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Uterine Artery Embolization
Jennifer R. Buckley, MD, MBA; Brandt C. Wible, MD
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KEY FACTS

  • Terminology

    • Procedure

      • Outcomes

        TERMINOLOGY

        • Synonyms

          • Uterine fibroid embolization
        • Definitions

          • Uterine artery embolization (UAE): Transcatheter delivery of embolic agent to block blood flow to uterus
            • Commonly used to treat uterine fibroids, adenomyosis, or postpartum hemorrhage
            • Can be permanent (particles) or temporary (Gelfoam)
          • Uterine leiomyoma (fibroid): Benign neoplasm of smooth muscle (myometrium) and accompanying connective tissue
          • Adenomyosis: Ectopic endometrial tissue in myometrium
            • Can cause bleeding symptoms similar to fibroids
          • Postpartum hemorrhage (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 and birth
            • Causes of PPH
              • Uterine atony (most common)
              • Genital tract laceration
              • Retained/adherent placenta
              • Maternal coagulopathies
            • Primary PPH: Occurs in first 24 hours after delivery
              • Usually associated with uterine atony or laceration
            • Secondary (delayed) PPH: Continued bleeding > 24 hours after delivery
              • Usually associated with retained gestational products
          • Balloon occlusion of internal iliac arteries: Placement of balloon-tipped catheters in internal iliac arteries to be inflated for temporary tamponade
            • Prophylactic placement for prevention of intraoperative bleeding in obstetric/gynecologic surgeries
              • Can also be used to deliver Gelfoam intraoperatively if bleeding occurs
            • Commonly used in conjunction with planned cesarean section for abnormal placentation
              • Abnormal placentation: Spectrum of disease (accreta, increta, percreta) in which placenta abnormally invades into uterine wall and possibly extrauterine structures, increasing risk of intrapartum hemorrhage
          • Superior hypogastric nerve block (SHNB): Direct percutaneous delivery of anesthetic to superior hypogastric plexus to help with procedural pain control and reduce need for postoperative opioids

        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. Caridi TM: Uterine artery embolization for adenomyosis. Tech Vasc Interv Radiol. 24(1):100726, 2021
                                    2. Loya MF et al: Uterine artery embolization for secondary postpartum hemorrhage. Tech Vasc Interv Radiol. 24(1):100728, 2021
                                    3. Manyonda I et al: Uterine-artery embolization or myomectomy for uterine fibroids. N Engl J Med. 383(5):440-51, 2020
                                    4. Park PJ et al: Efficacy of intraprocedural superior hypogastric nerve block in reduction of postuterine artery embolization narcotic analgesia use. Can Assoc Radiol J. 71(1):75-80, 2020
                                    5. 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
                                    6. Dariushnia SR et al: Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 25(11):1737-47, 2014
                                    7. Gupta JK et al: Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 12: CD005073, 2014
                                    8. 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
                                    9. Spencer EB et al: Clinical and periprocedural pain management for uterine artery embolization. Semin Intervent Radiol. 30(4):354-63, 2013
                                    10. Burke CT et al: ACR Appropriateness Criteria® on treatment of uterine leiomyomas. J Am Coll Radiol. 8(4):228-34, 2011
                                    11. Fennessy FM et al: Quality-of-life assessment of fibroid treatment options and outcomes. Radiology. 259(3):785-92, 2011
                                    12. 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
                                    13. 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
                                    14. 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
                                    15. 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
                                    16. 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
                                    17. 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
                                    18. Gonsalves M et al: The role of interventional radiology in obstetric hemorrhage. Cardiovasc Intervent Radiol. 33(5):887-95, 2010
                                    19. Hovsepian DM et al: Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 20(7 Suppl):S193-9, 2009
                                    20. Salazar GM et al: Transcatheter endovascular techniques for management of obstetrical and gynecologic emergencies. Tech Vasc Interv Radiol. 12(2):139-47, 2009
                                    21. 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
                                    22. 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

