Here there is a short description of the procedure that we conduct in our unit. The procedure is performed with local anesthesia, using lidocaine, and under anesthetic assistance; in our center we also conduct the superior hypogastric nerve block to ensure a better post-procedural pain management. Under fluoroscopic guidance, unilateral femoral arterial access is usually performed and then is placed a vascular introducer (4 to 6 Fr).

Then through the introduction of a 4 or 5 Fr visceral catheter, usually a Simmons 5 Fr, with an 0.035 inches hydrophilic guidewire and a microguide-microcatheter system, is reached the uterin artery ipsilateral to the puncture site, after navigating the common femoral artery, the external and internal iliac artery. Then an arteriographic study of the uterine artery is performed to selectively search for utero-ovarian anastomosis and classify it according to the angiographic images of iodine contrast reflux.

If utero-ovarian anastomosis is not detected, or if we find a type Ia anastomosis, we perform the embolization using Polyvinyl alcohol (PVA) microspheres, mixed with iodine contrast, first with a diameter between 500-700 μm. If, during the pre-embolization arteriography, the flow is directed toward the ovarian artery (type III) or if there is reflux of iodine contrast in the ovarian artery (type Ib), we try to go beyond the anastomosis with the microcatheter and continue the embolization using bigger microspheres with diameter betwen 700-900 μm or we try to release coils to protect the anastomosis; according to literature, in this way, we prevent reflux of microspheres back to the ovary and consequently ovarian failure. [5]

Sometimes during embolization the reflux of iodine contrast towards the ovarian artery, previously undetected, becomes evident; this is due to the flow, which previously the embolization was directed towards the uterine artery (type Ia), is reversed, giving reflux toward the ovarian artery (type Ib). Also in this case an attempt is made to go beyond the anastomosis, continuing the embolization with larger microspheres or, if is possible, we release coils to protect the anastomosis.

Once uterine artery embolization ipsilateral to the vascular access site has been completed, the same procedure, with the same criteria, is also performed in the contralateral artery.