Dataset Information

Preoperative Uterine Artery Embolisation for Large Uterine Fibroids with Subsequent Uterus Preservation - Three Case Histories and Review of the Literature.

ABSTRACT: Uterine artery embolisation (UAE) is an established procedure to treat uterine fibroids as an alternative to surgery. The combination of both approaches is reserved for only a few cases. A preoperative UAE (PUAE) contributes to reducing bleeding complications and helps preserve the uterus. We report here on 3 patients, each with very large fibroid (all >?1100?g), who were successfully treated by interdisciplinary hybrid intervention (embolisation followed by surgery). Preserving the uterus was a "sine qua non" for all 3 patients. As discussed in some articles, PUAE should be considered when treating patients who wish to preserve their uterus at all costs but who are considered preoperatively to be at increased risk of bleeding and/or patients who are considered to be at high risk of requiring a hysterectomy "for technical reasons". The additional costs of embolisation can be set against the potentially shorter hospitalisation times due to the more favourable intraoperative and postoperative course, the savings arising from the reduced need for blood transfusions, and the greater patient satisfaction.

SUBMITTER: David M

PROVIDER: S-EPMC4168409 | biostudies-literature | 2012 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Preoperative Uterine Artery Embolisation for Large Uterine Fibroids with Subsequent Uterus Preservation - Three Case Histories and Review of the Literature.

David M M Kröncke T T

Geburtshilfe und Frauenheilkunde 20120601 6

Uterine artery embolisation (UAE) is an established procedure to treat uterine fibroids as an alternative to surgery. The combination of both approaches is reserved for only a few cases. A preoperative UAE (PUAE) contributes to reducing bleeding complications and helps preserve the uterus. We report here on 3 patients, each with very large fibroid (all > 1100 g), who were successfully treated by interdisciplinary hybrid intervention (embolisation followed by surgery). Preserving the uterus was a ...[more]

PMID: 25284842

Similar Datasets

Project description:BackgroundUterine artery embolisation is well established as a treatment for symptomatic fibroids, however, there remain some uncertainties. We have carried out a focused literature review on three particularly challenging aspects - post-procedure fertility, symptomatic adenomyosis and large volume fibroids and uteri, to enable operators to utilise evidence-based guidance in patient selection, consent, and management.ReviewLiterature searches were performed of the PubMed/Medline, Google scholar, EMBASE and Cochrane databases. The outcomes of our analysis of studies which recorded fertility rates in women desiring pregnancy following UAE for symptomatic fibroids found an overall mean pregnancy rate of 39.4%, live birth rate of 69.2% and miscarriage rate of 22%. The major confounding factor was patient age with many studies including women over 40 years who already have lower fertility compared to younger cohorts. Miscarriage rates and pregnancy rates in the studies analysed were comparable to the age matched population. Treatment of pure adenomyosis and adenomyosis with co-existing uterine fibroids with UAE has been shown to produce symptomatic improvement with better outcomes in those with combined disease. Although the effectiveness is not as high as it is in pure fibroid disease, UAE provides a viable and safe alternative for patients seeking symptom relief and uterine preservation. Our analysis of studies assessing the outcomes of UAE in patients with large volume uteri and giant fibroids (> 10 cm) demonstrate no significant difference in major complication rates demonstrating that fibroid size should not be a contraindication to UAE.ConclusionOur findings suggest uterine artery embolisation can be offered to women desiring pregnancy with fertility and miscarriage rates comparable to that of the age-matched general population. It is also an effective therapeutic option for symptomatic adenomyosis as well as for the treatment of large fibroids > 10 cm in diameter. Caution is advised in those with uterine volumes greater than 1000cm3. It is however clear that the quality of evidence needs to be improved on with an emphasis on well-designed randomised controlled trials addressing all three areas and the consistent use of validated quality of life questionnaires for outcome assessment to enable effective comparison of outcomes in different studies.

Project description:BACKGROUND:Uterine leiomyomas are common benign tumours found in women of reproductive age that are rarely associated with intra-abdominal haemorrhage. The aetiology behind this relationship is poorly understood and the aforementioned association poorly recognized from a patient's clinical presentation. Available information in the literature is limited to case reports. The aim of this systematic review is to document and highlight the occurrence of intra-abdominal haemorrhage from uterine fibroids, and determine associated morbidity and mortality. METHODS:A systematic review of Medline, EMBASE, Web of Science, Scopus, and The Cochrane Library - CENTRAL was performed from the databases inception through to December 2018 for case report and series of patients who experienced intra-abdominal haemorrhage from uterine fibroids. Findings were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS:We identified 115 publications reporting on 125 original case reports. The documented intra-abdominal haemorrhage were commonly due to the rupture of superficial blood vessels over the surface of a fibroid, followed by rupture and avulsion of the fibroid involved. A clinical picture of sudden and profound hypovolemic shock with severe abdominal pain was often the presenting complaint, with a correct pre-operative diagnosis only made in 7 cases on computed tomography imaging. Hysterectomy and myomectomy were the most common surgery performed. Mortality was reported in 4 cases which were directly related to complications of uterine fibroids. CONCLUSION:Intra-abdominal haemorrhage secondary to uterine fibroids remained a rare phenomenon which is poorly recognized among clinicians. While this association is not representative of the population of interest, it highlights the pathophysiological spectrum of uterine fibroids and its relevance to emergency physicians, surgeons and gynaecologists during clinical practice.

Dataset Information

Preoperative Uterine Artery Embolisation for Large Uterine Fibroids with Subsequent Uterus Preservation - Three Case Histories and Review of the Literature.

Publications

Preoperative Uterine Artery Embolisation for Large Uterine Fibroids with Subsequent Uterus Preservation - Three Case Histories and Review of the Literature.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets