extremely uncommon in those younger than 40. Success of UAE is considered relief of symptoms; however an MRI should be performed in the months following UAE to check for complications including leiomyomasarcoma and adenomyosis.