Characteristics of vascular supply to uterine leiomyoma: an analysis of digital subtraction angiography imaging in 518 cases.

OBJECTIVES: To investigate the characteristics of the vascular supply to uterine leiomyomas based on digital subtraction angiography. METHODS: The feeding artery, vascularity of uterine leiomyoma and visualisation of the ovarian vessel network were studied in 518 patients undergoing uterine artery embolisation (UAE). Mean patient age was 38.97 ± 6.09 years (range, 22-54 years). The types of vascular supply were analysed by the vascular supply to the leimyoma and grades of vascularity by the degree of enhancement of the leimyoma compared with the myometrium. RESULTS: The blood supply of leiomyomas could not be classified in 3.28 % of patients. Blood was supplied solely by the uterine artery in 88.61 % of leiomyomas, 8.11 % of leiomyomas were partially fed by an ovarian artery, and 0.39 % by it exclusively. Leiomyoma blood supply was classified as unilateral predominant, bilateral balanced, single unilateral uterine artery and single ovarian artery in 36.48, 49.23, 10.62 and 0.39 % of cases respectively. Leiomyoma vascularity was classified as extremely hypervascular (8.69 %), hypervascular (46.14 %), isovascular (33.39 %) and hypovascular (11.78 %). CONCLUSIONS: Uterine leiomyomas supplied by both uterine arteries and with rich blood flow were seen in approximately 50 % of patients. However, close attention also should be given to the collateral circulation during UAE.

[The relevance between the effect on dysmenorrhea and the time of surgery of artery embolization in the treatment of adenomyosis].

OBJECTIVE: To analyze the relevance between the effect on dysmenorrhea of uterine artery embolization (UAE) in treatment of adenomyosis (AM) in different periods of the menstrual cycle and the time of the operation. METHODS: Totally 225 cases with preoperative dysmenorrhea voluntarily chose UAE in treatment of AM. They were divided into two groups according to the different times of menstrual cycle (proliferative phase or secretory phase). We analyzed the relevance between the effect of dysmenorrhea of patients in the two groups with the time of surgery after 1, 2, 3 and 4 years. RESULTS: (1) The numbers of the cases completely followed up were 142, 128, 119 and 101 each year in the following four years. (2) The effective rate on dysmenorrhea in the two groups of AM patients was 81% (43/53) and 76% (68/89) after 1 year (P > 0.05). (3) The effective rate was 75% (36/48) and 70% (56/80) after 2 years (P > 0.05). (4) The effective rate was 70% (32/46) and 63% (46/73) after 3 years (P > 0.05). (5) The effective rate was 63% (24/38) and 63% (40/63) after 4 years (P > 0.05). CONCLUSION: UAE has a good efficacy in treatment of AM, but the relevance is not significant between the time of surgery and the effectiveness on dysmenorrhea.

[Study of the injury to the urinary system caused by radiological vascular interventional therapy of obstetrical and gynecological benign diseases].

OBJECTIVE: To explore the injuries to the urinary system caused by uterine artery embolization (UAE) for treatment of obstetrical and gynecological benign diseases, including the classification, aetiology, therapy of the injuries and precaution methods. METHODS: The injuries of the urinary system were reviewed in 960 cases of obstetrical and gynecological benign diseases treated with UAE by our interventional centre. Of all 960 cases, 690 cases were myoma, 244 adenomyosis, 8 cervical pregnancy, 2 cornus pregnancy, 14 postpartum hemorrhage, 2 late postpartum hemorrhage. Meanwhile, the correlative problems of the vascular anatomy, DSA and the embolization technics of microcatheter were analyzed. RESULTS: (1) Different degrees of urinary system injuries occurred in 5 of 960 cases, the rate was 0.5%. None was severe injury, one case (0.1%) was moderate injury, and the patient suffered of hydronephrosis caused by segmental necrosis of unilateral ureter. Mild injury occurred in 4 cases (0.4%), including one case of inflammation of bladder, one case of partial necrosis of bladder mucosa membrane, 2 cases of transient slight unilateral hydronephrosis. Among all the injuries, 4 occurred in myoma patients, and one occurred in adenomyosis patient. The operation procedures of all five cases were bilateral uterine artery embolization, and none used microcatheter. (2) The ureter branch arising from the middle or lower part of the uterine artery supplied the middle or lower part of ureter and the length of this part of ureter is about 4 cm, the bladder branch arising from the middle or lower part of uterine artery supplied the bladder and communicated with the bladder vascular net. Correlative injuries could be caused by the retroflow of embolisms into the above arteries. (3) Placement of the catheter into the upper branch of the uterine artery or the tumor vascular net, using microcatheter if necessary and notation of the retroflow in the embolization process could avoid the embolization of bladder and ureter arteries. (4) Totally 506 cases used microcatheter, the ratio was 52.7%. The 5 cases of injuries did not use microcatheter. CONCLUSIONS: Injuries to the urinary system could occur in UAE for treatment of obstetrical and gynecological benign diseases, which can be prevented by carefully differentiating the vascular communicating branch and the conditions of branches, and embolization of the upper branch of uterine artery can avoid the injury.

