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Uterine Artery Embolization

Uterine artery embolization (UAE) is a radiological examination has recently presented as an alternative treatment of symptomatic uterine fibroids. The American College of Obstetrics and Gynecology warnings about its potential for infections and other serious complications that require emergency surgery.

Uterine artery embolization (UAE) is a radiological examination has recently presented as an alternative treatment of symptomatic uterine fibroids.  The American College of Obstetrics and Gynecology warnings about its potential for infections and other serious complications that require emergency surgery.

Radiologist inserts a catheter, usually through the right femoral artery in both uterine arteries that supply blood to the uterus, and in turn, fibroids.  A solution containing small particles is injected into the uterine arteries.  The particles block the branches of uterine arteries (blood) and thus reducing blood flow to the uterus and fibroids.  The procedure is usually performed under local anesthesia and sedation without general anesthesia.

Six months after the UAE average size of the fibroids is reduced by 40-60%.  Reportedly, United Arab Emirates reduces uterine bleeding and symptoms related to the size of the uterus, such as frequent urination and pelvic pain.  But studies have reported a reduction in bleeding patients using subjective assessment of bleeding without objective measures of royal blood discharged.  In addition, very large fibroids (uterine size larger than 24 weeks of gestation), myomectomy better relief of symptoms in bulk and abdominal protrusion average 40% reduction in uterine volume achieved by the UAE together.  The alleged benefits of UAE versus myomectomy include avoidance of abdominal surgery, abdominal scars, and general anesthesia, and reduced risk for significant blood loss, shorter hospital stay and faster recovery are additional benefits if the UAE vs myomectomy.

Recent studies have revealed that 22% of patients undergoing hysterectomy or myomectomy UAE necessary.  patients required additional hysteroscopy.  The reasons for hysterectomy was still bleeding, pain and related symptoms in bulk.  Hysteroscopy was necessary because of vaginal secretions and most patients eventually need a hysterectomy.

Magnetic resonance imaging (MRI) during pre-UAE evaluation can help to avoid a potentially ineffective UAE up to 20% of patients who are referred by the United Arab Emirates.  MRI can detect a pedunculated submukøst fibroid (see below), which is best treated by hysteroscopic resection, fibroids are not viable (with poor blood supply), which is unlikely to reduce the UAE Arab Emirates, and significant adenomyosis results UAE is poor (see below  ).  When the UAE performed because of pelvic pain in women with endometriosis, the UAE is unlikely to solve the pain is often caused by endometriosis.

Complications of UAE

A.  complications of surgery.

* Infection at the site of catheter insertion in the groin.
* Haematoma (bleeding) in the groin secondary to puncture.
* The reactions of contrast (and allergic and other adverse reactions) because of the contrast imaging.
* Nickname – abnormal collection of blood contact with the puncture of the artery in the groin, which may require surgery for repair.
* Arteriovenous fistula – an abnormal communication between artery and vein in the groin secondary to trauma of catheterization in the groin which may require surgery for repair.

2.  Unintentional embolization of other abdominal arteries causing reduced blood flow to organs supplied by ship.

Examples include: reduced blood supply to the buttocks with necrosis of muscle pain and skin, decreased blood supply to the bladder of damage to the bladder wall, blood flow and minimize damage to the ovaries and / or lips.

Three.  Post-embolization pain.

UAE is usually moderate to very painful, requiring management in hospital with intravenous medication pain for at least several hours.  It is not unusual for a short hospital stay is necessary for pain and nausea.

4.  The post-embolization syndrome.

This condition involves pain, ischemic (due to lack of oxygen to tissues), nausea and / or vomiting, malaise, mild fever and elevated white blood cell count.  This syndrome occurs in varying degrees in all patients, but over 50% of patients is an important clinical problem.  The post-embolization syndrome begins with one to five days after UAE and usually lasts 24 to 48 hours, sometimes longer.  In 10-15% of patients, this issue requires readmission to hospital.  This condition must be distinguished from the most severe complication of sepsis.

5.  Sepsis

This is a serious bacterial infection that spreads from the uterus into the bloodstream.  If not recognized early and treated effectively with life-threatening.  Sepsis is suspected when fever persists beyond typical syndrome from 24 to 48 hours after embolization.  Sepsis is most common in the United Arab Emirates takes place in a uterus too large (over 20 cm in height, when a fibroid is larger than 9 cm in diameter, or when there is a submukøst fibroid large (fibroid protruding into the uterine cavity). In  Also, the presence of chronic pelvic infection or sexually transmitted active UAE avoided. There have been reports of deaths from sepsis or pulmonary embolism.

6.  Premature ovarian failure.

Because the blood supply to the ovaries are part of the uterine arteries, reduces established in the UAE always blood supply to the ovaries, and the results of a reduction function of the ovary.  This is demonstrated by the almost universal increase in FSH (follicle stimulating hormone) after UAE.  FSH levels are an indirect measure of ovarian reserve.  The number of ovarian follicles in the ovaries decreases regularly from birth to menopause.  When the ovaries are depleted follicles to malfunction and premature menopause.  In fact, 2.4 to 15% of patients in the UAE in early menopause, especially among women over 40 years.  In patients under 40 who have UAE, there is also evidence of accelerated depletion of ovarian follicles that can lead to early menopause.

7.  Reduced fertility after UAE.

So far, there have been anecdotal reports of successful pregnancies after UAE.  In addition, small studies have reported a dramatic increase in abortions and premature deliveries after UAE.  The reduced blood flow to the uterus after UAE is likely to result in reduced endometrial receptivity and infertility and delayed intrauterine growth.  The decline in ovarian reserve (FSH manifested high) indicating a decline in ovarian follicle reserve leading to premature menopause in severe cases.  Recent studies have shown that the UAE causes of cancer of the ovary, as evidenced by more pronounced than the decrease of the normal age at hormone anti-Müller.  hormone levels of anti-Müller is relatively new and reliable quantitative marker of ovarian reserve.  This score reflects the decline in fertility.  This should be important for women wishing to preserve fertility.  Furthermore, compared with myomectomy, UAE significantly increases the risk of complications in future pregnancies, such as miscarriage, premature birth, and presentation and poor hemorrhrage after birth.  These facts have led most authorities to consider the desire of women to preserve their fertility potential disadvantages as a indication of the UAE.  The American College of Obstetricians and Gynaecologists WATER-cons considered in women wishing to preserve fertility.

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