Keywords:
Interventional non-vascular, Genital / Reproductive system female, Pelvis, Fluoroscopy, MR, Ultrasound, Embolisation
Authors:
M. C. Calcagno, C. Gozzo, A. Boncoraglio, A. Motta, G. Caltabiano, P. V. Foti, S. Palmucci, A. Basile; Catania/IT
DOI:
10.1594/ecr2018/C-0729
Aims and objectives
Uterine fibroids,
also called myoma or leiomyoma,
are the most common benign tumors of the female reproductive tract (1) and present in more than 40 % of women 40 years of age (2).
They arise from the uterine smooth muscular tissue of myometrium and consist of extracellular matrix; their etiopathology is multifactorial (3).
Approximately 50 % of patients are asymptomatic,
but often fibroids can cause significant morbidity (4).
Symptoms include abnormal uterine bleeding,
heavy mestrual bleeding,
and symptoms connected to the impact of uterus on the pelvic organs and structure (“bulk” sympotms).
More over fibroids can interfering with embrion transfer and impalntation reducing fertility and they can reduce life quality.
For the diagnosis the clinical suspicion of fibroids have to be confirmed with diagnostic imaging such as ultrasound and magnetic resonance.
Depends on factor such as location (submucous,
intramural or subserosal),
number,
size,
patient’s preferences (especially connected with pregnancy expectations) treatment options can be different: medical treatment,
surgery (hysterectomy or myomectomy),
uterine artery embolization (UAE) and magnetic resonance-guided focus ultrasound surgery (MRgFUS).
UAE is a mini-invasive valuable option for symptomatic fibroids that uses embolic material in order to reduce blood supply the fibroid throught the uterine artery; it is an organ preserving method,
safe and effective.
The target of this treatment is to reduce the symptoms connected to the fibroids; a reductionin volume of the fibroifs is also achieved (5).
It is recommended particulary in women with symptomatic fibroids; its role in women desiring oregnancy has not been precisely defined in literature (6),
even if a recent consensus focused the attention on the importance of a interdisciplinary radiologica-gynacolical approach (7-8).
UAE is especially indicated in women with history of heavy mestrual bleeding and other failed therapies.
Comparing to surgery UAE offers many advantages such as less duration of hospitalization,
and inferior time to return to work and normal activity levels.
Complications of UAE can be acute (< 24 hours after UAE),
subacute (> 24 hours after UAE) or chronc (9).
Acute complications include pain,
a very important clinical issue and post-embolization syndrome (with fever,
malaise,
local pain,
nausea and vomit).
Uterine discharge can be normal in the first weeks,
especially if submucosal fibroids are dominant (10); other possible complications include groin hematoma,
hot flashes,
cramping of the lower abdomen,
endometritis/myometritis,
deep vein trombosis/pulmonary embolus.
Pain after UAE is still an important clinical issue because most patients have cramping that require anelgesia (11-12-13-14).
The aim of this study is to evaluate post-procedural quality of life in patients underwent UAE through transradial and transfemoral approach.
Several drug administration for pain control can be used,
however,
few studies have compared transfemoral approach with transradial,