Interventional radiology in management of gynecological disorders
- Ducksoo Kim, MD
Ducksoo Kim, MD
- Professor of Radiology
- Boston University School of Medicine
- Stephen D Baer, MD
Stephen D Baer, MD
- Section Editors
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Percutaneous transcatheter interventional procedures are increasingly being employed in the management of obstetric and gynecological disorders [1-3]. This technology offers a minimally invasive and potentially cost effective alternative for management of several common obstetrical and gynecological problems. It is most commonly used for managing fibroids and postpartum hemorrhage. However, these procedures have not been evaluated against other treatment modalities in large randomized trials.
TRANSCATHETER EMBOLIZATION PROCEDURE
Percutaneous transcatheter embolization (PTE) procedures are typically performed under fluoroscopic guidance in the radiology suite. Intravenous conscious sedation and narcotics, local anesthetics, nonopioid analgesics, or nonsteroidal antiinflammatory agents are administered for management of anxiety and pain. Many radiologists give intravenous broad spectrum antibiotic prophylaxis to reduce the risk of infection, although randomized controlled clinical trials have never validated the use of antibiotics in this setting for reduction of postoperative morbidity . Antibiotic prophylaxis for gynecologic procedures is shown in the table (table 1) and discussed separately. (See "Overview of preoperative evaluation and preparation for gynecologic surgery", section on 'Surgical site infection prevention'.)
The Seldinger technique is used to introduce a catheter into the femoral artery (figure 1A) . The catheter is then advanced into the hypogastric or uterine artery, depending upon the indication for the procedure. After subselective catheterization, diagnostic angiography of the artery is obtained to confirm proper position, look for extravasation suggestive of acute bleeding, and evaluate for abnormal vascularity associated with chronic bleeding. Transcatheter embolization of one or more arteries can then be performed (figure 1A-B).
Tiny particles or microspheres (polyvinyl alcohol particles, 500 to 700 and/or 700 to 900 microns in size or tris-acryl gelatin microspheres, 500 to 700 and/or 700 to 900 microns in size) (picture 1) are used to embolize hypervascular lesions, such as leiomyomas or adenomyosis, associated with multiple large feeding vessels. However, particulate embolic agents should be avoided when iliac or uterine or ovarian arteriovenous malformation/fistula are targeted because inadvertent pulmonary embolization may result. Gelfoam, coils, and glue are more effective than microspheres for embolization of large arteries associated with acute obstetrical hemorrhage, arteriovenous malformation, or some fistula.
Uterine fibroid embolization (UFE) is based upon the hypothesis that reduction of myometrial arterial blood flow will result in infarction of fibroids and control symptoms . It is an option for symptomatic premenopausal women who wish to retain their uterus, escape side effects associated with prolonged medical therapy, and avoid surgical treatment (eg, hysterectomy, myomectomy) [7,8]. UFE is rarely indicated in postmenopausal women . Other relative contraindications to UFE include current use of GnRH analogs, submucosal fibroids, and, possibly, plans for future pregnancy. The procedure is discussed in detail separately. (See "Uterine leiomyomas (fibroids): Treatment with uterine artery embolization".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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