Abstract:

Department of Obstetrics and Gynaecology of the Therapeutic and Moscow Faculties of Scientific Research Practical Laboratory of intracardiac and contrast methods of roentgenological studies under the Federal Facility Russian State Medical University of the Russian Ministry of Public Health, Moscow.

This article opens a new series of publications dedicated to a currently important issue of endovascular treatment of uterine myoma - uterine artery embolization (UAE). The authors presently possessing the most abundant hands-on experience in UAE in Russia, based on own experience and literature data discuss herein the most urgent problems related to UAE in treatment for uterine myoma and other obstetrical and gynaecological pathology. Amongst them are the problems of determining the indications for and contraindications to an intervention, outcomes of UAE (including that combined with other therapeutic methods), problems of optimization of the technique and development of technical procedures allowing for UAE to be performed virtually in any situation, as well as the problems related to selection of embolizing substances. The authors also give a detailed consideration to the so-called "myths" about UAE - currently existing negative views on certain aspects of intervention, which are based on outdated and inexact evidence. The authors draw a conclusion that endovascular methods are highly promising in obstetrical and gynaecological pathology.

References

1.     Oliver J. A. Jr, Lance J.S. Selective embolization to control massive hemorrhage following pelvic surgery. Am. J. Obstet. Gynecol. 1979; 135: 431-432.

2.     Ravina J., Merland J., Herbreteau D. et al. Preoperative embolization of uterine fibroma. Preliminary results [10 cases] [letter, in French]. Presse Med. 1994; 23: 1540.

3.     Goodwin S., McLucas B., Lee M. et al. Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J. Vasc. Intervent. Radiol. 1999; 10: 1159-1165.

4.     Goodwin S., Vedantham S., McLucas B. et al. Preliminary experience with uterine artery embolization foruterine fibroids. J. Vasc. Interv. Radiol. 1997; 8: 517-526.

5.     Spies J., Scialli A., Jha R. et al. Initial results from uterine fibroid embolization for symptomatic leiomyomata.J.Vasc.Intervent.Radiol. 1999; 10: 1149-1157.

6.     Uterine Artery Embolization Survey: 10,500 Procedures Performed Worldwide, Fairfax, VA: Society ofInterventional Radiology. 2000.

7.     Hovsepian D., Siskin G., Bonn J. et al. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J. Vasc. Interv. Radiol. 2004; 15: 535-542.

8.     Wong G.C., Muir S.J., Lai A.P., Goodwin S.C. Uterine artery embolization: a minimally invasive technique for the treatment of uterine fibroids. J. Womens Health Gend. Based Med. 2000; 4(9): 357-362.

9.     Савельева Г.М., Бреусенко В.Г., Капранов С.А., Краснова И.А., Бобров Б.Ю., Шевченко Н.А., Аксенова В.Б., Алиева А.А. Эмболизация маточных артерий у больных с миомой матки. Акушерство и гинекология. 2004; 5: 21-24.

10.   Worthington-Kirsch R. Uterine artery embolization: state-of-the-art and new developments. Intervention. 2000; 2(4): 35-38.

11.   Beinfeld M.T., Bosch J.L., Isaacson K.B., Gazelle G.S. Cost-effectiveness of uterine artery embolization and hysterectomy for uterine fibroids. Radiology. 2004; 1(230): 207-213.

12.   Al-Fozan H., Dufort J., Kaplow M. et al. Cost analysis of myomectomy, hysterectomy and uterine artery embolization. Am. J. Obstet. Gynecol. 2002; 5(187): 1401-1404.

13.   Капранов С.А., Беленький А.С., Бобров Б.Ю., Доброхотова Ю.Э., Журавлева А.Д., Алиева А.А., Кайфаджан М.М. Эмболизация маточных артерий в лечении миомы матки: 126 наблюдений. Бюллетень НЦ ССХ им. А.Н. Бакулева РАМН «Сердечно-сосудистые заболевания». 2003; 11(4): 219.

