Uterine Artery Embolization for Leiomyomas and Adenomyosis: A Pictorial Essay Based on Our Experience from 1300 Cases
- Author:
Man Deuk KIM
1
Author Information
- Publication Type:Case Report
- Keywords: Uterine artery embolization; Leiomyoma; Adenomyosis; Uterus; MRI
- MeSH: Adenomyosis; Analgesia, Patient-Controlled; Angiography; Dexamethasone; Dexmedetomidine; Gonadotropin-Releasing Hormone; Humans; Injections, Intravenous; Leiomyoma; Lidocaine; Magnetic Resonance Imaging; Respiratory Insufficiency; Uterine Artery Embolization; Uterine Artery; Uterus
- From:Korean Journal of Radiology 2019;20(10):1462-1473
- CountryRepublic of Korea
- Language:English
- Abstract: Since its introduction in 1995, uterine artery embolization (UAE) has become an established option for the treatment of leiomyomas. Identification of a leiomyoma using arteriography improves the ability to perform effective UAE. UAE is not contraindicated in a pedunculated subserosal leiomyoma. UAE in a cervical leiomyoma remains a challenging procedure. A leiomyoma with high signal intensity on T2-weighted imaging responds well to UAE, but a malignancy with similar radiological features should not be misdiagnosed as a leiomyoma. Administration of gonadotropin-releasing hormone agonists before UAE is useful in selected patients and is not a contraindication for the procedure. The risk of subsequent re-intervention 5 years after UAE is approximately 10%, which represents an acceptable profile. UAE for adenomyosis is challenging; initial embolization using small particles can achieve better success than that by using larger particles. An intravenous injection of dexamethasone prior to UAE, followed by a patient-controlled analgesia pump and intra-arterial administration of lidocaine after the procedure, are useful techniques to control pain. Dexmedetomidine is an excellent supplemental sedative, showing a fentanyl-sparing effect without causing respiratory depression. UAE for symptomatic leiomyoma is safe and can be an alternative to surgery in most patients with a low risk of re-intervention.
