Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2017; 27(04): 488-495
DOI: 10.4103/ijri.IJRI_204_16
Intervention

Endovascular uterine artery interventions

Chandan J Das
Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Deepak Rathinam
Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
,
Smita Manchanda
Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
,
D N Srivastava
Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
  PDF Download Permissions and Reprints

Abstract

Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs), as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE) may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH), placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes.

Keywords

Angiography - embolization - uterine artery


Publication History

Article published online:
27 July 2021

© 2017. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Andrews RT, Spies JB, Sacks D, Worthington-Kirsch RL, Niedzwiecki GA, Marx MV, et al. Patient care and uterine artery embolization for leiomyomata. J Vasc Interv Radiol 2009;20:S307-11.
  • 2 Bulman JC, Ascher SM, Spies JB. Current concepts in uterine fibroid embolization. Radiographics 2012;32:1735-50.
  • 3 Resnick NJ, Kim E, Patel RS, Lookstein RA, Nowakowski FS, Fischman AM. Uterine artery embolization using a transradial approach: Initial experience and technique. J Vasc Interv Radiol 2014;25:443-7.
  • 4 Pelage JP, Le Dref O, Soyer P, Jacob D, Kardache M, Dahan H, et al. Arterial anatomy of the female genital tract: Variations and relevance to transcatheter embolization of the uterus. AJR Am J Roentgenol 1999;172:989-94.
  • 5 Binkert CA, Hirzel FC, Gutzeit A, Zollikofer CL, Hess T. Superior hypogastric nerve block to reduce pain after uterine artery embolization: Advanced technique and comparison to epidural anesthesia. Cardiovasc Intervent Radiol 2015;38:1157-61.
  • 6 Noel-Lamy M, Tan KT, Simons ME, Sniderman KW, Mironov O, Rajan DK. Intraarterial lidocaine for pain control in uterine artery embolization: A prospective, randomized study. J Vasc Interv Radiol 2017;28:16-22.
  • 7 Carrillo TC. Uterine artery embolization in the management of symptomatic uterine fibroids: An overview of complications and follow-up. Semin Interv Radiol 2008;25:378-86.
  • 8 Kitamura Y, Ascher SM, Cooper C, Allison SJ, Jha RC, Flick PA, et al. Imaging manifestations of complications associated with uterine artery embolization. RadioGraphics 2005;25:S119-32.
  • 9 Spies JB, Spector A, Roth AR, Baker CM, Mauro L, Murphy-Skrynarz K. Complications after uterine artery embolization for leiomyomas. Obstet Gynecol 2002;100:873-80.
  • 10 Soyer P, Morel O, Fargeaudou Y, Sirol M, Staub F, Boudiaf M, et al. Value of pelvic embolization in the management of severe postpartum hemorrhage due to placenta accreta, increta or percreta. Eur J Radiol 2011;80:729-35.
  • 11 Rajan DK, Beecroft JR, Clark TW, Asch MR, Simons ME, Kachura JR, et al. Risk of intrauterine infectious complications after uterine artery embolization. J Vasc Interv Radiol 2004;15:1415-21.
  • 12 Pelage JP, Le Dref O, Soyer P, Kardache M, Dahan H, Abitbol M, et al. Fibroid-related menorrhagia: Treatment with superselective embolization of the uterine arteries and midterm follow-up. Radiology 2000;215:428-31.
  • 13 Walker WJ, Pelage JP. Uterine artery embolisation for symptomatic fibroids: Clinical results in 400 women with imaging follow up. BJOG 2002;109:1262-72.
  • 14 Spies JB, Roth AR, Gonsalves SM, Murphy-Skrzyniarz KM. Ovarian function after uterine artery embolization for leiomyomata: Assessment with use of serum follicle stimulating hormone assay. J Vasc Interv Radiol 2001;12:437-42.
  • 15 Bilhim T, Pisco JM, Duarte M, Oliveira AG. Polyvinyl alcohol particle size for uterine artery embolization: A prospective randomized study of initial use of 350-500 μm particles versus initial use of 500-700 μm particles. J Vasc Interv Radiol 2011;22:21-7.
  • 16 Firouznia K, Ghanaati H, Sanaati M, Jalali AH, Shakiba M. Pregnancy after uterine artery embolization for symptomatic fibroids: A series of 15 pregnancies. AJR Am J Roentgenol 2009;192:1588-92.
  • 17 Costantino M, Lee J, McCullough M, Nsouli-Maktabi H, Nsrouli-Maktabi H, Spies JB. Bilateral versus unilateral femoral access for uterine artery embolization: Results of a randomized comparative trial. J Vasc Interv Radiol 2010;21:829-35.
  • 18 Spies JB, Bruno J, Czeyda-Pommersheim F, Magee ST, Ascher SA, Jha RC. Long-term outcome of uterine artery embolization of leiomyomata. Obstet Gynecol 2005;106:933-9.
  • 19 Myers ER, Barber MD, Gustilo-Ashby T, Couchman G, Matchar DB, McCrory DC. Management of uterine leiomyomata: What do we really know? Obstet Gynecol 2002;100:8-17.
  • 20 Silberzweig JE, Powell DK, Matsumoto AH, Spies JB. Management of uterine fibroids: A focus on Uuerine-sparing interventional techniques. Radiology 2016;280:675-92.
  • 21 Kröncke T, David M. Uterine artery embolization (uae) for fibroid treatment-results of the 5th radiological gynecological expert meeting. Rofo 2015;187:483-5.
  • 22 Mara M, Fucikova Z, Maskova J, Kuzel D, Haakova L. Uterine fibroid embolization versus myomectomy in women wishing to preserve fertility: Preliminary results of a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2006;126:226-33.
  • 23 Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008;31:73-85.
  • 24 Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Uterine artery embolization versus laparoscopic uterine artery occlusion: The outcomes of a prospective, nonrandomized clinical trial. Cardiovasc Intervent Radiol 2012;35:1041-52.
  • 25 Wu CC, Lee MH. Transcatheter arterial embolotherapy: A therapeutic alternative in obstetrics and gynecologic emergencies. Semin Interv Radiol 2006;23:240-8.
  • 26 Thabet A, Kalva SP, Liu B, Mueller PR, Lee SI. Interventional radiology in pregnancy complications: Indications, technique, and methods for minimizing radiation exposure. Radiographics 2012;32:255-74.
  • 27 Ghai S, Rajan DK, Asch MR, Muradali D, Simons ME, TerBrugge KG. Efficacy of embolization in traumatic uterine vascular malformations. J Vasc Interv Radiol JVIR 2003;14:1401-8.
  • 28 Grivell RM, Reid KM, Mellor A. Uterine arteriovenous malformations: A review of the current literature. Obstet Gynecol Surv 2005;60:761-7.
  • 29 Popovic M, Puchner S, Berzaczy D, Lammer J, Bucek RA. Uterine artery embolization for the treatment of adenomyosis: A review. J Vasc Interv Radiol 2011;22:901-9.
  • 30 Yamashita Y, Harada M, Yamamoto H, Miyazaki T, Takahashi M, Miyazaki K, et al. Transcatheter arterial embolization of obstetric and gynaecological bleeding: Efficacy and clinical outcome. Br J Radiol 1994;67:530-4.
  • 31 Mihmanli I, Cantasdemir M, Kantarci F, Halit Yilmaz M, Numan F, et al. Percutaneous embolization in the management of intractable vaginal bleeding. Arch Gynecol Obstet 2001;264:211-4.
  • 32 Moodley M, Moodley J. Transcatheter angiographic embolization for the control of massive pelvic hemorrhage due to gestational trophoblastic disease: A case series and review of the literature. Int J Gynecol Cancer 2003;13:94-7.
  • 33 Dehaeck CM. Transcatheter embolization of pelvic vessels to stop intractable hemorrhage. Gynecol Oncol 1986;24:9-16.
  • 34 Gilbert L, Porter W, Brown VA. Postpartum haemorrhage-a continuing problem. Br J Obstet Gynaecol 1987;94:67-71.
  • 35 Kirby JM, Kachura JR, Rajan DK, Sniderman KW, Simons ME, Windrim RC, et al. Arterial embolization for primary postpartum hemorrhage. J Vasc Interv Radiol 2009;20:1036-45.
  • 36 Gonsalves M, Belli A. The role of interventional radiology in obstetric hemorrhage. Cardiovasc Intervent Radiol 2010;33:887-95.
  • 37 Ornan D, White R, Pollak J, Tal M. Pelvic embolization for intractable postpartum hemorrhage: Long-term follow-up and implications for fertility. Obstet Gynecol 2003;102:904-10.
  • 38 Vedantham S, Goodwin SC, McLucas B, Mohr G. Uterine artery embolization: An underused method of controlling pelvic hemorrhage. Am J Obstet Gynecol 1997;176:938-48.
  • 39 Deux JF, Bazot M, Le Blanche AF, Tassart M, Khalil A, Berkane N, et al. Is selective embolization of uterine arteries a safe alternative to hysterectomy in patients with postpartum hemorrhage? AJR Am J Roentgenol 2001;177:145-9.
  • 40 Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic review of conservative management of postpartum hemorrhage: What to do when medical treatment fails. Obstet Gynecol Surv 2007;62:540-7.
  • 41 Morison JE. Placenta accreta. A clinicopathologic review of 67 cases. Obstet Gynecol Annu 1978;7:107-23.
  • 42 Diop AN, Chabrot P, Bertrand A, Constantin JM, Cassagnes L, Storme B, et al. Placenta accreta: Management with uterine artery embolization in 17 cases. J Vasc Interv Radiol 2010;21:644-8.
  • 43 Yu PC, Ou HY, Tsang LLC, Kung FT, Hsu TY, Cheng YF. Prophylactic intraoperative uterine artery embolization to control hemorrhage in abnormal placentation during late gestation. Fertil Steril 2009;91:1951-5.
  • 44 Sivan E, Spira M, Achiron R, Rimon U, Golan G, Mazaki-Tovi S, et al. Prophylactic pelvic artery catheterization and embolization in women with placenta accreta: Can it prevent cesarean hysterectomy? Am J Perinatol 2010;27:455-61.
  • 45 Banovac F, Lin R, Shah D, White A, Pelage JP, Spies J. Angiographic and interventional options in obstetric and gynecologic emergencies. Obstet Gynecol Clin North Am 2007;34:599-616.
  • 46 Zakaria MA, Abdallah ME, Shavell VI, Berman JM, Diamond MP, Kmak DC. Conservative management of cervical ectopic pregnancy: Utility of uterine artery embolization. Fertil Steril 2011;95:872-6.
  • 47 Hirakawa M, Tajima T, Yoshimitsu K, Irie H, Ishigami K, Yahata H, et al. Uterine artery embolization along with the administration of methotrexate for cervical ectopic pregnancy: Technical and clinical outcomes. AJR Am J Roentgenol 2009;192:1601-7.
  • 48 Trambert JJ, Einstein MH, Banks E, Frost A, Goldberg GL. Uterine artery embolization in the management of vaginal bleeding from cervical pregnancy: A case series. J Reprod Med 2005;50:844-50.
  • 49 Frates MC, Benson CB, Doubilet PM, Di Salvo DN, Brown DL, Laing FC, et al. Cervical ectopic pregnancy: Results of conservative treatment. Radiology 1994;191:773-5.