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Uterine Artery Embolization
Brandt C. Wible, MD; Gloria M. Salazar, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Outcomes

          TERMINOLOGY

          • Synonyms

            • Uterine fibroid embolization
          • Definitions

            • Uterine leiomyoma (fibroid): Benign uterine tumor originating from smooth muscle (myometrium) & accompanying connective tissue
            • Uterine artery (UA) embolization (UAE): Transcatheter particle delivery to block UA blood supply
              • Primarily used for treatment of uterine fibroids
              • Also used to treat postpartum hemorrhage (PPH)
            • PPH: Excessive bleeding during/after childbirth; may be life-threatening
              • Characterized by
                • Blood loss > 500 mL during vaginal delivery
                • Blood loss > 1,000 mL during cesarean section
                • Hematocrit drop ≥ 10% between admission & birth
              • Causes of PPH
                • Uterine atony
                  • Most common cause; up to 80% of cases
                • Genital tract laceration
                  • 2nd most common cause
                • Retained/adherent placenta
                  • Prevents adequate uterine contraction
                • Maternal coagulopathies
              • Primary PPH: Occurs in first 24 hours after delivery
                • Associated with uterine atony or laceration
              • Secondary (delayed) PPH: Continued bleeding > 24 hours after delivery
                • Associated with retained gestational products
            • Adenomyosis: Ectopic endometrial tissue in myometrium; can cause painful &/or profuse menses
          • Pertinent Vascular Anatomy

            • Internal iliac artery originates from bifurcation of common iliac artery; has 2 divisions
              • Anterior division
                • Obturator artery
                • Superior vesical artery
                • Vaginal (female patients)/inferior vesical (male patients) artery
                • Middle rectal artery
                • Internal pudendal artery
                • Inferior gluteal artery
                • UA
                  • Vaginal artery may arise from UA
              • Posterior division
                • Superior gluteal artery
                • Lateral sacral artery
                • Iliolumbar artery
            • Ovarian artery (OA)
              • Arises from abdominal aorta below renal arteries
                • Courses in ovarian suspensory ligament

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Findings and Reporting

                        • Alternative Procedures/Therapies

                          POST PROCEDURE

                          • Things to Do

                            • Things to Avoid

                              • Clinical Follow-Up

                                • Postprocedure Imaging

                                  OUTCOMES

                                  • Complications

                                    • Expected Outcomes

                                      Selected References

                                      1. Binkert CA et al: Superior hypogastric nerve block to reduce pain after uterine artery embolization: advanced technique and comparison to epidural anesthesia. Cardiovasc Intervent Radiol. 38(5):1157-61, 2015
                                      2. Dariushnia SR et al: Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 25(11):1737-47, 2014
                                      3. Gupta JK et al: Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 12: CD005073, 2014
                                      4. Mara M et al: Embolization of uterine fibroids from the point of view of the gynecologist: pros and cons. Int J Womens Health. 6:623-9, 2014
                                      5. Spencer EB et al: Clinical and periprocedural pain management for uterine artery embolization. Semin Intervent Radiol. 30(4):354-63, 2013
                                      6. Burke CT et al: ACR Appropriateness Criteria® on treatment of uterine leiomyomas. J Am Coll Radiol. 8(4):228-34, 2011
                                      7. Fennessy FM et al: Quality-of-life assessment of fibroid treatment options and outcomes. Radiology. 259(3):785-92, 2011
                                      8. Gayat E et al: Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study. Intensive Care Med. 37(11):1816-25, 2011
                                      9. Gorny KR et al: Magnetic resonance-guided focused ultrasound of uterine leiomyomas: review of a 12-month outcome of 130 clinical patients. J Vasc Interv Radiol. 22(6):857-64, 2011
                                      10. Kim MD et al: Uterine artery embolization for symptomatic adenomyosis: a new technical development of the 1-2-3 protocol and predictive factors of MR imaging affecting outcomes. J Vasc Interv Radiol. 22(4):497-502, 2011
                                      11. Moss JG et al: Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG. 118(8):936-44, 2011
                                      12. van der Kooij SM et al: Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol. 205(4):317, 2011
                                      13. Yu SC et al: Comparison of clinical outcomes of tris-acryl microspheres versus polyvinyl alcohol microspheres for uterine artery embolization for leiomyomas: results of a randomized trial. J Vasc Interv Radiol. 22(9):1229-35, 2011
                                      14. Gonsalves M et al: The role of interventional radiology in obstetric hemorrhage. Cardiovasc Intervent Radiol. 33(5):887-95, 2010
                                      15. Hovsepian DM et al: Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 20(7 Suppl):S193-9, 2009
                                      16. Salazar GM et al: Transcatheter endovascular techniques for management of obstetrical and gynecologic emergencies. Tech Vasc Interv Radiol. 12(2):139-47, 2009
                                      17. Kim HS et al: Pain levels within 24 hours after UFE: a comparison of morphine and fentanyl patient-controlled analgesia. Cardiovasc Intervent Radiol. 31(6):1100-7, 2008
                                      18. Razavi MK et al: Angiographic classification of ovarian artery-to-uterine artery anastomoses: initial observations in uterine fibroid embolization. Radiology. 224(3):707-12, 2002
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Preprocedure

                                          • Procedure

                                            • Outcomes

                                              TERMINOLOGY

                                              • Synonyms

                                                • Uterine fibroid embolization
                                              • Definitions

