Uterine fibroid embolization
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Uterine Fibroid Embolization. Renan Uflacker, M.D. Interventional Radiology Medical University of South Carolina Charleston, SC. Uterine Fibroids. At least 25% of women will develop fibroids in the uterus 40% of all women over 35 have fibroids Most fibroids do not require treatment

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Uterine fibroid embolization l.jpg

Uterine Fibroid Embolization

Renan Uflacker, M.D.

Interventional Radiology

Medical University of South Carolina

Charleston, SC


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Uterine Fibroids

  • At least 25% of women will develop fibroids in the uterus

  • 40% of all women over 35 have fibroids

  • Most fibroids do not require treatment

  • Most common symptoms are

    • Excessive menstrual bleeding (heavy bleeding anemia)

    • Pain (Pelvic discomfort)

    • Heaviness

    • Infertility (difficulty getting or staying pregnant)

    • Compressive symptoms (rectum, bladder)

      • Painful or difficult bowel movements

      • Frequent urination


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Uterine Fibroids

  • Cause unknown

  • Usually occur just before menopause

  • May be related to estrogen levels

  • Most common benign tumor in women

  • Black women more vulnerable

  • Most common cause of hysterectomy


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Uterine Fibroids

  • Differential diagnosis

    • Adenomyosis

    • Ovarian Cysts

    • Uterine Carcinoma


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Uterine Fibroids

  • Available treatments

    • Myomectomy

    • Myolysis

    • Hormonal treatment

  • If above treatments fail or are not feasible

    • Hysterectomy

  • New less invasive treatment

    • Uterine artery embolization


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Uterine Fibroids

  • UAE is a fundamentally different treatment for fibroids

  • Minimally invasive

  • Low complication rates

  • Effective

  • Repeatable if necessary

  • Uses proved technique of embolization, available for more than 30 years


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Uterine Artery Embolization

  • Uterine artery embolization (UAE) as a primary form of therapy was reported by Ravina in 1995

  • 16 patients were treated

  • Polyvinyl alcohol particles used as embolic agent

  • Mean FU 20 months

  • Symptoms resolved in 11 of 16 patients

  • 3 partially improved

  • 2 failures (1 hysterectomy @ 6 weeks, 1 myomectomy @ 6 months

Ravina et al. Lancet 1995



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Uterine Artery Embolization

  • SCVIR (SIR) survey in October 2000:

  • 2741 Institutions were surveyed, 330 Institutions responded

  • Aggregate caseload of the institutions was 542 procedures per month

  • 10,501 - UAE performed world-wide

  • 8,644 - UAE performed in USA

  • 40 (0.03%) complications resulting in additional surgery within 30 days of the procedure

  • 1 (0.009%) death

CIRREF Fibroid Registry 2000


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Uterine Artery Embolization

  • The procedure got a boost from a large multicenter prospective study involving 555 patients in Canada

  • Median uterine fibroid size was reduced by 35%

  • Dominant fibroid size was reduced by 42%

  • 83% reduction in menorrhagia

  • 77% reduction in dysmenorrhea

  • 86% reduction in urinary frequency

Pron et al Fertility & Sterility, 2003


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Uterine Artery Embolization

  • Severe bleeding was controlled, even in women with large uteri and minimal initial volume reductions

  • UAE reduced the average menstrual duration from 7.6 to 5.4 days

  • 17 pregnancies were observed

  • Major complications occurred in 1% of the cases

Pron et al Fertility & Sterility, 2003




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