home→Gastritis→ An embolization procedure to treat a benign kidney condition. Embolization of the uterine arteries as a method of therapy for uterine fibroids

An embolization procedure to treat a benign kidney condition. Embolization of the uterine arteries as a method of therapy for uterine fibroids

Embolization is a minimally invasive procedure that can complement surgery or be used alone. Surgeon through a puncture in femoral artery conducts a special catheter into the arteries that directly feed the tumor and closes them through it with special particles - emboli, which block the blood flow. In some cases, emboli are used that can release a chemotherapy drug into the tumor tissue - this intervention is called chemoembolization.

Arterial embolization for the treatment of tumors and their metastases helps to solve the following problems:

as an independent method of treatment - embolization (most often in the variant of chemoembolization) can lead to ischemia of the tumor tissue and its death. For some diseases, such as a number of liver tumors, this treatment can lead to complete remission without surgical treatment.
in combination with surgical treatment, embolization is used as an auxiliary technology - most often to reduce bleeding during surgery due to devascularization (bleeding) of the neoplasm;
in some cases, embolization performed before surgery makes it possible to perform a more radical operation due to the preliminary reduction of the tumor;
embolization may also be used to manage symptoms and complications oncological diseases- this is primarily a stop of dangerous bleeding that threatens the patient's life, in addition - relief of pain caused by a malignant neoplasm; another effect is to reduce the volume and slow down the growth of the tumor.

Embolization technology

Embolization is performed by radiologists in a specially equipped angiographic operating room. Angiography is always done before embolization. A radiopaque substance is injected into the vessels, during which an x-ray image is recorded in digital video format. This helps the doctor to assess the location and anatomy of the vessels, to determine from which arteries the tumor is supplied with blood.

Most often, embolization is performed under local anesthesia. In rare cases, general anesthesia (narcosis) has to be used. 4-5 hours before the procedure, the patient is asked to limit food intake, sometimes they are given sedatives.

In most cases, access to the desired vessel is obtained through the femoral artery, this is the most typical access for all angiographic studies and interventions, but other arteries in other places (radial at the wrist, brachial in the elbow, etc.) can also be used. The doctor treats the skin with an antiseptic and makes a small puncture, inserts a special catheter no larger than 1.5 mm into the artery and advances it until it reaches the desired vessel. Through the catheter, emboli are introduced into the vessel, which block its lumen.

Method of endovascular occlusion / embolization of tumor arteries

Today, various methods of embolization and embolizing materials are used: endovascular injection of balloons, coils, adhesives based on polyvinyl chloride, thrombogenic and sclerosing drugs, embosphers, chemoembolization, etc. The meaning of the techniques lies in the occlusion of the lumen of the vessel that feeds the organ or neoplasm, ischemia of the organ, and, consequently, the tumor.

Preoperative occlusion of the vessels of the removed tumor makes it possible to achieve a sharp decrease in the vascularization of the organ, which leads to a reduction in the volume of the tumor mass, surgical blood loss, as a result of which the surgical technique of ligation of the vessels is greatly simplified and the duration of the operation is reduced. In addition, preliminary angioagraphy allows obtaining comprehensive information about the spread of the cancer process, which makes it possible to outline a clear operation plan and avoid the wrong choice of access.

As a result, successful occlusion leads to the fact that the tumor is noticeably reduced in size, access to the vascular pedicle is facilitated, the probability of dissemination of cancer cells through the bloodstream is reduced, the removal of paravasal lymph nodes is facilitated, and due to the resulting edema, the boundaries of the tumor are clearly defined. The conducted morphological studies show that during the day a thrombus is formed in the lumen of the embolized artery, which completely fills its lumen. Subsequently, a connective tissue framework is formed.

It is also possible to use embolotherapy as a palliative method of treatment of inoperable patients with widespread metastatic lesions of the primary tumor, with tumors with germination into neighboring organs and vessels, with metastases and germination of a tumor thrombus into a vein, as well as in elderly and senile patients with concomitant somatic diseases. In such cases, embolization is more effective than radiation and chemotherapy.

Thus, the method of X-ray endovascular occlusion is an important link in the preoperative preparation of a cancer patient, especially in the presence of large hypervascular tumors. Along with this, embolization is also significant in terms of palliative treatment of inoperable patients.

Transarterial catheter embolization in the treatment of soft tissue and bone tumors in Germany

Currently, German oncologists in the treatment of malignant neoplasms of soft tissues and bones are successfully using the method of transarterial catheter embolization, the essence of which is blockage of blood vessels supplying arterial blood to a specific area, in this case, to a tumor, as a result of which its further growth is inhibited.

Due to the fact that the neoplasm is reduced due to insufficient blood supply, it can be transferred from an inoperable to an operable state and ablative radical removal of the tumor with an anatomical case with subsequent restoration of limb function by replacing the formed bone defect with an allograft or appropriate metal structures can be performed.

Thus, experts now consider transarterial catheter embolization as one of the best options the so-called "neoadjuvant", i.e. preoperative treatment, especially when it comes to tumors of the bones of the skeleton and soft tissues.

Another problem successfully solved by performing neoadjuvant embolization is the prevention of abundant, life-threatening patient blood loss during surgical intervention. In addition, thanks to the use of this minimally invasive method, it is possible to significantly reduce the severity of the pain syndrome caused by cancer, which patients literally immediately feel after the procedure is completed. As a palliative measure, catheter embolization makes it possible to significantly improve the quality of life of patients and increase their motor activity.

The procedure is carried out under angiographic video control. With the help of a selective catheter in the area of tumor localization, the vascular zone is carefully probed and the artery feeding the neoplasm is precisely determined. