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Obstetrics and Gynegology2020№9
Uterine artery embolization for uterine...

Uterine artery embolization for uterine leiomyoma: the state of the problem

DOI
https://dx.doi.org/10.18565/aig.2020.9.18-26

Kalmykov E.L., Rakhimov F.R., Umarzoda S.G., Baratov A.K.

1) Vascular and Endovascular Surgery Clinic, Helios University Hospital, Wuppertal, Germany; 2) Surgical Diseases Department No. 2, Avicenna Tajik State Medical University, Dushanbe, Tajikistan; 3) Department of Oncology and Radiation Diagnosis, Avicenna Tajik State Medical University, Dushanbe, Tajikistan; 4) Department of Endovascular Surgery, Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Tajikistan
The presented review of the literature is devoted to the diagnosis and treatment of uterine leiomyoma (UL). It considers the impact of UL on reproductive function and the place of uterine artery embolization (UAE) in its treatment. The review describes the technical features of UAE, different vascular approaches to its implementation, and the use of various embolization agents. Analysis of a number of randomized trials could provide information on the comparative efficiency of UAE, on the one hand, and hysterectomy and myomectomy, on the other, in treating UL. Particular emphasis is laid to the description of postembolization syndrome, the prevention and treatment of which are still an insufficiently developed aspect. Various specific and nonspecific UAE complications that can occur both during the procedure and in the immediate and late postprocedural periods are analyzed. Attention is focused on an important point, such as the impact of UAE on subsequent pregnancies and childbirth. Whether transient amenorrhea and ovarian dysfunction may develop after UAE is considered. In addition, information is given on morphological studies of the uterus after UAE.
Conclusion. Thus, the analysis of the literature has shown that, despite contradictory data at times, UAE can be considered as an alternative for the surgical treatment of UL, showing rather good results in the early and late postoperative periods.

Keywords

uterine leiomyoma
uterine artery embolization
postembolization syndrome
hysterectomy
myomectomy
Full text (in Russian)

