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17 - Reasons and prevention of embolization failure
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- By Bruce McLucas, UCLA Medical Center, Los Angeles, CA, USA
- Edited by Togas Tulandi, McGill University, Montréal
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- Book:
- Uterine Fibroids
- Published online:
- 10 November 2010
- Print publication:
- 23 October 2003, pp 125-132
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- Chapter
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Summary
This chapter will examine the failures of uterine artery embolization (UAE) in our center. The overall results of UAE and our standard to define failures have been discussed in Chapter 14. In short, these standards are minimal or no shrinkage, no relief of symptoms, and hysterectomy. Here, we will also discuss technical failures and failures to achieve fertility.
Excluded patients
In our practice, we perform endoscopic evaluations of the uterus, as well as taking into account the possible contraindication or factors that may lead to failure. We exclude patients prior to embolization using the scheme outlined in the Chapter 14. Prevention of failure starts with selecting the correct procedure. We have excluded six patients with gynecologic malignancy. Twelve patients who presented with acute uterine hemorrhage and were embolized prior to endoscopic evaluation on an emergency basis were evaluated with endoscopy after embolization. One of these patients was discovered to have a malignancy and was referred for a definitive therapy. We also excluded 22 patients with atypical endometrial hyperplasia and eight patients with acute pelvic infection.
Definition of failure
Minimal shrinkage
Shrinkage alone is not a sole criterion of success. Later in this chapter, we will analyze patients who presented with uterine shrinkage of 50%, but they could not be categorized into the success group.
14 - Results of uterine artery embolization
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- By Bruce McLucas, UCLA Medical Center, Los Angles, CA, USA
- Edited by Togas Tulandi, McGill University, Montréal
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- Book:
- Uterine Fibroids
- Published online:
- 10 November 2010
- Print publication:
- 23 October 2003, pp 101-110
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- Chapter
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Summary
The first embolization for symptomatic myomata in Los Angeles was performed on November 24, 1994, at the University of California. The patients' bleeding following myomectomy was diminished using gelfoam delivered via arterial catheter. This began a collaboration between interventional radiologists and gynecologists for the treatment of symptomatic myomata using uterine artery embolization (UAE). During this study period, the technique of UAE has undergone some changes mainly due to the increasing experience of the interventional radiologists. Changes include the amount of devascularization, size of particles, and the introduction of new embolic materials.
Since the beginning of the procedure, our group has expanded to several interventional radiologists, and three types of facilities have been used to conduct the procedure. For the purpose of this review, we have evaluated whether the outcome of UAE is operator dependent or affected by the type and amount of particles used. We now have a five-year follow-up of women who have undergone the procedure. We have evaluated the long-term effects of embolization and the need for subsequent surgery. This chapter concentrates on analysis of results. We will briefly report our failures, and then reexamine them in Chapter 17.
Pre-embolization evaluation
Pre- and postmenopausal women are eligible if they have symptomatic uterine fibroid. We inform the potential patients about the lack of long-term follow up, and alternative treatment modalities.