Embolization of angiographically visible type I and II utero-ovarian anastomoses during uterine artery embolization for fibroid tumors: impact on symptom recurrence and permanent amenorrhea.

PURPOSE: To compare the incidences of symptom recurrence and permanent amenorrhea following uterine artery embolization (UAE) for symptomatic fibroid tumors in patients with type I and II utero-ovarian anastomoses (UOAs) with versus without ovarian artery embolization (OAE). MATERIALS AND METHODS: A retrospective, institutional review board-approved study of 99 women who underwent UAE for symptomatic fibroid tumors from April 2005 to October 2010 was conducted to identify patients who had type I or II UOAs at the time of UAE. Based on the embolization technique, patients were categorized into standard (ie, UAE only), combined (ie, UAE and OAE), and control (patients without UOAs who underwent UAE) groups. Data collected included patient characteristics, procedural technique and findings, symptom recurrence, secondary interventions, and permanent amenorrhea. Statistical analysis was performed with the Fisher exact test, with significance reached at P < .05. RESULTS: Twenty patients (20.2%; mean age, 46.9 y ± 6.3) had type I (n = 3) or II (n = 17) UOAs. Thirteen (65%) underwent UAE only (standard group) and seven (35%) underwent UAE and OAE (combined group). There were no significant differences between groups in demographics or in the incidence of permanent amenorrhea after procedures (follow-up, 561 d ± 490). There was a significantly higher incidence of symptom recurrence in the standard group compared with the control group (P = .01), with no differences between combined and control groups (P = 1). CONCLUSIONS: There were no statistical differences in permanent amenorrhea rates in the groups studied, with significantly higher symptom recurrence rates observed when OAE was not performed in the setting of UOA.

Evaluation and management of acute vascular trauma.

With the technical advances and the increasing availability of sophisticated imaging equipment, techniques, and protocols, and with continually evolving transcatheter endovascular therapies, minimally invasive imaging and treatment options are being routinely used for the clinical management of trauma patients. Thus, the primary treatment algorithm for managing acute vascular trauma now increasingly involves the interventional radiologist or other endovascular specialist. Endovascular techniques represent an attractive option for both stabilizing and definitively treating patients who have sustained significant trauma, with resultant vascular injury. Endovascular treatment frequently offers the benefit of a focused definitive therapy, even in the presence of massive hemorrhage that allows for preservation of major vessels or injured solid organs and serves as an alternative to an open surgical intervention. This article presents an overview of various endovascular techniques that can be used for trauma patients presenting with vascular injuries.

Transcatheter endovascular techniques for management of obstetrical and gynecologic emergencies.

Since the initial description of selective uterine artery embolization for the treatment of postpartum hemorrhage in 1979, transcatheter embolization and other endovascular techniques have become the second-line therapeutic option for the management of intractable obstetrical and gynecologic bleeding. Advances in catheter-based techniques, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the management of hemorrhage for a variety of indications, such as postpartum hemorrhage, menorrhagia, and postmenopausal bleeding. Transcatheter interventions include the following: (1) prophylactic selective catheterization of the internal iliac arteries, with either temporary balloon occlusion or embolotherapy; (2) selective embolization of collateral pelvic vessels in the setting of surgical ligation of the internal iliac arteries and/or delivery-related injuries to the genital tract; (3) transarterial embolization for the management of abnormal placentation; and (4) massive bleeding secondary to uterine leiomyomas (fibroids) and/or arteriovenous malformations. Transcatheter embolization is a fast, safe, and effective minimally invasive alternative to hysterectomy, when medical treatment fails to control uterine bleeding. Moreover, it preserves the uterus with little or no significant impact on future pregnancies and fertility. This article reviews the transcatheter endovascular techniques that are used in a variety of clinical scenarios for the management of obstetrical and gynecologic emergencies.