References

  1. Stewart E.A. Uterine fibroids. Lancet. 2001; 357(9252): 293-8. https://dx. doi.org/10.1016/S0140-6736(00)03622-9.
  2. Baird D.D., Dunson D.B., Hill M.C., Cousins D., Schectman J.M. Highcumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am. J. Obstet. Gynecol. 2003; 188(1): 100-7. https://dx. doi.org/10.1067/mob.2003.99.
  3. Kjerulff K.H., Langenberg P., Seidman J.D., Stolley P.D., Guzinski G.M. Uterine leiomyomas: racial differences in severity, symptoms and age at diagnosis. J. Reprod. Med. 1996; 41(7): 483-90.
  4. Marshall L.M., Spiegelman D., Goldman M.B., Manson J.E., Colditz G.A., Barbieri R.L. et al. A prospective study of reproductive factors and oral contraceptive use in relation to the risk of uterine leiomyomata. Fertil. Steril. 1998; 70: 432-9. https://dx. doi.org/10.1016/s0015-0282(98)00208-8.
  5. Borah B.J., Nicholson W.K., Bradley L., Stewart E.A. The impact of uterine leiomyomas: a national survey of affected women. Am. J. Obstet. Gynecol. 2013; 209(4): 319. e1e319.e20. https://dx. doi.org/10.1016/j.ajog.2013.07.017.
  6. Pritts E.A. Fibroids and infertility: a systematic review of the evidence. Obstet. Gynecol. Surv. 2001; 56(8): 483-91. https://dx.doi.org/ 10.1097/00006254-200108000-00022.
  7. Rashidi B., Montazeri A., Ramezanzadeh F., Shariat M., Abedinia N., Ashrafi M. Health-related quality of life in infertile couples receiving IVF or ICSI treatment. BMC Health Serv. Res. 2008; 19(8): 186. https://dx.doi.org/ 10.1186/1472-6963-8-186.
  8. Каробекова Д.А., Рахматулоева Ш.Х., Сафаров Ч.Б. Хирургическое лечение больных с миомой матки. Вестник Авиценны. 2014; 2: 79-83. [Karobekova D.A., Rakhmatuloeva Sh.Kh., Safarov Ch.B. Surgical treatment of patients with leiomyoma. Vestnik Avitsenny/Avicenna Bulletin. 2014;2:79-83. (in Russian)]. https://elibrary.ru/item.asp?id=21987882.
  9. Расулова Г.Т., Турсунова Д.Т., Вахобова Ш.Х., Одинаева Ф.К. Клинический случай ведения беременности и родов при миоме матки. Вестник Авиценны. 2019; 21(2): 343-6. [Rasulova G.T., Tursunova D.T., Vakhobova Sh.Kh., Odinaeva F.K. Clinical case of pregnancy and birth in uterine fibroids. Vestnik Avitsenny/Avicenna Bulletin. 2019;21(2):343-6. (in Russian)]. http://dx.doi.org/10.25005/2074-0581-2019-21-2-343-346.
  10. Klatsky P.C., Tran N.D., Caughey A.B., Fujimoto V.Y. Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am. J. Obstet. Gynecol. 2008; 198(4): 357-66. https://dx.doi.org/ 10.1016/j.ajog.2007.12.039.
  11. Spies J.B. Current role of uterine artery embolization in the management of uterine fibroids. Clin. Obstet. Gynecol. 2016; 59(1): 93-102. https://dx. doi.org/10.1097/GRF.0000000000000162.
  12. Гришин И.И., Хачатрян А.С., Ибрагимова Д.М., Доброхотова Ю.Э. Лечение субмукозных миоматозных узлов методом эмболизации маточных артерий. Акушерство и гинекология. 2014; 10: 48-51. [Grishin II, Khachatryan A.S., Ibragimova D.M., Dobrokhotova Yu.E. Treatment of submucous myomatous nodes with uterine artery embolization. Akusherstvo i ginekologiya/ Obstetrics and Gynecology. 2014;10:48-51.(in Russian)].
  13. Nakhaei M., Mojtahedi A., Faintuch S., Sarwar A., Brook O.R. Transradial and transfemoral uterine fibroid embolization comparative study: technical and clinical outcomes. J. Vasc. Interv. Radiol. 2020; 31(1): 123-9. https://dx.doi.org/10.1016/j.jvir.2019.08.016.
  14. Гаязов Д.Р., Терегулов А.Ю., Терегулова Л.Е. Сравнительный анализ трансрадиального и трансфеморального сосудистых доступов при проведении эмболизации маточных артерий. Практическая медицина. 2017; 2: 119-23. [Gayazov D.R., Teregulov A.Yu., Teregulova L.E. Comparative analysis of transradial and transfemoral vascular approaches in uterine artery embolization. Prakticheskaya meditsina/Practical medicine. 2017; 2:119-123. (in Russian)]. https://elibrary.ru/item.asp?id=29044750.
  15. Das R., Champaneria R., Daniels J.P., Belli A.M. Comparison of embolic agents used in uterine artery embolisation: a systematic review and meta-analysis. Cardiovasc. Intervent. Radiol. 2014; 37(5): 1179-90. https://dx. doi.org/10.1007/s00270-013-0790-0.
  16. Бреусенко В.Г., Краснова И.А., Капранов С.А., Аксенова В.Б., Бобров Б.Ю., Шевченко Н.А. Спорные вопросы эмболизации маточных артерий при миоме матки. Вопросы гинекологии, акушерства и перинатологии. 2005; 4(4): 44-8. [Breusenko V.G., Krasnova I.A., Kapranov S.A., Aksenova V.B., Bobrov B.Yu., Shevchenko N.A. Controversial issues of uterine artery embolization in uterine myoma. Voprosy ginekologii, akusherstva i perinatologii/Questions of gynecology, obstetrics and Perinatology. 2005;4(4):44-8.(in Russian)].
  17. Carlson K.J., Miller B.A., Fowler F.J.Jr. The Maine Women's Health Study: I. Outcomes of hysterectomy. Obstet. Gynecol. 1994; 83(4): 556-65. https://dx.doi.org/10.1097/00006250-199404000-00012.
