Rofo 2018; 190(07): 616-622
DOI: 10.1055/s-0044-101555
Interventional Radiology
© Georg Thieme Verlag KG Stuttgart · New York

Analysis of presurgical uterine artery embolization (PUAE) for very large uterus myomatosus; patient’s desire to preserve the uterus; case series and literature review

Article in several languages: English | deutsch
Dirk Schnapauff
1   Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Radiology, Berlin, Germany
,
Manon Russ
2   Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Gynecology, Berlin, Germany
,
Thomas Kröncke
3   Klinikum Augsburg, Department of Diagnostic and Interventional Radiology and Neuroradiology, Augsburg, Bavaria, Germany
,
Matthias David
2   Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Department of Gynecology, Berlin, Germany
› Author Affiliations
Further Information

Publication History

19 July 2017

04 January 2018

Publication Date:
07 March 2018 (online)

Abstract

Purpose Purpose of this paper to present results of a group of 21 consecutive patients who underwent uterine artery embolization (UAE) immediately before myomectomy. Surgical myomectomy can lead to a substantial blood loss in case of large or multiple tumors due to the hypervascularization of the tumors. This may lead to multiple blood transfusion or hysterectomy. In cases were the preservation of the uterus is demanded, pre-operative embolization could reduce the risk of substantial bleeding.

Materials and Methods Between January 2011 and March 2016, 21 patients underwent UAE 24 hours before myomectomy. All patients were asked by questionnaire about post-surgical follow-up, complications, the length of the scar, satisfaction and improvement of symptoms. Data of the operation and embolization were retrospectively assessed.

Results UAE could be performed in all patients without complications. Mean diameter of the largest myoma was 12.7 ± 3.2 cm, primary preservation of the uterus succeeded in all cases. In none of the cases a perioperative blood transfusion was necessary. One patient underwent hysterectomy in another hospital after primary successful resection, one patient received transfusion of 2 bags of red blood cell concentrate during her stay in hospital.

11 of 21 patients responded to the questionnaire. 10 of 11 had subjective symptom improvement. Mean inability to work was 31 days, the mean self-measured length was 12 cm. 9 of 11 patients would recommend the procedure, one patient was in the second trimester of pregnancy.

Conclusion Preoperative uterine artery embolization facilitates a safe and uterus-preserving myomectomy in patients with very large or multiple fibroids.

Key Points

  • Uterus-preserving myomectomy can be used in cases of large uteri or with multiple fibroids with low amount of blood loss.

  • The combination of preoperative embolization and subsequent myomectomy may be a therapeutic option in cases of infertility due to a fibroid-induced uterine deformation.

  • Good interdisciplinary cooperation is essential for sustainable results in this complex group of patients.

Citation Format

  • Schnapauff D, Russ M, Kröncke T et al. Analysis of presurgical uterine artery embolization (PUAE) for very large uterus myomatosus; patient’s desire to preserve the uterus; case series and literature review. Fortschr Röntgenstr 2018; 190: 616 – 622

