1. Uterine/Femoral Fibroid Embolization Danielle Carberry Erik Backa Sadia Zabeen William Jung Robert Tsang Tiara John Roksana Sobczak

2. Patient X 34 year old Hispanic female Entered St. Luke’s Hospital Reason: Sever Pain in her leg and was unable to walk  No symptoms of any disease or previous medical history

3. Patient X After the patient was seen by the doctor it was believed that she has an femoral fibroid Patient X was then sent to Interventional Radiology.

4. Diagnosis The patient’s had an extremely large fibroid. The femoral embolization was needed to remove the fibroid and allow normal circulation to the lower limbs.

5. What is a Fibroid? Fibroids are muscular tumors that grow in the wall of the uterus/womb. Are almost always benign (not cancerous). They can grow as a single tumor, or there can be multiple They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large.

6. Fibroids Generally occurs during childbearing age and half of all women have fibroids by age 50 No one knows for sure what causes fibroids or what causes them to grow or shrink.

7. Symptoms of fibroids Most fibroids do not cause any symptoms, but some women with fibroids can have: -Heavy bleeding -Enlargement of the lower abdomen -Frequent urination -Pain during sex -Lower back pain -Complications during pregnancy and labor, -Reproductive problems, such as infertility

8. What is a Uterine Fibroid Embolization? Uterine Fibroid Embolization is a invasive treatment for fibroid tumors of the uterus.

9. Patient Prep The patient was instructed not to eat the night before-12 am until the start of the exam. Medication given: 30 Mg of Kertoralac-used for cramping 4 Mg of Zofran- to counteract nausea and vomiting 1 gm of Ancef- antibiotics Feutange- used for pain Versed- relaxation

10. Contrast Used

11. Radiographic Positioning Patient was placed Supine Patient’s leg was monitored to evaluate the circulation within the legs The procedure took approximately 15 minutes

12. Uterine/Femoral Fibroid Embolization A catheter is inserted into the skin, through the femoral artery It travels to the common iliac arteries Small particles are injected to block the arteries that supply blood to the fibroids

13. The goal is to block blood supply to the fibroids starving them, in hopes that the fibroid will shrink and die. The femoral embolization would now allow normal circulation to the lower limbs

14. Technique and Equipment Equipment: C- Arm Technique :70 KVP (Kilovoltage Peak) 2 mAs (mill amperage per second)

15. A guide wire and catheter were used to assist in the access of the arteries.

16. Anatomy and Physiology The blood circulates in this order: It travels from the aorta where it bifurcates into the common iliac arteries and further divides into the internal iliac arteries.

17. Anatomy and Physiology Iliac crest Ilium Sacrum Coccyx Hip joint Ischium Pubis symphysis Femur

18. Follow-Up After the patient’s fibroids were removed,her leg was extended for 1 hour and compressed for 15 minutes at a time. This is to force circulation into the lower extremities. The patient was immobile and the punctured leg was extended for 6 hours to prevent bleeding.

19. Follow UP The patient was immobile and the punctured leg was extended for 6 hours to prevent bleeding. The pain in the patient’s leg was completely was gone.

20. Follow-Up Further test such as MRI and Ultrasound will be done to visualize the continued absence of the neoplasm. Patient could walk normally again

21. Summary Patient X, a 34 year old, Hispanic, female came to St. Luke’s Hospital with severe leg pain and the inability to walk. After seeing the physician, she was sent to interventional radiology to have a Femoral Fibroid Embolization.

22. Summary The Uterine Embolization was done to remove a neoplasm called a fibroid. The fibroid was thriving off the blood that should have been circulating to her lower limbs. After the fibroid’s source of survival was cut off, the patient regained the full ability to walk and no pain in her legs.

23. References http://www.womenshealth.gov/ http://www.nlm.nih.gov/ http://emedicine.medscape.com/ Human Anatomy and Physiology Fetal Pig Version by Susan J. Mitchell, 2013

24. THANK YOU!