Uterine artery embolization for symptomatic uterine myomas

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Presentation transcript:

Uterine artery embolization for symptomatic uterine myomas Bradley S Hurst, M.D., Daniel J Stackhouse, M.D., Michelle L Matthews, M.D., Paul B Marshburn Fertility and Sterility Volume 74, Issue 5, Pages 855-869 (November 2000) DOI: 10.1016/S0015-0282(00)01572-7

Figure 1 Pelvic magnetic resonance imaging of a 46-year-old woman with menorrhagia, urinary frequency, constipation, and pelvic pain. The fast-spin echo coronal image demonstrates an enlarged uterus (ut) containing multiple myomas. All subsequent images are from this patient. Hurst. Uterine artery embolization for myomas. Fertil Steril 2000. Fertility and Sterility 2000 74, 855-869DOI: (10.1016/S0015-0282(00)01572-7)

Figure 2 Midline sagittal T1-weighted pelvic image demonstrates uterine (ut) compression of the bladder (bl). Hurst. Uterine artery embolization for myomas. Fertil Steril 2000. Fertility and Sterility 2000 74, 855-869DOI: (10.1016/S0015-0282(00)01572-7)

Figure 3 Digital subtraction flush pelvic arteriogram. A 5-F flush catheter is placed from a right common femoral approach through the right external iliac artery (ext iliac art) and positioned with the side holes just above the aortic bifurcation. Normal pelvic vasculature with hypertrophy of the uterine arteries (ut art) is seen. Hurst. Uterine artery embolization for myomas. Fertil Steril 2000. Fertility and Sterility 2000 74, 855-869DOI: (10.1016/S0015-0282(00)01572-7)

Figure 4 Unsubtracted flush pelvic arteriogram. Hurst. Uterine artery embolization for myomas. Fertil Steril 2000. Fertility and Sterility 2000 74, 855-869DOI: (10.1016/S0015-0282(00)01572-7)

Figure 5 The flush catheter has been exchanged for a selective catheter, which is positioned in the left uterine artery. Note the hypertrophy of the uterine artery and the rounded hypervascular myoma in the inferior aspect of this subtracted image. Hurst. Uterine artery embolization for myomas. Fertil Steril 2000. Fertility and Sterility 2000 74, 855-869DOI: (10.1016/S0015-0282(00)01572-7)

Figure 6 Unsubtracted selective arteriogram of the left uterine artery. Hurst. Uterine artery embolization for myomas. Fertil Steril 2000. Fertility and Sterility 2000 74, 855-869DOI: (10.1016/S0015-0282(00)01572-7)

Figure 7 Selective digital subtraction arteriogram of the right uterine artery shows hypervascular myomas. Hurst. Uterine artery embolization for myomas. Fertil Steril 2000. Fertility and Sterility 2000 74, 855-869DOI: (10.1016/S0015-0282(00)01572-7)

Figure 8 Unsubtracted selective arteriogram of the right uterine artery. Hurst. Uterine artery embolization for myomas. Fertil Steril 2000. Fertility and Sterility 2000 74, 855-869DOI: (10.1016/S0015-0282(00)01572-7)

Figure 9 Following embolization of both uterine arteries with PVA particles, a repeat flush digital subtraction pelvic arteriogram reveals no flow to the fibroids through the uterine arteries. All other vasculature is unchanged. In this figure, the vascular pattern of the uterus (M1, M2, M3) is demonstrated. Contrast is seen in the left uteroovarian artery (ov art). Embolization of the ovary through the uteroovarian artery may occur. Hurst. Uterine artery embolization for myomas. Fertil Steril 2000. Fertility and Sterility 2000 74, 855-869DOI: (10.1016/S0015-0282(00)01572-7)

Figure 10 Late-phase digital subtraction pelvic arteriogram reveals contrast in stumps of occluded uterine arteries (arrows). The lack of washout in these vessels confirms complete occlusion. Hurst. Uterine artery embolization for myomas. Fertil Steril 2000. Fertility and Sterility 2000 74, 855-869DOI: (10.1016/S0015-0282(00)01572-7)

Figure 11 Unsubtracted pelvic arteriogram after uterine artery embolization. Hurst. Uterine artery embolization for myomas. Fertil Steril 2000. Fertility and Sterility 2000 74, 855-869DOI: (10.1016/S0015-0282(00)01572-7)