14.   Тихомиров А.Л., Лубнин Д.М. Эмболизация маточных артерий в лечении миомы матки. Вопросы гинекологии, акушерства и перинатологии. 2002; 2(1): 83-85.

15.   Билан М.И., Козюра О.П. Эмболизация маточных артерий при миоме матки: особенности катетеризационной техники. Международный журнал интервенционной кардиоангиологии. 2004; 4: 43-46.

16.   Кавтеладзе З.А., Дроздов С.А., Былов К.В. и др. Эмболизация маточных артерий при фибромиоме матки. Международный журнал интервенционной кардиоангиологии. 2005; 7: 55.

17.   Бреусенко В.Г., Краснова И.А., Капранов С.А., Бобров Б.Ю., Аксенова В.Б., Шевченко Н.А., Арютин Д.Г. Некоторые дискуссионные вопросы эмболизации маточных артерий при лечении миомы матки. Акушерство и гинекология. 2006; 3: 23-26.

18.   Коков Л.С., Самойлова Т.Е., Ситкин И.И., Цыганков В.Н., Гус А.И. Динамика редукции миоматозных узлов в зависимости от их локализации у пациенток, перенесших эмболизацию маточных артерий по поводу миомы матки. Материалы конференции «Радиология 2006» 25-27 апреля 2006; 235.

19.   Lohle P.N.M., Lapmann L., Boekkooi F.P., Vervest H.A.M. Specialists collaborate in fibroid treatment. Diagnostic Imaging Europe. 2002; 23-25.

20.   David M., Ebert A.D. Treatment of uterine fibroids by embolization - advantages, disadvantages, and pitfalls. Eur. J.Obstet. Gynecol. Reprod Biol. 2005; 2(122): 144-150.

21.   Nikolic B., Spies J.B., Campbell L. et al. Uterine artery embolization: Reduced radiation with refined technique. J. Vasc. Intervent. Radiol. 2001; (12): 39-44.

22.   Brunereau L., Herbreteau D., Gallas S. et al. Uterine artery embolization in the primary treatment of uterine leiomyomas: technical features and prospective follow-up with clinical and sonographic examinations in 58 patients. AJR. 2000; 175: 1267-1272.

23.   Pelage J., Le Dref O., Soyer P. et al. Arterial anatomy of the female genital tract: Variations and relevance to transcatheter embolization of the uterus. AJR. 1999; 172: 989-994.

24.   Katsumori T., Nakajima K., Mihara T., Tokuhiro M. Uterine artery embolization using gelatin sponge particles alone for symptomatic uterine fibroids: Midterm results. AJR. 2002; 178: 135-139.

25.   Du J., Zuo Y., Chen X. et al. Clinical observation of transcatheter uterine artery embolization for uterine myoma. Zhonghua Fu Chan Ke Za Zhi. 2002; 1(37): 12-15.

26.   Belenky A., Cohen M., Bachar G. Uterine arterial embolization for the management of leiomyomas. Isr. Med.Assoc.J. 2001; 10(3): 719-721.

27.   Доброхотова Ю.Э., Капранов С.А., Бобров Б.Ю., Алиева А.А., Гришин И.И. Эмболизация маточных артерий - постэмболизационный синдром. Российский вестник акушера-гинеколога. 2005; 2(5): 44-49.

28.Nagao T., Ohwada T., Kitazono M., Ohshima K., Shimizu H., Katayama M. Thoracic epidural analgesia is effective in perioperative pain relief for uterine artery embolization. Masui. 2005; 2(54): 156-159.

29.   Saito S., Chiba A., Hayakawa S.,Toyoshima M., Enomoto A. Pain control with epidural anesthesia for uterine artery embolization. Masui. 2004; 4(53): 391-395.

30.   Ryan J.M., Gainey M., Glasson J., DohertyJ., Smith T.P. Simplified pain-control protocol after uterine artery embolization. Radiology. 2002; 2(224): 610-611, discussion 611-613.