                                      • Procedure

                                        • Outcomes

                                          TERMINOLOGY

                                          • Synonyms

                                            • Uterine fibroid embolization
                                          • Definitions

                                            • Uterine artery embolization (UAE): Transcatheter delivery of embolic agent to block blood flow to uterus
                                              • Commonly used to treat uterine fibroids, adenomyosis, or postpartum hemorrhage
                                              • Can be permanent (particles) or temporary (Gelfoam)
                                            • Uterine leiomyoma (fibroid): Benign neoplasm of smooth muscle (myometrium) and accompanying connective tissue
                                            • Adenomyosis: Ectopic endometrial tissue in myometrium
                                              • Can cause bleeding symptoms similar to fibroids
                                            • Postpartum hemorrhage (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 and birth
                                              • Causes of PPH
                                                • Uterine atony (most common)
                                                • Genital tract laceration
                                                • Retained/adherent placenta
                                                • Maternal coagulopathies
                                              • Primary PPH: Occurs in first 24 hours after delivery
                                                • Usually associated with uterine atony or laceration
                                              • Secondary (delayed) PPH: Continued bleeding > 24 hours after delivery
                                                • Usually associated with retained gestational products
                                            • Balloon occlusion of internal iliac arteries: Placement of balloon-tipped catheters in internal iliac arteries to be inflated for temporary tamponade
                                              • Prophylactic placement for prevention of intraoperative bleeding in obstetric/gynecologic surgeries
                                                • Can also be used to deliver Gelfoam intraoperatively if bleeding occurs
                                              • Commonly used in conjunction with planned cesarean section for abnormal placentation
                                                • Abnormal placentation: Spectrum of disease (accreta, increta, percreta) in which placenta abnormally invades into uterine wall and possibly extrauterine structures, increasing risk of intrapartum hemorrhage
                                            • Superior hypogastric nerve block (SHNB): Direct percutaneous delivery of anesthetic to superior hypogastric plexus to help with procedural pain control and reduce need for postoperative opioids

                                          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. Caridi TM: Uterine artery embolization for adenomyosis. Tech Vasc Interv Radiol. 24(1):100726, 2021
                                                                      2. Loya MF et al: Uterine artery embolization for secondary postpartum hemorrhage. Tech Vasc Interv Radiol. 24(1):100728, 2021
                                                                      3. Manyonda I et al: Uterine-artery embolization or myomectomy for uterine fibroids. N Engl J Med. 383(5):440-51, 2020
                                                                      4. Park PJ et al: Efficacy of intraprocedural superior hypogastric nerve block in reduction of postuterine artery embolization narcotic analgesia use. Can Assoc Radiol J. 71(1):75-80, 2020
                                                                      5. 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
                                                                      6. Dariushnia SR et al: Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 25(11):1737-47, 2014
                                                                      7. Gupta JK et al: Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 12: CD005073, 2014
                                                                      8. 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
                                                                      9. Spencer EB et al: Clinical and periprocedural pain management for uterine artery embolization. Semin Intervent Radiol. 30(4):354-63, 2013
                                                                      10. Burke CT et al: ACR Appropriateness Criteria® on treatment of uterine leiomyomas. J Am Coll Radiol. 8(4):228-34, 2011
                                                                      11. Fennessy FM et al: Quality-of-life assessment of fibroid treatment options and outcomes. Radiology. 259(3):785-92, 2011
                                                                      12. 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
                                                                      13. 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
                                                                      14. 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
                                                                      15. 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
                                                                      16. 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
                                                                      17. 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
                                                                      18. Gonsalves M et al: The role of interventional radiology in obstetric hemorrhage. Cardiovasc Intervent Radiol. 33(5):887-95, 2010
                                                                      19. Hovsepian DM et al: Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol. 20(7 Suppl):S193-9, 2009
                                                                      20. Salazar GM et al: Transcatheter endovascular techniques for management of obstetrical and gynecologic emergencies. Tech Vasc Interv Radiol. 12(2):139-47, 2009
                                                                      21. 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
                                                                      22. 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