  18. American College of Obstetricians and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet. Gynecol. 2008; 112(2, Pt 1): 387-400. https://dx.doi.org/ 10.1097/AOG.0b013e318183fbab.
  19. Dariushnia S.R., Nikolic B., Stokes L.S., Spies J.B. Society of Interventional Radiology Standards of Practice Committee. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J. Vasc. Interv. Radiol. 2014; 25(11): 1737-47. https://dx.doi.org/ 10.1016/j.jvir.2014.08.029.
  20. Bucek R.A., Puchner S, Lammer J. Mid- and long-term quality-of-life assessment in patients undergoing uterine fibroid embolization. Am. J. Roentgenol. 2006; 186(3): 877e82. https://dx.doi.org/10.2214/AJR.04.1767.
  21. Pron G., Bennett J., Common A., Wall J., Asch M., Sniderman K. Ontario Uterine Fibroid Embolization Collaboration Group. The Ontario uterine fibroid embolization trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertil. Steril. 2003; 79(1): 120-7. https://dx.doi.org/10.1016/s0015-0282(02)04538-7.
  22. Hehenkamp W.J., Volkers N.A., Birnie E., Reekers J.A., Ankum W.M. Pain and return to daily activities after uterine artery embolization and hysterectomy in the treatment of symptomatic uterine fibroids: results from the randomized EMMY trial. Cardiovasc. Intervent. Radiol. 2006; 29(2): 179-87. https://dx.doi.org/10.1007/s00270-005-0195-9.
  23. Hehenkamp W.J., Volkers N.A., Donderwinkel P.F., de Blok S., Birnie E., Ankum W.M. et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri- and postprocedural results from a randomized controlled trial. Am. J. Obstet. Gynecol. 2005; 193: 1618-29. https://dx.doi.org/10.1016/j.ajog.2005.05.017.
  24. Goodwin S.C., Bradley L.D., Lipman J.C., Stewart E.A., Nosher J.L., Sterling K.M. et al. UAE versus Myomectomy Study Group. Uterine artery embolization versus myomectomy: a multicenter comparative study. Fertil. Steril. 2006; 85(1): 14-21. https://dx.doi.org/10.1016/j.fertnstert.2005.05.074.
  25. Gupta J.K., Sinha A., Lumsden M.A., Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst. Rev. 2012; (5): CD005073. https://dx.doi.org/10.1002/14651858.CD005073.pub3.
  26. Spies J.B., Bruno J., Czeyda-Pommersheim F., Magee S.T., Ascher S.A., Jha R.C. Long-term outcome of uterine artery embolization of leiomyomata. Obstet. Gynecol. 2005; 106(5, Pt 1): 933-9. https://dx.doi.org/ 10.1097/01.AOG.0000182582.64088.84.
  27. Spies J.B. Current evidence on uterine embolization for fibroids. Semin. Intervent. Radiol. 2013; 30(4): 340-6. https://dx.doi.org/10.1055/s-0033-1359727.
  28. Spencer E.B., Stratil P., Mizones H. Clinical and periprocedural pain management for uterine artery embolization. Semin. Intervent. Radiol. 2013; 30(4): 354-63. https://dx.doi.org/10.1055/s-0033-1359729.
  29. Хачатрян А.С., Гришин И.И., Капранов С.А., Доброхотова Ю.Э. Ретроспективный анализ осложнений при эмболизации маточных артерий. Акушерство и гинекология. 2012; 8: 15-9. [Khachatryan A.S., Grishin A.I., Kapranov S.A., Dobrokhotova Yu.E. A retrospective analysis of complications of uterine artery embolization. Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2012;8:15-9. (in Russian)].
  30. Савельева Г.М., Краснова И.А., Бреусенко В.Г., Капранов С.А., Аксенова В.Б., Арютин Д.Г., Краснова А.С., Есипова И.А. Эффективность и профилактика возможных осложнений ЭМА при лечении миомы. Акушерство и гинекология. 2014; 11: 74-9. [Savelyeva G.M., Krasnova I.A., Breusenko V.G., Kapranov S.A., Aksenova V.B., Aryutin D.G., Krasnova A.S., Esipova I.A. The effectiveness and prevention of possible complications of UAE in the treatment of fibroids. Akusherstvo i ginekologiya/ Obstetrics and Gynecology. 2014;11:74-9. (in Russian)].
  31. Рахимов Ф.Р., Баратов А.К., Расулова Г.Т. Стойкий спазм маточной артерии в ходе её эмболизации по поводу миомы матки. Вестник Авиценны. 2019; 21(4): 683-8. [Rakhimov F.R., Baratov A.K., Rasulova G.T. Persistent uterine artery vasospasm during uterine fibroids embolization for leiomyoma. Vestnik Avitsenny/Avicenna Bulletin. 2019;21(4):683-8. (in Russian)]. Doi: 10.25005/2074-0581-2019-21-4-683-688.
  32. Toor S.S., Jaberi A., Macdonald D.B., McInnes M.D.F., Schweitzer M.E., Rasuli P. Complication rates and effectiveness of uterine artery embolization in the treatment of symptomatic leiomyomas: a systematic review and metaanalysis. Am. J. Roentgenol. 2012; 199(5): 1153-63. https://dx.doi.org/ 10.2214/AJR.11.8362.
  33. Martin J., Bhanot K., Athreya S. Complications and reinterventions in uterine artery embolization for symptomatic uterine fibroids: a literature review and meta analysis. Cardiovasc. Intervent. Radiol. 2013; 36: 395-402. https://dx. doi.org/10.1007/s00270-012-0505-y.
  34. Ohmaru-Nakanishi T., Kuramoto K., Maehara M., Takeuchi R., Oishi H., Ueoka Y. Complications and reproductive outcome after uterine artery embolization for retained products of conception. J. Obstet. Gynaecol. Res. 2019; 45(10): 2007-14. https://dx.doi.org/10.1111/jog.14067.