31.   Rasuli P., Jolly E.E., Hammond I., French G.J., Preston R., Goulet S., Hamilton L., Tabib M. Superior hypogastric nerve block for pain control in outpatient uterine artery embolization. J. Vasc. Interv. Radiol. 2004; 12(15): 1423-1429.

32.   Keyoung J.A., Levy E.B., Roth A.R. et al. Intraarterial lidocaine for pain control after uterine artery embolization for leiomyomata. J. Vasc. Interv. Radiol 2001; 9(12): 1065-1069.

33.   Капранов С.А., Бреусенко В.Г., Бобров Б.Ю., Краснова И.А., Шевченко Н.А., Алиева А.А., Аксенова В.Б. Применение эмболизации маточных артерий при лечении миомы матки: анализ 258 наблюдений. Международный журнал интервенционной кардиоангиологии. 2005; 7: 56.

34.   Walker W.J., Pelage J.P. Uterine fibroid embolization: Results in 400 women with imaging follow-up. J. Vasc. Interv. Radiol. 2002; 13 (Suppl. 2): 18.

35.   Доброхотова Ю.Э., Капранов С.А., Алиева А.А., Бобров Б.Ю., Гришин И.И. Новый органосохраняющий метод лечения миомы матки — эмболизация маточных артерий. Лечебное дело. 2005; 2: 24—27. 36.Jha R.C., Ascher S.M., Imaoka I., Spies J.B. Symptomatic fibroleiomyomata: MR imaging of the uterus before and after uterine arterial embolization. Radiology. 2000; (217): 228-235.

37.   Бреусенко В.Г., Краснова И.А., Капранов С.А., Аксенова В.Б., Бобров Б.Ю., Шевченко Н.А. Спорные вопросы эмболизации маточных артерий при миоме матки. Вопросы гинекологии, акушерства и перинатологии. 2005; 4(4): 44—48.

38.   Kim M.D., Kim N.K., Kim H.J., Lee M.H. Pregnancy following uterine artery embolization with polyvinylalcohol particles for patients with uterine fibroid or adenomyosis. Cardiovasc. Intervent. Radiol. 2005; 5(28): 611-615.

39.   D'Angelo A., Amso N.N., Wood A. Spontaneous multiple pregnancy after uterine artery embolization for uterine fibroid: case report. Eur. J. Obstet. Gynecol. Reprod. Biol. 2003; 2(110): 245-246.

40.   Nabeshima H., Murakami T., Sato Y., Terada Y., Yaegashi N., Okamura K. Successful pregnancy after myomectomy using preoperative adjuvant uterine artery embolization. Tohoku J. Exp. Med. 2003; 3(200): 145-149.

41.   Carpenter T.T., Walker W.J. Pregnancy following uterine artery embolisation for symptomatic fibroids: a series of 26 completed pregnancies. BJOG. 2005; 3(112): 321-325.

42.   Price N., Gillmer M.D., Stock A., Hurley P.A. Pregnancy following uterine artery embolisation. J. Obstet. Gynaecol. 2005; 1(25): 28-31.

43.   Stringer N.H., Grant T., Park J., Oldham L. Ovarian failure after uterine artery embolization for treatment of myomas. J. Am. Assoc. Gynecol. Laparosc. 2000; 3(7): 395-400.

44.   Hascalik S., Celik O., Sarac K., Hascalik M. Transient ovarian failure: a rare complication of uterine fibroid embolization. Acta Obstet. Gynecol. Scand. 2004; 7(83): 682-685.

45.   Payne J.F., Robboy S.J., Haney A.F. Embolic microspheres within ovarian arterial vasculature after uterine artery embolization. Obstet. Gynecol. 2002; 5(100): 883-886.

46.   Healey S., Buzaglo K., Seti L., Valenti D., Tulandi T. Ovarian function after uterine artery embolization and hysterectomy. J. Am. Assoc. Gynecol. Laparosc. 2004; 3(11): 348-352.

47.   Tropeano G., Di Stasi C., Litwicka K., Romano D., Draisci G., Mancuso S. Uterine artery embolization for fibroids does not have adverse effects on ovarian reserve in regularly cycling women younger than 40 years. Fertil. Steril. 2004; 4(81): 1055-1061.

