Intraprocedural complications of uterine fibroid embolisation and their impact on long-term clinical outcome.

OBJECTIVES: Authors evaluate the impact of intraprocedural complications on successful technical realisation and long-term clinical outcome of the uterine fibroid embolisation. BACKGROUND: The uterine artery embolisation (UAE) has become an accepted treatment method for uterine fibroids. In general, the unilateral embolisation is considered to be insufficient due to poor clinical effect. METHODS: Overall, 165 uterine artery embolisations were analysed (retrospectively-prospectively) in 163 female patients. Intraprocedural complications and their impact on the possibility to perform bilateral embolisationwere evaluated. In patients with unscheduled unilateral embolisation, short-term as well as long-term clinical effects were observed with mean follow-up period of 41 months. RESULTS: The bilateral uterine artery embolisation was possible in 95.7 % (95 %, CI 91.3-99.4 %) procedures. The unilateral embolisation was reported in 7 procedures (4.3 %, CI 1.2-8.3 %) and reasons were following: resistant arterial spasm in 4 patients (2.5 %, CI 0.7 %-5.3 %) and impossible catheterisation due to unfavourable anatomic situation in 3 patients (1.8 %, CI 0.3-4.1 %). Other complications, such as dissection and perforation, did not affect the successful technical realisation. The long-term clinical effect of unscheduled unilateral embolisation was reported in 5 patients. CONCLUSION: The results of our series of unscheduled unilateral uterine fibroid embolisation had high long-term clinical success rate. In way of unscheduled unilateral embolisation, we recommend MRI follow-up and reintervention only in way of persistence or recurrence of symptoms with concurrent MRI finding of residual fibroids(Tab. 5, Fig. 3, Ref. 12).

Arterio-venous fistula with pseudoaneurysm of renal artery.

INTRODUCTION: The authors describe a rare but potentially severe, sometimes even life-threatening complication occurring after various invasive renal interventions. The cause that gives rise to a fistula formation between close branches of renal artery and vein is an injury of these vessels during resection of a localised renal tumour, renal biopsy, percutaneous nephrostomy, and even blunt injury of the kidney. Blood flows under pressure from renal artery, pushes the surrounding renal parenchyma open, and creates a cavity varying in size and shape. This pseudoaneurysm may communicate with the collecting system of the kidney, in which case it may lead to haematuria, one of the typical symptoms of arteriovenous fistula. MATERIAL AND METHODS: The authors observed this complication in 8 patients (6 males aged from 56 to 70, average 61.7, and two females aged 28 and 54). In 7 patients, the fistula developed after resection of a localised renal tumour, in one patient after percutaneous nephrolitholapaxy of a stone in the kidney. The fistulae manifested themselves between 7 an 21 days after surgery by massive haematuria in 4 patients and by intermittent macroscopic haematuria in 3 patients. In one patient the fistula was asymptomatic while the pseudoaneurysm at the place of pathological connection of renal veins was found during ultrasonographic examination after renal resection. RESULTS: In all patients, the diagnosis of arteriovenous fistula and pseudoaneurysm of renal artery was achieved by ultrasonographic and/or CT examinations. The highest diagnostic value can be ascribed to digital subtraction renoangiography by Seldinger method that subsequently allowed active treatment by introducing an endovascular coil. By this method we cured 5 fistulae. In two patients, urgent nephrectomies were needed because of massive life-threatening haematuria. One of arteriovenous fistulae underwent spontaneous thrombosis. CONCLUSION: The symptomatic arteriovenous fistula requires fast and precise diagnosis subsequently enabling efficient treatment. Endovascular manipulation is a method allowing the preservation of kidney affected by arteriovenous fistula with renal artery pseudoaneurysm (Fig. 7, Ref. 21).

Myoma expulsion after uterine artery embolization.

Uterine artery embolization (UAE) has become a standard therapy in the treatment of symptomatic uterine myomas. The procedure is associated with a few complications. One of them is myoma expulsion. A 32-year-old woman was sent to our hospital with diagnosed intramural myoma with dysmenorrhea and pressure symptoms. UAE was performed since the patient preferred conservative treatment. The procedure was without any complications. Three weeks after embolization, she was readmitted because of vaginal discharge and minor bleeding. We diagnosed expulsion of necrotic myoma and performed transvaginal resection. Four months later, the patient is symptom free. Expulsion of intramural myoma can be thus considered as definite treatment and not a complication of embolization therapy.