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Gynecological Assessment Prior to Uterine Artery Embolization

  • Linda D. Bradley
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

Benign uterine fibroids, or leiomyomas, are the most common benign tumors found in women in a gynecologic practice. Approximately 50–80 % of women have fibroids. Most women with fibroids are asymptomatic. Women with symptomatic fibroids may present with heavy menstrual bleeding, pelvic pain, leukorrhea, pressure and bloating, increased abdominal girth, and severe dysmenorrhea. However, these symptoms can mimic other gynecologic and non-gynecologic conditions. It is imperative that physicians take an excellent history and perform a thorough pelvic examination prior to recommending uterine fibroid embolization for therapy. The patient’s desire for future pregnancy should be ascertained. As a part of the evaluation it is important that the patient does not have other indications for surgical intervention such as the presence of an adnexal mass, abnormal pap test, or endometrial malignancy/endometrial hyperplasia that would be treated with surgical intervention or other necessary therapy. Hysterectomy has long been utilized as a definitive method to treat fibroids in women. Medical therapy often requires long term use of single or multiple medical therapies to alleviate fibroid-related symptoms. Uterine fibroid embolization (UFE) using particulate emboli to occlude the uterine arteries, thereby disrupting the blood supply to fibroids and leading to devascularization and infarction, has been reported to be effective in alleviating fibroid-related symptoms. Excellent gynecological assessment is essential prior to referring a patient for uterine fibroid embolization.

Keywords

Magnetic Resonance Imaging Imaging Uterine Artery Embolization Uterine Fibroid Adnexal Mass Laparoscopic Myomectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. AAGL (2012) AAGL practice report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol 19(2):152–171 (Mar–Apr)Google Scholar
  2. ACOG (2008) ACOG patient education pamphlet AP074: Uterine fibroids. american college of obstetrics and gynecology web site. www.acog.org/publications/patient_education/bp074.cfm. Accessed Mar 20 2008
  3. Andrews RT, Spies JB, Sacks D, Worthington-Kirsch RL, Niedzwiecki GA, Marx MV et al (2004) Task force on uterine artery embolization and the standards division of the society of interventional radiology. Patient care and uterine artery embolization for leiomyomata. J Vasc Interv Radiol 15(suppl 2, pt 1):115–120Google Scholar
  4. Cura M, Cura A, Bugnone A (2006) Role of magnetic resonance imaging in patient selection for uterine artery embolization. Acta Radiol 47:1105–1114PubMedCrossRefGoogle Scholar
  5. Fauconnier A, Chapron C, Babaki-Fard K, Dubuisson JB (2000) Recurrence of leiomyomata after myomectomy. Hum Reprod Update 6:595–602PubMedCrossRefGoogle Scholar
  6. Goldberg J (2007) Current thinking on the role of interventional radiology in women’s health. Expert Rev Obstet Gynecol 2:621–629CrossRefGoogle Scholar
  7. Goodwin SC, Spies JB, Worthington-Kirsch R, Peterson E, Pron G, Li S, Myers ER, Fibroid Registry for Outcomes Data (FIBROID) Registry Steering Committee and Core Site Investigators (2008) Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID registry. Obstet Gynecol 111:22–33Google Scholar
  8. Gupta Janesh K, Sinha Anju, Lumsden MA, Hickey Martha (2012) Uterine artery embolization for symptomatic uterine fibroids. Source Cochrane Database Syst Rev 5:CD005073 ([Review] Update of Cochrane Database Syst Rev. 2006 1:CD005073; PMID:16437515)Google Scholar
  9. Mäkinen J, Johansson J, Tomás C, Tomás E, Heinonen PK, Laatikainen T et al (2001) Morbidity of 10, 110 hysterectomies by type of approach. Hum Reprod 16:1473–1478PubMedCrossRefGoogle Scholar
  10. Manyonda Isaac T, Bratby Mark, Horst Jessica S, Banu Nassera, Gorti Maha, Belli Anna-Maria (2012) Uterine artery embolization versus myomectomy: impact on quality of life–results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) trial. Cardiovasc Intervent Radiol 35(3):530–536 (Jun)Google Scholar
  11. McPherson K, Metcalfe MA, Herbert A, Maresh M, Casbard A, Hargreaves J et al (2004) Severe complications of hysterectomy: the VALUE study. BJOG 111:688–694Google Scholar
  12. McPherson K, Herbert A, Judge A, Clarke A, Bridgman S, Maresh M, Overton C (2005) Psychosexual health 5 years after hysterectomy: population-based comparison with endometrial ablation for dysfunctional uterine bleeding. Health Expect 8:234–243PubMedCrossRefGoogle Scholar
  13. Pelage J, Guaou GN, Jha R et al (2004) Long term imaging outcome after embolization for uterine fibroid tumors. Radiology 230:803–809PubMedCrossRefGoogle Scholar
  14. Ravina JH, Herbreteau D, Ciraru-Vigneron N, Bouret JM, Houdart E, Aymard A, Merland JJ (1995) Arterial embolisation to treat uterine myomata. Lancet 346:671–672PubMedCrossRefGoogle Scholar
  15. Rossetti A, Sizzi O, Soranna L, Cucinelli F, Mancuso S, Lanzone A (2001) Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy. Hum Reprod 16:770–774PubMedCrossRefGoogle Scholar
  16. Spies J, Allison S, Sterbis K et al (2004) Polyvinyl alcohol particles and tris acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a randomized comparative study. J Vasc Interv Radiol 15:793–800PubMedCrossRefGoogle Scholar
  17. Spies J, Myers ER, Worthington-Kirsch R et al (2005) The fibroid registry: symptom and quality-of-life status 1 year after therapy. Obstet Gynecol 106:1309–1318PubMedCrossRefGoogle Scholar
  18. Spies JB, Cornell C, Worthington-Kirsch R, Lipman JC, Benenati JF (2007) Long-term outcome from uterine fibroid embolization with tris-acryl gelatin microspheres: results of a multicenter study. J Vasc Interv Radiol 18:203–207PubMedCrossRefGoogle Scholar
  19. Usadi RS, Marshburn PB (2007) The impact of uterine artery embolization on fertility and pregnancy outcome. Curr Opin Obstet Gynecol 19:279–283PubMedCrossRefGoogle Scholar
  20. Yousefi S, Czeyda-Pommersheim F, White A (2006) Repeat uterine artery embolization: indications and technical findings. J Vas Interv Radiol 17:1923–1929CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Gynecology and Women’s Health Institute, Center for Menstrual Disorders, Fibroids and Hysteroscopic ServicesCleveland ClinicClevelandUSA

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