Success and unsolved issues of embolization of the uterine arteries in uterine fibroid

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Abstract

Introduction: According to the clinical recommendations of the Healthcare Ministry of Russia (2021), uterine artery embolization (UAE) in uterine fibroid is an alternative to surgical treatment in case of high surgical risk and absence of contraindications in women who do not desire pregnancy. The advantages of UAE are associated with lesser blood loss, shorter hospital stay, and recovery of the working capacity. Here, we present an analysis of the literature and our 14-year clinical experience in performing UAE in uterine fibroid. Screening and primary diagnosis of uterine fibroid and indications and contraindications of UAE in the current publications were analyzed. Different methods of EUA implementation were described, and the advantages of the transradial access (TRA) are demonstrated on the basis of the actual clinical experience.

Conclusion: The results obtained in the use of TRA revealed the reduction of radioscopy time and surgery time in general, which are beneficial in terms of the reduction of radiation exposure. Besides, an argument for the given access is a considerably lower frequency of serious complications at the access site. The main obstacles to the introduction and wide use of TRA are based on the lack of specialist experience, absence of specialized training programs, and use of unsuitable and traumatizing instruments. One of the unsolved questions is the absence of an anesthesia protocol, which must be developed with the participation of both gynecologists and specialists on X-ray endovascular diagnostics and treatment.

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About the authors

Elena Y. Antropova

Kazan State Medical Academy – Branch of Russian Medical Academy of Continuing Professional Education

Email: antropoval@mail.ru
ORCID iD: 0000-0002-5991-5163
SPIN-code: 1393-8280

MD, Cand. Sci. (Med.)

Russian Federation, Kazan

Bulat M. Sharafutdinov

Kazan State Medical Academy – Branch of Russian Medical Academy of Continuing Professional Education; Medical Unit of Kazan (Privolzhsk) Federal University

Email: bulaty555@mail.ru
ORCID iD: 0000-0002-4149-118X
SPIN-code: 6282-4554

MD, Cand. Sci. (Med.)

Russian Federation, Kazan; Kazan

Sergey Aleksandrovich Ryzhkin

Kazan State Medical Academy – Branch of Russian Medical Academy of Continuing Professional Education; Kazan State Medical University; Kazan (Privolzhsk) Federal University; Federal Center of Toxicological, Radiation and Biological Safety

Email: rsa777@inbox.ru
ORCID iD: 0000-0003-2595-353X
SPIN-code: 5955-5712

MD, Dr. Sci. (Med.), Associate Professor

Russian Federation, Kazan; Kazan; Kazan; Kazan

Madina I. Mazitova

Kazan State Medical Academy – Branch of Russian Medical Academy of Continuing Professional Education

Author for correspondence.
Email: madina13@list.ru
ORCID iD: 0000-0002-9608-2076
SPIN-code: 7653-6594

MD, Dr. Sci. (Med.)

Russian Federation, Kazan

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Supplementary files

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2. Fig. 1. Number of procedures of embolization of uterine fibroids performed in the Russian Federation in 2010-2019 in, absolute values [8].

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3. Fig. 2. US results of patient K., 39 years old (proprietary observation).

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4. Fig. 3. Results of US with color flow mapping of patient K., 39 years old (proprietary observation).

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5. Fig. 4. Results of selective angiography of multiple uterine fibroids of large size from the left uterine artery in patient A., 46 years old.

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6. Fig. 5. Results of embolization of the left uterine artery in patient A., 46 years old.

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7. Fig. 6. Results of selective angiography of a large nodule from the right uterine artery in patient O., 46 years old.

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8. Fig. 7. Results of embolization of the right uterine artery with retrograde filling of the ovarian artery in patient O., 46 years old.

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9. Fig. 8. A standard kit for transradial UAE.

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10. Fig. 9. Results of selective angiography of the left uterine artery in patient N., 32 years old.

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11. Fig. 10. Results of embolization of the left uterine artery in patient N., 32 years old.

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12. Fig. 11. Results of selective angiography of the right uterine artery in patient N., 32 years old.

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13. Fig. 12. Results of embolization of the right uterine artery in patient N., 32 years old.

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14. Fig. 13. Clinical case of patient I., 54 years of age.

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15. Fig. 14. Clinical case of patient Z., 56 years of age.

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16. Fig. 15. Clinical case of patient A., 47 years of age.

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17. Fig. 16. Clinical case of patient G., 51 years old.

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