Pelvic embolization

Oman D, White R, Pollack J, Tal M (2003) Pelvic embolization for intractable post partum hemorrhage long term follow-up and implication for fertility. Obstet Gynecol 102 904-10... 

Pourrat XJ, Fourquet F, Guerif F, Viratelle N, Herbreteau D, Marret H. Medico-economic approach to the management of uterine myomas a 6- month cost-effectiveness study of pelvic embolization versus vaginal hysterectomy (2003) Fur J Obstet Gynecol Reprod Biol 111 59-64... 

Uterine leiomyomas, or fibroids, are the most common type of solid tumors in adult women, clinically apparent in at least 25% of those of reproductive age [24-26]. Abnormal menstrual bleeding, pelvic pain, and infertility are the most commonly experienced symptoms in these women. Uterine fibroids are the leading cause of hysterectomies performed in the United States, accounting for over 200,000 of these procedures each year. Other invasive surgical interventions for the treatment of uterine fibroids include myomectomy and uterine artery embolization. Leiomyomas are estrogen-responsive tumors that can be treated... 

Venous stasis resulting from prolonged bed rest, cardiac failure, or pelvic, abdominal, or hip surgery may precipitate thrombus formation in the deep veins of the leg or calf and may lead to fatal pulmonary embolism. Heparin may also be used prophylactically following surgery. 

Paradoxical embolism can occur in a patent foramen ovale with a right to left shunt. Embolic material arising from the pelvic or leg veins or elsewhere in the venous system may bypass the pulmonary system and reach the cerebral arteries (Braun et al. 2004). 

Patients with a high risk for clotting require thromboprophylaxis. Some risk factors for venous thromboembolism include age greater than 40 years, prolonged immobility, history of prior venous thromboembolism (DVT, pulmonary embolism [PE]), cancer, major surgery (abdominal, pelvic, or lower extremity), fracture (pelvis, hip, or leg), CHF, Ml, stroke, obesity, and high-dose estrogen use. 

Agolini, S.F., Shah, K., Jaffe, J., Newcomb, J., Rhodes, M., Reed, J.F. 1997. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma 43, 395-399. 

Velmahos GC, Toutouzas KG, Vassiliu P, et al. (2002) A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma 53303-308... 

Maleux G, Stockx L, Wihns G, Marchal G (2000) Ovarian vein embolization for the treatment of pelvic congestion syndrome long-term technical and clinical results. J Vase Intervent Radiol 11 859-864... 

Ramirez Jl, Velmahos GC, Best CR, Chan LS, Demetriades D (2004) Male sexual function after bilateral internal iliac artery embolization for pelvic fracture. J Trauma 56 734-739... 

Coils are available in a wide variety of sizes from 2 mm to 15 mm in size and are made from either stainless steel or platinum and may have Dacron fibers placed at right angles to the long axis of the coil to increase the surface area and thereby to increase the speed and permanence of thrombosis. In practice, most coils utilized in microcatheters are platinum and those in 4- to 5-F catheters, stainless steel. It should be noted that all coils are permanent devices and should be utilized when the desired occlusion is permanent. Coils should not be used in combination with particulate embolization for the treatment of tumors, as they will occlude the access for further treatment. Coils may, on the other hand, be utilized with Gelfoam embolization in the treatment of pelvic bleedings allowing the hemorrhage to be halted quickly and permanently. 

Pisco JM, Martins JM, Correia MG (1989) Internal iliac artery embolization to control hemorrhage from pelvic neoplasms. Radiology 172 337-339... 

Lang EK (1981) Transcatheter embolization of pelvic vessels for control of intractable hemorrhage. Radiology 140 331-339... 

Schneider GT (1984) Pelvic arteriography in obstetrics and gynecology arteriovenous fistulas and embolization. South Med J 77 1494-1497... 

Jander HP, Russinovich NAE (1980) Transcatheter Gelfoam embolization in abdominal, retroperitoneal, and pelvic hemorrhage. Radiology 136 337-344... 

Sieber P (1994) Bladder necrosis secondary to pelvic artery embolization case report and literature review. J Urol 151 422... 

Vedantham S, Goodwin SC, McLucas B, et al. (1997) Uterine artery embolization an underused method of controlling pelvic hemorrhage. Am J Ohstet Gynecol 176 938-948... 

Choo YC, Cho KJ (1980) Pelvic abscess complicating embolic therapy for control of bleeding cervical carcinoma and simultaneous radiation therapy. Obstet Gynecol 55[Suppl] 76S-78S... 

Collins CD, Jackson JE (1995) Pelvic arterial embolization following hysterectomy and bilateral internal iliac artery ligation for intractable primary post partum hemorrhage, gin Radiol 50 710-713... 

Fertility and pregnancy outcome following pelvic arterial embolization for severe post-partum haemorrhage. A cohort study. Hum Reprod 18 849-852... 

Crampy pelvic pain commonly occurs within the first 24 h of UAE and is usually controlled with a patient controlled analgesia (PCA) pump using morphine or another narcotic. Patients should be placed on an anti-inflammatory prior to the embolization and while in the hospital. Toradol intravenously prior to the embolization and during the hospitalization appears to be very effective. It is reasonable to develop a set of standard orders that the patient will receive to cover the most common eventualities. 

Fig. 10.4.1a,b. A 39-year-old woman with fibroid-related menorrhagia and pelvic pressure, a Pre-embolization sagittal T2-weighted MRI demonstrates a multifibroid uterus, b Post-embolization sagittal T2-weighted MRI obtained 6 months after embolization demonstrates a marked volume reduction of 55%. The patient s condition has also greatly improved... 

One of the potentially more serious complications of uterine artery embolization is the occurrence of an infection after embolization. Several studies have reported cases of pelvic sepsis after uterine artery embolization [6, 78, 79]. However, when several of the largest published series are considered in aggre-... 

Bilateral occlusion of the uterine arteries during uterine artery embolization clearly increases the risk of global uterine ischemia and subsequent infarction in patients undergoing this procedure [10]. In fact, it is not unreasonable to assume that uterine ischemia occurs in all patients undergoing this procedure and that this ischemia likely contributes to the post-procedure pain that is commonly experienced by most patients after embolization. However, rarely this transient ischemia worsens to the point where the uterus becomes globally infarcted. There have been reports of diffuse uterine ischemia and necrosis after uterine artery embolization [84, 85]. The typical presentation of uterine ischemia consists of long-standing pelvic pain which persists for several weeks associated... 

---