RETROSPECTIVE ANALYSIS OF UTERINE ARTERY EMBOLIZATION


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Abstract

Subjects and methods. The case histories of 1500 patients who had undergone UMA for uterine myoma in 2003 to 2010 and had been followed up by the authors for 2—3 years were retrospectively analyzed. The patients aged 21 to 56 years; 81.3% were reproductive-aged. Before UMA, the authors performed a small pelvic ultrasound study, by determining the Doppler blood flow values in the uterine arteries (UAs) and their branches, aspiration to evaluate the endometrium, and, if indicated, hysteroscopy and separate diagnostic curettage of the uterine cavity walls. To evaluate ovarian function, the hormonal prof ile was examined before and after UAE. Results. UA catheterization failures occurred, when the procedure was being mastered, and were due to the anatomical features of UAs. The latter’s perforation was encountered in 10 patients. Two hundred and forty patients were observed to have abnormalities in the uterine vascular anatomic network: in 9 patients, blood supply to the uterus was from the hypertrophic ovarian arteries; there were specif ic origins of UAs in 10, giant UAs in 5, an abnormal network of blood supply to myomatous nodules in 15, and utero-ovary anastomoses of varying degrees in 200. After UAE, menometrorrhagias were ameliorated during 2—3 months; the degree of symptoms of small pelvic compression and chronic pelvic pains were reduced during 4-6 months. Thirty patients required repeat UAE due to its ineffectiveness and the presence of clinical symptoms: 20 patients had undergone partial or complete UA recanalization; 10 had ineffective embolization at the first attempt. Fourteen patients were found to have oligomenorrhea without changes in basal follicle-stimulating hormone levels; their menstrual cycle became normal within 4—6 months. Transient amenorrhea occurred in 7 (0.5%) patients; persistent amenorrhea was noted in 2 cases (patients were aged 44 and 46 years). Conclusion. UAE is highly effective in treating uterine myoma; the procedure can induce complications associated with iatrogenic errors and the anatomic features of blood supply to myomatous nodules. To avoid these complications, UAE must be performed by highly skilled X-ray vascular surgeons, by taking into account the specific features of the anatomy of small pelvic organs and blood supply to them.

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About the authors

A. M KHACHATRYAN

N.I. Pirogov Russian National Research Medical University

Email: aznardoc@yahoo.com

I. I GRISHIN

N.I. Pirogov Russian National Research Medical University

Email: doctoraibolit@rambler.ru

S. A KAPRANOV

N.I. Pirogov Russian National Research Medical University

Yu. E DOBROKHOTOVA

N.I. Pirogov Russian National Research Medical University

Email: doctoraibolit@rambler.ru

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