An Academic Tertiary Referral Centerís Experience with a Vascular Surgery-Based Uterine Artery Embolization Program
Naiem Nassiri, MD RPVI1, Adrian Balica, MD2, Nolan C. Cirillo-Penn, BA2, Dustin Tyler Crystal, BS2, Gloria Bachmann, MD MS2.
1Yale University, New Haven, CT, USA, 2Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Objective(s): Despite growing endovascular experience within the vascular surgery community, some catheter-based interventions - such as uterine artery embolization (UAE) - remain outside the clinical scope of most vascular surgeons owing mostly to established referral patterns and limited awareness among referring colleagues. We present our experience with a vascular surgery-based, multidisciplinary UAE program at an academic tertiary referral center.
Methods: In a collaborative effort between vascular surgery and gynecology, a Pelvic Vascular Disease Program has been established to provide palliative, prophylactic, and therapeutic embolizations including but not limited to UAE. For UAE, inclusion criteria are women over the age 18 with symptomatic uterine fibroids demonstrated on magnetic resonance imaging and negative endometrial biopsy. Exclusion criteria are desire for future pregnancy and previous embolizations. Technique and perioperative protocol is presented. Data including symptom resolution, fibroid size, need for further procedures, and complications were prospectively gathered and retrospectively reviewed.
Results: Over an 18-month period, 30 patients with symptomatic fibroids were referred for potential UAE. Five patients were excluded due to uncertainty about future pregnancy wishes (4) and prior embolization (1). Twenty-four bilateral and 2 unilateral UAEs were performed (Mean age 46.3 years [range 28-53 years]). Presenting symptoms were pelvic and abdominal pain (25), cramps (25), menorrhagia (25), dysmenorrhea (25), urinary frequency (12), and dyspareunia (5). Technical success, defined as successful microcatheterization of uterine arteries and delivery of a particulate liquid embolic agent (embospheres, 500-700 microns), was 100%. There were no perioperative or delayed complications. Twenty-one patients (87.5%) reported complete symptomatic relief without further intervention at the time of last follow-up. Three patients (12.5%) reported pain relief but had persistent vaginal bleeding requiring hysterectomy 12 months after UAE. All patients underwent a 23-hour observation post-operatively for pain control. Mean follow-up was 7.4 months (1-23 months) and included pelvic ultrasound assessment of fibroid size at 1, 3, and 6 months post-UAE and annually thereafter. One patient was lost to follow-up. Fibroid shrinkage was noted in all patients. Given the willingness and capability to work-up, admit, treat, and follow-up patients, vascular surgery was deemed the preferred service for UAE by the referring gynecologists.EndFragment
Conclusions: Within the framework of a collaborative, multidisciplinary program, vascular surgery can play a growingly more prominent role in providing safe and effective UAE.
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