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Evaluation of the Efficacy of Uterine Artery Embolization for Focused Ultrasound Surgery Therapeutic Failures. Alisa Suzuki, MD Brigham and Women’s Hospital, Department of Radiology. Basic Fibroid Treatment Algorithm. asymptomatic. symptomatic. operation. hormone therapy.

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Evaluation of the Efficacy of Uterine Artery Embolization for Focused Ultrasound Surgery Therapeutic Failures

Alisa Suzuki, MD

Brigham and Women’s Hospital,

Department of Radiology


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Basic Fibroid Treatment for Algorithm

asymptomatic

symptomatic

operation

hormone therapy

Watch carefully

MRgFUS

laparotomy

hysteroscopy

laparoscopy

UAE

hysterectomy

TCR

stable

myomectomy

progression

T V Hysterectomy

observation

L Hysterectomy

LAVHysterectomy

L Myomectomy

LA Myomectomy


We evaluate the effect of uae in patients who are unsatisfied with fus treatment l.jpg
We evaluate the effect of UAE in patients who are unsatisfied with FUS treatment.


New treatment option from radiology for symptomatic fibroids l.jpg
New treatment option from radiology for unsatisfied with FUS treatment.SYMPTOMATIC FIBROIDS

  • MR guided Focused Ultrasound Surgery = since 2001

  • MRgFUS = a new method ofnon-invasive thermal(heat) ablationfor symptomatic fibroids.

  • 73% to 91 % of the women who have been treated reported asignificant improvementin their uterine fibroid symptoms.

  • MRgFUS is an FDA-approved treatmentfor symptomatic uterine fibroids


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UAE unsatisfied with FUS treatment.

Procedure

POST Procedure


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UAE unsatisfied with FUS treatment.

3 month POST

PRE


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MRgFUS unsatisfied with FUS treatment.

POST

PRE


Uae and mrgfus similarities l.jpg
UAE and MRgFUS - unsatisfied with FUS treatment.similarities

Less or non- invasive compared to conventional gynecological surgeries.

= short hospital stay, short recovery

= smaller incision, or no incision

= No general anesthesia (intravenous conscious sedation)

Similar or lower serious adverse event %

= High patient satisfaction

Performed by a radiologist


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UAE vs. MRgFUS - differences unsatisfied with FUS treatment.


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? unsatisfied with FUS treatment.

  • 73 - 91% of women who have been treated with FUS reported asignificant improvementin their uterine fibroid symptoms.

  • 9 - 27 % of women did not report clinically satisfactory outcome.

10 patients underwent UAE subsequently at BWH.

options : myomectomy, hysterectomy, UAE, re-FUS

Patients were allowed to select their treatment.


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Study design: unsatisfied with FUS treatment.

  • FUS performed in BWH from March 2002 and June 2004.

  • 7 patients were reviewed.

  • Pre and post FUS and UAEuterine size.

  • Pre and post FUS and UAEfibroid size.

  • Clinicalsymptoms


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Result 1 unsatisfied with FUS treatment.

  • Size of Fibroid

    • The mean volume of

      • pre-FUS fibroid 279cc

      • 12 month post-FUS fibroid 316cc, -13.0%

      • post-UAE fibroid 163cc, -49%

    • Significant decrease in size between post-FUS 12 month size and post-UAE fibroid size. (p=0.02)


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Result 2 unsatisfied with FUS treatment.

  • Size of Uterus

    • The mean volume of

      • pre-FUS uterus 617 cc

      • Post-FUS 12 month uterus 682 cc, +10.0%

      • post-UAE uterus was 475cc, - 31%

    • Significant decrease in uterine size betweenpre-FUS and post UAE. (p=0.03)

    • Significant decrease in size between 12 month post-FUS fibroid size and post-UAE fibroid size. (p=0.002)


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Result 3 unsatisfied with FUS treatment.

Clinical symptoms

Clinical symptoms including heavy bleeding, bulk, and pelvic pressure wereimproved in all patients. (as reported by patient)


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@ FUS Nov-2003 unsatisfied with FUS treatment.

Post FUS Gd Image

These two fibroids were targeted.


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Post FUS 6 & 13 months unsatisfied with FUS treatment.

May- 04, 6 month follow up.

Uterus size 12.1 x 11.7 x 9.8 cm,

721cc

Jan -05, 13 month follow up.

Uterus size 14.4 x 12.4 x 7.8 cm, 738cc


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@ UAE, Post FUS 23 months unsatisfied with FUS treatment.

Dec-05 UAE.


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Post UAE 13 months, Post FUS 36 month unsatisfied with FUS treatment.

Jan -05,

Post FUS13 monthfollow up.

Uterus size 14.4 x 12.4 x 7.8 cm, 738cc

Nov-06

Post FUS36 m, post UAE 13 m

follow up. Uterine size

11.4 x 9.6 x 8.4 cm, 487.2cc


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UAE can be therapeutic after unsatisfactory outcomes of FUS. unsatisfied with FUS treatment.

MRg FUS is a new, exciting technique which can ‘zap’ fibroids in 3 hours while the patient is sleeping on the MRI table.

Patients who develop clinical failure after FUS treatment could subsequently receive full benefit from Uterine Artery Embolization.

Now we can comfortably inform patients that an FUS treatment failure does not require subsequent highly invasive surgery procedure as a minimally invasive procedure (like UAE) may resolve the patient's symptoms.


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