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Uterine Fibroid Embolization

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

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  1. Uterine Fibroid Embolization Renan Uflacker, M.D. Interventional Radiology Medical University of South Carolina Charleston, SC

  2. 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

  3. 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

  4. Uterine Fibroids • Differential diagnosis • Adenomyosis • Ovarian Cysts • Uterine Carcinoma

  5. Uterine Fibroids • Available treatments • Myomectomy • Myolysis • Hormonal treatment • If above treatments fail or are not feasible • Hysterectomy • New less invasive treatment • Uterine artery embolization

  6. Potential problems with hysterectomy • Post hysterectomy depression (?) • Lack of interest in sex (7%) (not significant) • Lack of enjoyment of sex (1%)

  7. 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

  8. 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

  9. PVA 300-500 microns

  10. Fibroids die (caseous necrosis) • Then scar down (hyaline sclerosis) and shrink

  11. 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

  12. 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

  13. 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

  14. Uterine Artery Embolization

  15. Uterine Fibroid Embolization

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