Uterine artery embolization

The uterine fibroid embolization, also called Uterusarterienembolisation, is a therapeutic method for the treatment of benign uterine tumors ( fibroids ). While in the uterus is an artificial infarction - ie an intentional obstruction of the uterine arteries - caused, and thus interruption of the blood supply to the or to the fibroids. These are ( ranging in size from 500-900 microns) initiated gelatin or plastic particles through a catheter through arteries in the groin into the respective uterine arteries in the uterine fibroid embolization sand -grain-sized. The reduction or interruption of blood supply causes all fibroids present in the uterus during this intervention can be treated simultaneously and shrink within a few months. The degree of shrinkage of the fibroids or not correlates 1:1 with the degree of improvement in symptoms (most fibroids in the myometrium to contract by about 50-70 %).

History

Since the adoption by Ravina 1995, the angiographic treatment of symptomatic uterine fibroids using a through the skin ( percutaneous) inserted into the uterine artery angiography catheter under fluoroscopic control in a world angiography has a rapid spread experienced ( > 200,000 Myomembolisationen worldwide). After initially mainly in France, Great Britain and the United States took place (so-called uterine fibroid embolization UFE ), this minimally invasive angiographic procedures in Germany has been applied since 2000.

Implementation

In the non-operating, minimally invasive uterine artery embolization is an artificial uterus in the infarct - ie an intentional obstruction of the uterine arteries - caused, and thus interruption of the blood supply to the or to the fibroids. For this purpose, in the uterine fibroid embolization sand -grain-sized (measuring between 500-900 microns) gelatin or plastic particles via a catheter into the femoral artery in the two uterine arteries initiated. The reduction or interruption of blood supply causes all fibroids present in the uterus during this intervention can be treated simultaneously and shrink within a few months. The degree of shrinkage of the fibroids is saying nothing, whether the regression of pre-interventional symptoms will be particularly good. The Myombedingten symptoms, such as pain and cramps in the abdomen, constant urge to urinate and massively increased or prolonged menstrual bleeding do better by engaging mostly or completely disappear. The dead tissue pieces are removed after a few weeks by the human body or shrink or submucosal shares (ie Myomanteile to the uterine cavity back ) are disposed of by withdrawal during the period.

The procedure should be performed only possible in cooperation between a ( interventional ) radiologists (implementation of embolization ) and a gynecologist ( patient preparation and clinical follow -up ). The uterine fibroid embolization, the indications in a clinically symptomatic Myomerkrankung with transmural, non- pedunculated subserosal and submucosal fibroids small ( with a myometrial anchoring > 50% of Uteruszirkumferenz ) are provided.

Contraindications a manifest inflammation of the urinary and genital organs, pedunculated subserosal or submucosal fibroids, a uterine adenomyosis ( endometriosis in the uterine muscle layer ) without dominant fibroid and a clinically asymptomatic Myomerkrankung apply.

The Uterusarterienembolisation is not a treatment for infertility patients with fibroids. Before, however, in a patient with no family planning a hysterectomy is contemplated, which is not actually displayed in case of infertility, the possibility of UAE should be examined. For patients wishing to have children, the role of the UAE has not been elucidated as a treatment option. So far there is no prospectively collected data that allow their results with the necessary evidence a statement on the impact of UAE on fertility and pregnancy outcome. "

The Myomembolisation leads in the medium term course to a significant improvement of myombedingten symptoms ( increased and / or prolonged menstrual bleeding, pressure symptoms and discomfort during urination ) at about 80-85% of the embolized patients. The satisfaction of patients with treatment outcome is very high, as well as the willingness to recommend the procedure. Serious or complications requiring treatment as a permanent or passageres absence of periods (amenorrhea ) or the need for hysterectomy (surgical removal of the uterus ) due to bleeding or infection after Myomembolisation are rare, but they can still a few weeks to a few months occur after therapy.

Technical Process a Myomembolisation

A Myomembolisation should only be performed by an experienced interventional radiologist. After storage of the patient to the angiography table, the strip is washed and locally (as in the OP) covered the bar and the lower body with sterile towels. The organizing radiologist makes a local anesthetic (usually in the right sidebar ) and then to puncture the femoral artery. About this, a catheter under fluoroscopic control in the two, the uterus is pushed to one side of each serving uterine arteries. For the treatment of pain ( due to the increasing ischemia of the fibroids under the embolization ) usually requires a so-called pain (PCA ) pump ( Patient Controlled Analgesia ), where independent intravenous painkillers portions can be accessed via a Perfusorspritze of the patient. To represent the vessels supplying the uterus, a contrast medium is injected via the catheter. Only when the catheter is securely placed in the afferent vasculature of the fibroid, the feeding vessel is embolized through this system. The small gelatin or plastic -like particles most commonly used flow into the terminal arteries of, or fibroids and remain there permanently. About a few minutes, the feeding vessels are blocked slow. The embolization is continued until almost complete blockage of blood flow in the fibroid. This procedure must be carried out in the same manner also in the relevant vasculature of the other side of the uterus. After the embolization, the withdrawal of the catheter and the sealing of the puncture site is done by a pressure bandage which is left for 24 hours. Usually, the patient remains according to this one to one and a half hours to two stationary engaging another day and required over the first 24 h and a concomitant pain.