 
  • References

  • 1 Baird DD. et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188: 100-107
  • 2 Drayer SM, WH Catherino. Prevalence, morbidity, and current medical management of uterine leiomyomas. Int J Gynaecol Obstet 2015; 131: 117-122
  • 3 Della RossaMG. et al. Uterine Reconstruction Due to a Giant Myoma. A Case Report and Literature Review. Open Journal of Obstetrics and Gynecology 2016; 6: 64
  • 4 Gupta S, Jose J, Manyonda I. Clinical presentation of fibroids. Best practice & research Clinical obstetrics & gynaecology 2008; 22: 615-626
  • 5 Borah BJ. et al. The impact of uterine leiomyomas: a national survey of affected women. American journal of obstetrics and gynecology 2013; 209: 319. e1-319. e20
  • 6 Klatsky PC. et al. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. American journal of obstetrics and gynecology 2008; 198: 357-366
  • 7 Parazzini F, Tozzi L. et al. Pregnancy outcome and uterine fibroids. Best Practice & Research Clinical Obstetrics & Gynaecology 2016; 34: 74-84
  • 8 McLucas B, Voorhees WD. The effectiveness of combined abdominal myomectomy and uterine artery embolization. International Journal of Gynecology & Obstetrics 2015; 130: 241-243
  • 9 Ravina J. et al. Value of preoperative embolization of uterine fibroma: report of a multicenter series of 31 cases. Contraception, fertilite, sexualite (1992) 1995; 23: 45-49
  • 10 Ngeh N. et al. Pre‐myomectomy uterine artery embolisation minimises operative blood loss. BJOG: An International Journal of Obstetrics & Gynaecology 2004; 111: 1139-1140
  • 11 Vilos AG. et al. Uterine artery embolization for symptomatic uterine myomas using gelfoam pledgets alone vs embospheres plus gelfoam pledgets: a randomized comparison. Gynecological Surgery 2016; 13: 409-414
  • 12 Scheurig-Muenkler C. et al. Clinical long-term outcome after uterine artery embolization: sustained symptom control and improvement of quality of life. Journal of Vascular and Interventional Radiology 2013; 24: 765-771
  • 13 Albrecht H. Die operative Behandlung des Myoms. Geschichtlicher Überblick. In: Biologie und Pathologie des Weibes. Ein Handbuch der Frauenheilkunde und Geburtshilfe, in Die operative Behandlung des Myoms. Geschichtlicher Überblick. In: Biologie und Pathologie des Weibes. Ein Handbuch der Frauenheilkunde und Geburtshilfe, J.H.u.L. Seitz, Editor. Berlin, Wien: Urban & Schwarzenberg; 1928: 416-465
  • 14 Ravina J. et al. Arterial embolisation to treat uterine myomata. The Lancet 1995; 346: 671-672
  • 15 Unger JB, Paul R, Caldito G. Hysterectomy for the massive leiomyomatous uterus. Obstetrics & Gynecology 2002; 100: 1271-1275
  • 16 Kröncke T, David M. Uterine Artery Embolization (UAE) for fibroid treatment–results of the 6th Radiological Gynecological Expert Meeting. in RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. 2017. © Georg Thieme Verlag KG; 6. 511-514
  • 17 Guo W. et al. Amenorrhea after uterine fibroid embolization: a report of six cases. Ai zheng= Aizheng= Chinese journal of cancer 2008; 27: 1094-1099
  • 18 Katsumori T. et al. Amenorrhea and resumption of menstruation after uterine artery embolization for fibroids. International Journal of Gynecology & Obstetrics 2008; 103: 217-221
  • 19 Nabeshima H. et al. Successful pregnancy after myomectomy using preoperative adjuvant uterine artery embolization. The Tohoku journal of experimental medicine 2003; 200: 145-149
  • 20 Paxton BE, Lee JM, Kim HS. Treatment of intrauterine and large pedunculated subserosal leiomyomata with sequential uterine artery embolization and myomectomy. Journal of vascular and interventional radiology 2006; 17: 1947-1950
  • 21 David M, Kröncke T. Preoperative uterine artery embolisation for large uterine fibroids with subsequent uterus preservation–three case histories and review of the literature. Geburtshilfe und Frauenheilkunde 2012; 72: 539-542
  • 22 Butori N. et al. Interest of uterine artery embolization with gelatin sponge particles prior to myomectomy for large and/or multiple fibroids. European journal of radiology 2011; 79: 1-6
  • 23 Dumousset E. et al. Preoperative uterine artery embolization (PUAE) before uterine fibroid myomectomy. Cardiovascular and interventional radiology 2008; 31: 514-520
  • 24 Goldman KN. et al. Uterine artery embolization immediately preceding laparoscopic myomectomy. International Journal of Gynecology & Obstetrics 2012; 116: 105-108
  • 25 Malartic C. et al. Conservative two-step procedure including uterine artery embolization with embosphere and surgical myomectomy for the treatment of multiple fibroids: Preliminary experience. European journal of radiology 2012; 81: 1-5
  • 26 Tixier H. et al. Embolisation artérielle utérine par matériel résorbable avant myomectomie. Journal de Radiologie 2008; 89: 1925-1929
  • 27 Üstünsöz B. et al. Is uterine artery embolization prior to myomectomy for giant fibroids helpful?. Diagnostic and Interventional Radiology 2007; 13: 210
  • 28 Smeets AJ. et al. Safety and Effectiveness of Uterine Artery Embolization in Patients with Pedunculated Fibroids. Journal of Vascular and Interventional Radiology 20: 1172-1175
  • 29 Margau R. et al. Outcomes after Uterine Artery Embolization for Pedunculated Subserosal Leiomyomas. Journal of Vascular and Interventional Radiology 2008; 19: 657-661
  • 30 Strahlenschutz, B.f. 2017 Available from: http://www.bfs.de/DE/themen/ion/umwelt/natuerliche-strahlenbelastung/natuerliche-strahlenbelastung_node.html