Uterine fibroid embolization

The uterine artery embolization , also Uterusarterienembolisation called, is a therapeutic method to treat benign uterine tumors ( fibroids ). This triggers an artificial infarct in the uterus - that is, a deliberate clogging of the uterine arteries - and thus interrupts the blood supply to or to the myomas. For this purpose, during uterine fibroid embolization, grains of sand (between 500 and 900 micrometers in size) gelatine or plastic particles are introduced into the respective uterine arteries via a catheter through arteries in the groin. The reduction or interruption of the blood supply means that all fibroids in the uterus can be treated simultaneously during this procedure and shrink within a few months. The degree of shrinkage of the fibroid (s) does not correlate 1: 1 with the degree of improvement in the symptoms (most fibroids in the myometrium shrink by around 50–70%).

history

Since it was first used by Ravina in 1995, the angiographic treatment of symptomatic uterine fibroids using an angiographic catheter inserted through the skin (percutaneously) into the uterine artery under X-ray control in an angiography has experienced rapid spread worldwide (> 200,000 myomembolizations worldwide). After it initially took place in France, Great Britain and the USA (so-called uterine fibroid embolization UFE), this minimally invasive angiographic procedure has been used in Germany since 2000.

execution

In the case of non-operative, minimally invasive uterine fibroid embolization, an artificial infarction - i.e. a deliberate clogging of the uterine arteries - is triggered in the uterus, thereby interrupting the blood supply to the fibroids . In uterine myoma embolization, gelatine or plastic particles the size of a grain of sand (between 500 and 900 micrometers in size) are introduced into the two uterine arteries via a catheter in the inguinal artery. The reduction or interruption of the blood supply means that all fibroids in the uterus can be treated simultaneously during this procedure and shrink within a few months. The extent of the shrinkage of the fibroids does not say anything about whether the regression of the pre-interventional symptoms will be particularly good. The myoma-related symptoms, such as pain and cramps in the abdomen, constant urge to urinate and massively increased or prolonged menstrual bleeding usually improve or disappear completely as a result of the procedure. The dead tissue pieces are broken down or shrink by the human organism after a few weeks or submucosal parts (i.e. myoma parts towards the uterine cavity) are disposed of by excretion during the period.

If possible, the procedure should only be carried out in collaboration between an (interventional) radiologist (performing the embolization) and a gynecologist (patient preparation and clinical follow-up). Uterine fibroid embolization can be used as an indication for clinically symptomatic fibroid disease with transmural, non-pedicled small subserous and submucosal fibroids (with a myometrial anchorage> 50% of the circumference of the uterus).

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

Uterine artery embolization is not a treatment method for fertility patients with fibroids. However, before a hysterectomy is considered in a patient who has not yet completed family planning, which is actually not indicated if the patient wishes to have children, the possibility of UAE should be examined. The role of UAE as a treatment option for patients who wish to have children has not yet been clarified. So far, there are no prospectively collected data whose results allow a statement to be made about the influence of UAE on the fertility rate and pregnancy outcome with the necessary evidence.

In the medium term, myoma embolization leads to a significant improvement in myoma-related symptoms (increased and / or prolonged menstrual bleeding, pressure discomfort and urination problems) in around 80–85% of embolized patients. The satisfaction of the patients with the treatment result is very high, as is the willingness to recommend the procedure to others. Serious complications or complications that require treatment, such as a permanent or temporary absence of your period ( amenorrhea ) or the need for a hysterectomy (surgical removal of the uterus) due to bleeding or infection after fibroid embolization are rare, but can still occur a few weeks to a few months after therapy.