  35. Доброхотова Ю.Э., Кнышева И.Г., Джобава Э.М., Гришин И.И., Данелян С.Ж. Эмболизация маточных артерий и беременность: дискуссионные вопросы. Акушерство и гинекология. 2013; 5: 42-7. [Dobrokhotova Yu.E., Knysheva I.G., Jobava E.M., Grishin A.I., Danelyan S.J. Uterine artery embolization and pregnancy: debatable issues. Akusherstvo i ginekologiya/ Obstetrics and Gynecology. 2013;5:42-47. (in Russian)].
  36. Carpenter T.T., Walker W.J. Pregnancy following uterine artery embolization for symptomatic fibroids: a series of 26 completed pregnancies. BJOG. 2005; 112(3): 321-5. https://dx.doi.org/10.1111/j.1471-0528.2004.00414.x.
  37. Pisco J.M., Duarte M., Bilhim T., Branco J., Cirurgião F., Forjaz M. et al. Spontaneous pregnancy with a live birth after conventional and partial uterine fibroid embolization. Radiology. 2017; 285(1): 302-10. https://dx. doi.org/10.1148/radiol.2017161495.
  38. Pron G., Mocarski E., Bennett J., Vilos G., Common A., Vanderburgh L. Ontario UFE Collaborative Group. Pregnancy after uterine artery embolization for leiomyomata: the Ontario multicenter trial. Obstet. Gynecol. 2005; 105(1): 67-76. https://dx.doi.org/10.1097/01.AOG.0000149156.07061.1f.
  39. Goldberg J., Pereira L., Berghella V., Diamond J., Daraï E., Seinera P. et al. Pregnancy outcomes after treatment for fibromyomata: uterine artery embolization versus laparoscopic myomectomy. Am. J. Obstet. Gynecol. 2004; 191(1): 18-21. https://dx.doi.org/10.1016/j.ajog.2004.01.046.
  40. Mara M., Maskova J., Fucikova Z., Kuzel D., Belsan T., Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc. Intervent. Radiol. 2008; 31(1): 73-85. https://dx.doi.org/10.1007/s00270-007-9195-2.
  41. Homer H., Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil. Steril. 2010; 94(1): 324-30. https://dx.doi.org/10.1016/j.fertnstert.2009.02.069.
  42. El Shamy T., Amer S.A.K., Mohamed A.A., James C., Jayaprakasan K. The impact of uterine artery embolization on ovarian reserve: A systematic review and meta-analysis. Acta Obstet. Gynecol. Scand. 2020; 99(1): 16-23. https://dx.doi.org/10.1111/aogs.13698.
  43. Mara M., Horak P., Kubinova K., Dundr P., Belsan T., Kuzel D.J. Hysteroscopy after uterine fibroid embolization: evaluation of intrauterine findings in 127 patients. Obstet. Gynaecol. Res. 2012; 38(5): 823-31. https://dx. doi.org/10.1111/j.1447-0756.2011.01782.x.
  44. Титова Г.П., Коков Л.С., Дамиров М.М., Олейникова О.Н., Белозеров Г.Е. Морфологические изменения тканей матки после эмболизации маточных артерий у больных с лейомиомой. Журнал им. Н.В. Склифосовского Неотложная медицинская помощь. 2017; 6(4): 331-5. https://dx.doi.org/10.23934/2223-9022-2017-6-4-331-335. [Titova G.P., Kokov L.S., Damirov M.M., Oleynikova O.N., Belozerov G.E. Morphological changes of uterine tissues after embolization of uterine arteries in patients with leiomyoma. Zhurnal im. N.V. Sklifosovskogo Neotlozhnaya medicinskaya pomosh/ N.V. Sklifosovsky Journal Emergency medical care. 2017;6(4):331-5. (in Russian)].
  45. Абишев Б.Х., Алиакпаров М.Т., Тажибаев Д.М., Питель Е.С. Отдаленные результаты эмболизации маточных артерий при миоме матки по данным ультразвукового исследования и магнитно-резонансной томографии. РМЖ. Мать и дитя. 2014; 22(14): 1020-2. [Abishev B.Kh., Aliakparov M.T., Tazhibaev D.M., Pitel E.S. Long-term results of uterine artery embolization in uterine fibroids according to ultrasound and magnetic resonance imaging. RMZh. Mat’ i ditya/Russian Medical Journal. Mother and child. 2014;22(14):1020-1022. (in Russian)].
  46. Lacayo E.A., Khera S.S., Spies J.B. Impact of patient and procedure-related factors on radiation exposure from uterine artery embolization. Cardiovasc. Intervent. Radiol. 2020; 43(1): 120-6. https://dx.doi.org/ 10.1007/s00270-019-02321-7.
  47. Nocum D.J., Robinson J., Liang E., Thompson N., Reed W. The factors contributing to the total radiation exposure of patients during uterine artery embolization. J. Med. Radiat. Sci. 2019; 66(3): 200-11. https://dx.doi.org/ 10.1002/jmrs.347.
  48. Katsumori T., Yoshikawa T., Miura H. Insufficient leiomyoma infarction in uterine artery embolization: relationship with tumor location. J. Vasc. Interv. Radiol. 2019; 30(5): 668-75. e1. https://dx.doi.org/10.1016/j.jvir.2018.11.041.
  49. Баратов А.К., Калмыков Е.Л. Эмболизация маточных артерий при миоме матки. Вестник Авиценны. 2007; 2: 16-23. [Baratov A.K., Kalmykov E.L. Uterine artery embolization for uterine myoma. Vestnik Avitsenny/ Avicenna Bulletin. 2007;2:16-23. (in Russian)].
  50. Kröncke T., David M. Uterine artery embolization (UAE) for fibroid treatment – Results of the 7th Radiological Gynecological Expert Meeting. Geburtsh. Frauenheilkd. 2019; 79(7): 688-92. https://dx.doi.org/10.1055/a-0893-4807.

