The efficiency of EMA and prevention of its possible complications in the treatment of myoma


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Abstract

Objective. To study the efficiency and safety of EMA and to develop methods for preventing its possible complications. Subjects and methods. The experience in performing 2145 EMAs in patients aged 18 to 45 years with uterine myoma in the period 2002-2014 was generalized. All the patients underwent EMA as an alternative to hysterectomy. EMA was carried out in the X-ray operating suite, by using ОЕС 98-00 (General Electric, USA) and Integris Allura (Philips) angiography devices via femoral access employing 4-5 F Cobra (C2) catheters; Roberts, Judkins Right; following arteriography, embolization was performed applying 500- to 900-pm PVA particles. Hysterectomy, mechanical myomectomy, or myoma resection, as well as abdominal myomectomy using the laparoscopic or laparotomic approach were done as indicated. Results. The efficiency of EMA was 94.7%. Its main effect was a 2-4-fold decrease in the volume of the uterus and nodules during a year. There was an effect of EMA-induced migration of myomatous nodules into the uterine cavity to create conditions for transcervical myomectomy. An algorithm was elaborated to manage patients after EMA and to prevent its possible complications after migration of myomatous nodules into the uterine cavity. The specific features of blood supply of the ovaries were assessed; utero-ovarian anastomoses were detected by angiography and Doppler ultrasonography; EMA techniques were developed, which allowed for reducing the possibility of unintended ovarian embolization. The outcomes of 125 pregnancies occurring 1 to 5 years after EMA were assessed.

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About the authors

Galina Mikhailovna Savelyeva

N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russia

Email: agpf-gms@rambler.ru
academician RAMS, MD, professor, Head of the department of obstetrics and gynecology

Irina Alekseevna Krasnova

N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russia

Email: krasnovairina@mail.ru
MD, professor of the department of obstetrics and gynecology

Valentina Grigorievna Breusenko

N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russia

Email: agpf-gms@rambler.ru
MD, professor of the department

Sergey Anatolievich Kapranov

N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russia

Email: 7203704@mail.ru
MD, professor, the senior researcher associate of SRL «The health of the woman, mother and child», the department of obstetrics and gynecology

Victoria Borisovna Aksenova

N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russia

Email: viktoriya-aksenova@yandex.ru
PhD, MD, the senior researcher associate of SRL «The health of the woman, mother and child», the department of obstetrics and gynecology

D. G Aryutin

N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russia

Email: aryutin@mail.ru
PhD, MD, head of the gynecology department of the Moscow State Hospital №29, senior researcher associate of SRL «The health of the woman, mother and child», the department of Obstetrics and Gynecology

Anastasia Sergeevna Krasnova

N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russia

Email: 9262211885@mail.ru
post-graduate student of the department of obstetrics and gynecology

Irina Andreevna Esipova

N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russia

Email: esipova.ira@inbox.ru
the senior researcher associate of SRL «The health of the woman, mother and child», the department of obstetrics and gynecology

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