The clinical significances of selective ovarian arterial angiography and embolization in the obstetrics and gynecology
- VernacularTitle:卵巢动脉造影及栓塞在妇产科疾病介入治疗中的意义
- Author:
Feng DUAN
;
Fengyong LIU
;
Maoqiang WANG
- Publication Type:Journal Article
- Keywords:
Ovary arterial;
Angiography;
Uterine fibroids;
Postpartum hemorrhage;
Therapeutic embolization,Therapeutic
- From:
Journal of Interventional Radiology
2001;0(06):-
- CountryChina
- Language:Chinese
-
Abstract:
Transcatheter internal iliac arterial embolization has become a first-choice treatment for control of life-threatened bleeding associated with pelvic tumors or obstetric disorders.Recently,uterine arterial embolization(UAE)has offered a successful alternative to surgery in the treatment of uterine fibroid.Clinical failure rates for this procedure was reported from 4% to 19% in literature,probably due to the existence of collateral flow to the pelvic lesions,especially the ovarian arteries(OA)being the most important source.Furthermore,the anastomosis between the ovarian and uterine arteries has been suggested as the pathway for nontarget embolization of the ovaries causing premature menopause.The OA are simple paired vessels and they usually arise from the anterolateral part of the abdominal aorta at the level of the second lumbar vertebra.Variations in origin of OA occur in 2%-10% with diameter smaller than 1.1 mm and routinely not identified on conventional aortography.However,in the presence of a uterine or other pelvic diseases,the OA become dilated as the result of pathologic blood supply demand.OA supply to the pelvic lesions are more frequently found in patients with large fundal fibroids,history of the pelvic surgery,post embolization of the uterine arteries,and dysplasia of uterine artery.In patient with one or more of these predisposing factors,the extent of OA supply to the pelvic lesions should be assessed using pigtail catheter pelvic aortography with the tip at the level of the renal arteries,followed by selective OA catheterization.In case of identified OA supply to the pelvic lesions,superselective embolization of the OA should be considered,using particles with diameters larger than 500 ?m.Proximal OA embolization,in combination with bilateral UAE,may significantly increase the risk of iatrogenic ovarian dysfunction.When necessary in a premenopausal patient,OA embolization should be performed unilaterally and as near as possible to the lesions,and the procedure is performed only with specific informed consent.