                                                • Uterine leiomyoma (fibroid): Benign uterine tumor originating from smooth muscle (myometrium) & accompanying connective tissue
                                                • Uterine artery (UA) embolization (UAE): Transcatheter particle delivery to block UA blood supply
                                                  • Primarily used for treatment of uterine fibroids
                                                  • Also used to treat postpartum hemorrhage (PPH)
                                                • PPH: Excessive bleeding during/after childbirth; may be life-threatening
                                                  • Characterized by
                                                    • Blood loss > 500 mL during vaginal delivery
                                                    • Blood loss > 1,000 mL during cesarean section
                                                    • Hematocrit drop ≥ 10% between admission & birth
                                                  • Causes of PPH
                                                    • Uterine atony
                                                      • Most common cause; up to 80% of cases
                                                    • Genital tract laceration
                                                      • 2nd most common cause
                                                    • Retained/adherent placenta
                                                      • Prevents adequate uterine contraction
                                                    • Maternal coagulopathies
                                                  • Primary PPH: Occurs in first 24 hours after delivery
                                                    • Associated with uterine atony or laceration
                                                  • Secondary (delayed) PPH: Continued bleeding > 24 hours after delivery
                                                    • Associated with retained gestational products
                                                • Adenomyosis: Ectopic endometrial tissue in myometrium; can cause painful &/or profuse menses
                                              • Pertinent Vascular Anatomy

                                                • Internal iliac artery originates from bifurcation of common iliac artery; has 2 divisions
                                                  • Anterior division
                                                    • Obturator artery
                                                    • Superior vesical artery
                                                    • Vaginal (female patients)/inferior vesical (male patients) artery
                                                    • Middle rectal artery
                                                    • Internal pudendal artery
                                                    • Inferior gluteal artery
                                                    • UA
                                                      • Vaginal artery may arise from UA
                                                  • Posterior division
                                                    • Superior gluteal artery
                                                    • Lateral sacral artery
                                                    • Iliolumbar artery
                                                • Ovarian artery (OA)
                                                  • Arises from abdominal aorta below renal arteries
                                                    • Courses in ovarian suspensory ligament

                                              PREPROCEDURE

                                              • Indications

                                                • Contraindications

                                                  • Preprocedure Imaging

                                                    • Getting Started

                                                      PROCEDURE

                                                      • Patient Position/Location

                                                        • Procedure Steps

                                                          • Findings and Reporting

                                                            • Alternative Procedures/Therapies

                                                              POST PROCEDURE

                                                              • Things to Do

                                                                • Things to Avoid

                                                                  • Clinical Follow-Up

                                                                    • Postprocedure Imaging

                                                                      OUTCOMES

                                                                      • Complications

                                                                        • Expected Outcomes

                                                                          Selected References

                                                                          1. Binkert CA et al: Superior hypogastric nerve block to reduce pain after uterine artery embolization: advanced technique and comparison to epidural anesthesia. Cardiovasc Intervent Radiol. 38(5):1157-61, 2015
                                                                          2. Dariushnia SR et al: Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 25(11):1737-47, 2014
                                                                          3. Gupta JK et al: Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 12: CD005073, 2014
                                                                          4. Mara M et al: Embolization of uterine fibroids from the point of view of the gynecologist: pros and cons. Int J Womens Health. 6:623-9, 2014
                                                                          5. Spencer EB et al: Clinical and periprocedural pain management for uterine artery embolization. Semin Intervent Radiol. 30(4):354-63, 2013
                                                                          6. Burke CT et al: ACR Appropriateness Criteria® on treatment of uterine leiomyomas. J Am Coll Radiol. 8(4):228-34, 2011
                                                                          7. Fennessy FM et al: Quality-of-life assessment of fibroid treatment options and outcomes. Radiology. 259(3):785-92, 2011
                                                                          8. Gayat E et al: Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study. Intensive Care Med. 37(11):1816-25, 2011
                                                                          9. Gorny KR et al: Magnetic resonance-guided focused ultrasound of uterine leiomyomas: review of a 12-month outcome of 130 clinical patients. J Vasc Interv Radiol. 22(6):857-64, 2011
                                                                          10. Kim MD et al: Uterine artery embolization for symptomatic adenomyosis: a new technical development of the 1-2-3 protocol and predictive factors of MR imaging affecting outcomes. J Vasc Interv Radiol. 22(4):497-502, 2011
                                                                          11. Moss JG et al: Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG. 118(8):936-44, 2011
                                                                          12. van der Kooij SM et al: Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol. 205(4):317, 2011
                                                                          13. Yu SC et al: Comparison of clinical outcomes of tris-acryl microspheres versus polyvinyl alcohol microspheres for uterine artery embolization for leiomyomas: results of a randomized trial. J Vasc Interv Radiol. 22(9):1229-35, 2011
                                                                          14. Gonsalves M et al: The role of interventional radiology in obstetric hemorrhage. Cardiovasc Intervent Radiol. 33(5):887-95, 2010
                                                                          15. Hovsepian DM et al: Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 20(7 Suppl):S193-9, 2009
                                                                          16. Salazar GM et al: Transcatheter endovascular techniques for management of obstetrical and gynecologic emergencies. Tech Vasc Interv Radiol. 12(2):139-47, 2009
                                                                          17. Kim HS et al: Pain levels within 24 hours after UFE: a comparison of morphine and fentanyl patient-controlled analgesia. Cardiovasc Intervent Radiol. 31(6):1100-7, 2008
                                                                          18. Razavi MK et al: Angiographic classification of ovarian artery-to-uterine artery anastomoses: initial observations in uterine fibroid embolization. Radiology. 224(3):707-12, 2002