[Intermediate and long term clinical effects of uterine arterial embolization in treatment of adenomyosis].

OBJECTIVE: To assess the intermediate and long term clinical effectiveness of uterine arterial embolization (UAE) in treatment of adenomyosis. METHODS: The standard UAE was performed in 189 patients with adenomyosis in our hospital from Jun 1999 to Jun 2004. The fresh gelfoam particles or polyvinyl alcohol particles (PVA) or sodium alginate microspheres for vascular embolization (KMG) mixed with antibiotics were used to embolize the arteries. The degree of dysmenorrhea and amount of menorrhea after the operation were investigated. RESULTS: (1) The number of the cases completely followed up was 168, with a ratio of 88.9%, and a follow-up time of (50 +/- 15) months. (2) The symptom of dysmenorrhea: in all 168 patients, 159 had dysmenorrhea before the operation. Clinical effectiveness was observed in 82.4% (131/159) of patients after the operation, but in 17.6% (28/159) of patients there was no clinical effectiveness, and in 5.0% (8/159) of patients the dysmenorrhea recurred after the operation. (3) The clinical effectiveness between the patients with adenomyosis with and without myoma or between the patients with local and diffuse adenomyosis had no significant difference (P > 0.05). (4) The amount of menorrhea: in the 93 patients with hypermenorrhea, the amount of menorrhea returned to normal in 83.9% (78/93), oligomenorrhea occurred in 10.8% (10/93), the menorrhea of 2 patients was rare, transient amenorrhea occurred in one case, and the amount of menorrhea did not change in two patients. Among the 74 patients with normal menorrhea, the menorrhea amount did not change in 77.0% (57/74), oligomenorrhea occurred in 20.3% (15/74), uterine amenorrhea occurred in two patients. The menorrhea amount of one patient with oligomenorrhea returned to normal after the UAE therapy. (5) Nine patients accepted hysterectomy due to reoccurrence of dysmenorrhea or ineffectiveness or hypermenorrhea. CONCLUSION: UAE has a good intermediate and long term effectiveness in treatment of adenomyosis.

[Influence of interventional radiotherapy for severe postpartum hemorrhage on postpartum menorrhea].

OBJECTIVE: To discuss the influence of interventional radiotherapy for treating severe postpartum hemorrhage on postpartum menorrhea. METHODS: From Mar. 1995 to Feb. 2002, 18 cases of severe postpartum hemorrhage treated with arterial embolization served as the interventional group. Twenty parturients without postpartum complication were recruited as control group. The continuance of lochia, recovery of menorrhea between the two groups were compared. Serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E(2)) of the non-lactating women in the two groups were assayed during the 3rd-5th days of the first menstrual cycle. RESULTS: Continuance times of lochia were (33.9 +/- 2.0) days, and (36.2 +/- 3.1) days in interventional group and control group, respectively. Recovery times of menorrhea were (75 +/- 17) days, and (95 +/- 16) days in interventional group and control group. The quantity of the postpartum menorrhea was 1.3 +/- 0.1 times of that before delivery in interventional group, 1.3 +/- 0.2 times of that in control group. The number of menstrual cycle before recovery to normal menorrhea was 2 cycles in interventional group, 1.9 cycles in control group. Postpartum menstrual cycle was (33.9 +/- 2.2) days in interventional group, (33.2 +/- 1.6) days in control group. Serum FSH, LH, E(2) of the non-lactating women during the 3rd approximately 5th days of the first menstrual cycle were (5.2 +/- 1.1) U/L, (7.5 +/- 1.6) U/L, (262 +/- 14) pmol/L in interventional group, (4.3 +/- 2.1) U/L, (6.3 +/- 1.3) U/L, (280 +/- 12) pmol/L in control group. There was no significant difference between the two groups (P > 0.05). CONCLUSIONS: No obvious influence of interventional radiotherapy for postpartum hemorrhage on postpartum menorrhea was observed.