Received 19.03.2020

Accepted 17.06.2020

About the Authors

Egan L. Kalmykov, MD, PhD, Vascular Surgeon, Vascular and Endovascular Surgery Clinic, Helios University Hospital, Wuppertal. E-mail: egan0428@mail.ru.
ORCID: 0000-0001-6784-2243, Researcher ID: K-9827-2013, SCOPUS ID: 36172240400, Author ID: 843609, SPIN-code: 8623-8897.
Farshed R. Rakhimov, MD, Postgraduate Student, Department of Surgical Diseases No. 2, Avicenna Tajik State Medical University, Dushanbe.
E-mail: frrahimov@mail.ru. ORCID: 0000-0001-7418-1383.
Saida G. Umarzoda, MD, PhD, Associate Professor, Department of Oncology and Radiation Diagnostics, Avicenna Tajik State Medical University, Dushanbe.
E-mail: saida.umarova@bk.ru. ORCID:0000-0002-3739-4854, Researcher ID: AAE-7337-2020.
Alisher K. Baratov, MD, PhD, Associate Professor, Endovascular Surgeon, Department of Endovascular Surgery, Republican Scientific Center for Cardiovascular Surgery, Dushanbe. E-mail: alishbar@rambler.ru. ORCID: 0000-0002-8072-5751, Researcher ID: AAE-6818-2019, Scopus ID: 8249648700, Author ID: 268956, SPIN-code: 6576-1680.

For citation: Kalmykov E.L., Rakhimov F.R., Umarzoda S.G., Baratov A.K. Uterine artery embolization for uterine leiomyoma: the state of the problem.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 9: 18-26 (in Russian).
https://dx.doi.org/10.18565/aig.2020.9.18-26

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