48.   Ahmad A., Qadan L., Hassan N., Najarian K. Uterine artery embolization treatment of uterine fibroids: effect on ovarian function in younger women. J. Vasc. Interv. Radiol. 2002; 10(13): 1017-1020.

49.   Pelage J.P., Walker W.J., Le Dref O., Rymer R. Ovarian artery: angiographic appearance, embolization and relevance to uterine fibroid embolization. Cardiovasc. Intervent. Radiol. 2003; 3(26): 227-233.

50.   Barth M.M., Spies J.B. Ovarian artery embolization supplementing uterine embolization for leiomyomata. J. Vasc. Interv. Radiol. 2003; 9(14): 1177-1182.

51.   Andrews R.T., Bromley P.J., Pfister M.E. Successful embolization of collaterals from the ovarian artery during uterine artery embolization for fibroids: a case report. J. Vasc. Interv. Radiol. 2000; 5(11): 607-610.

52.   YangJ.J., Xiang Y., Wan X.R., Yang X.Y Diagnosis and management of uterine arteriovenous fistulas with massive vaginal bleeding. Int. J. Gynaecol. Obstet. 2005; 2(89): 114-119. 53.Rubod C., Mubiayi N., Robert Y., Vinatier D. Uterine arteriovenous malformation. A rare cause of recurrent metrorrhagia. Gynecol. Obstet. Fertil. 2005; 7-8(33): 511-513.

54.   Lipari C.W., Badawy S.Z. Arteriovenous malformation in a bicornuate uterus leading to recurrent severe uterine bleeding: a case report. J. Reprod. Med. 2005; 1(50): 57-60.

55.   Amagada J.O., Karanjgaokar V, Wood A., Wiener J.J. Successful pregnancy following two uterine artery embolisation procedures for arteriovenous malforma tion. J. Obstet. Gynaecol. 2004; 1(24): 86-87.

56.   Lambert P., Marpeau L., Jan net D. et al. Cervical pregnancy: conservative treatment with primary embolization of the uterine arteries. A case report. Review of the literature. J. Gynecol. Obstet. Biol. Reprod. 1995; 1(24): 43-47.

57.   Suzumori N., Katano K., Sato T. et al. Conservative treatment by angiographic artery embolization of an 11-week cervical pregnancy after a period of heavy bleeding. Fertil. Steril. 2003; 3(80): 617-619.

58.   Sherer D.M., Lysikiewicz A., Abulafia O. Viable cervical pregnancy managed with systemic Methotrexate, uterine artery embolization, and local tamponade with inflated Foley catheter balloon. Am. J. Perinatol. 2003; 5(20): 263-267.

59.   Itakura A., Okamura M., Ohta T., Mizutani S. Conservative treatment of a second trimester cervicoisthmic pregnancy diagnosed by magnetic resonance imaging. Obstet. Gynecol. 2003; 5(101): 1149-1151.

60.   Hong T.M., Tseng H.S., Lee R.C., Wang J.H., Chang C.Y Uterine artery embolization: an effective treat ment for intractable obstetric haemorrhage. Clin. Radiol. 2004; 1(59): 96-101.

61.   Liu X., Fan G., Jin Z., Yang N., Jiang Y., Gai M., Guo L., Wang Y., Lang J. Lower uterine segment pregnancy with placenta increta complicating first trimester induced abortion: diagnosis and conservative management. Chin. Med. J. 2003; 5(116): 695-698.

62.Sugawara J., Senoo M., Chisaka H., Yaegashi N., Okamura K. Successful conservative treatment of a cesarean scar pregnancy with uterine artery embolization. Tohoku J. Exp. Med. 2005; 3(206): 261-265.

63.   Kapranov S.A., Kurtser M.A., Bobrov B.Y., Alieva A.A., Zlatovratsky A.G. Non-fibroid indications for UAE: twelve cases. CIRSE 2006: 244.