Technical process of myoma embolization

Myoma embolization should only be performed by an experienced interventional radiologist. After the patient has been placed on the angiography table, the groin is washed off locally and (as in the operating room) the groin and lower body are covered with sterile cloths. The performing radiologist will apply local anesthesia (usually in the right groin ) in order to puncture the femoral artery . A catheter is pushed through this under X-ray control into the two uterine arteries supplying the uterus on one side. To treat the pain (due to the increasing ischemia of the fibroids under the embolization), a so-called pain (PCA) pump (patient-controlled analgesia) is usually required, from which the patient can independently retrieve intravenous pain medication portions. In order to show the vessels supplying the uterus, a contrast medium is injected through the catheter. Only when the catheter is securely placed in the supplying vascular system of the myoma is the supplying vascular system embolized via it. The mostly used small gelatine or plastic-like particles flow into the end arteries of the myoma (s) and remain there permanently. The supplying vessels are slowly blocked over a few minutes. The embolization is continued until the blood flow in the fibroid is almost completely blocked. This procedure must also be carried out in the same way in the relevant vascular system on the opposite side of the uterus. After embolization, the catheter is withdrawn and the puncture site is closed with a pressure bandage that is left in place for 24 hours. After this one to one and a half hour procedure, the patient usually remains inpatient for one to two days and needs accompanying pain therapy for the first 24 hours.

literature

German speaking

• TJ Kröncke, M. David: Results of the 2nd radiological-gynecological expert meeting - Uterine artery embolization (UAE) for myoma treatment. (Consensus paper). In: Fortschr Röntgenstr. 179, 2007, pp. 325-326. doi: 10.1055 / s-2007-972191
• TK Helmberger, TF Jakobs, MF Reiser : Technique and methods in uterine leiomyoma embolization. In: Radiologist. 43, 2003, pp. 634-640.
• TJ Kröncke, B. Hamm: Role of magnetic resonance imaging (MRI) in establishing the indication for, planning, and following up uterine artery embolization (UAE) for treating symptomatic leiomyomas of the uterus. In: Radiologist. 43, 2003, pp. 624-633.
• BA Radeleff, S. Satzl, M. Eiers, K. Fechtner, A. Hakim, S. Rimbach, GW Kauffmann, GM Richter: Clinical 3-year follow-up of uterine fibroid embolization. In: Röfo. 179, 2007, pp. 593-600.
• GM Richter, B. Radeleff, S. Rimbach et al: Uterine fibroid embolization with spheric micro-particles using flow guiding: safety, technical success and clinical results. In: Röfo. 176, 2004, pp. 1648-1657.
• R. Gaetje, S. Zangos, T. Vogl, M. Kaufmann: Myoma embolization - pelocket titonitis in abscessed, necrotic myoma. In: obstetric women's health. 63, 2003, pp. 156-159, doi: 10.1055 / s-2003-37464

English speaking

• J. Pelage: Treatment of uterine fibroids. In: Lancet. 12 (357 (9267)), 2001, p. 1530.
• JH Ravina, A. Aymard, N. Ciraru-Vigneron and others: Uterine fibroids embolization: results about 454 cases. In: Gynecol Obstet Fertil. 31, 2003, pp. 597-605.
• JB Spies, J. Bruno, F. Czeyda-Pommersheim and others: Long-term outcome of uterine artery embolization of leiomyomata. In: Obstet Gynecol. 106, 2005, pp. 933-939.

Individual evidence

1. ↑ TJ Kröncke, M. David: Results of the 2nd radiological-gynecological expert meeting - Uterine artery embolization (UAE) for myoma treatment. (Consensus paper). In: Fortschr Röntgenstr. 179, 2007, pp. 325-326, doi: 10.1055 / s-2007-972191
2. ^ Thomas Kröncke, Matthias David: Uterine artery embolization for myoma treatment. In: Gynecologist. 51, 2010, pp. 644–646, (online ( memento of the original dated December 12, 2013 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice . , PDF document, 213 kB) 
3. ↑ Thomas Römer, Hans-Rudolf Tinneberg: Commentary on: Thomas Kröncke, Matthias David: Uterus artery embolization for myoma treatment. In: Gynecologist. 51, 2010, pp. 647–648, (online ( memento of the original dated December 12, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice . , PDF document, 213 kB) 

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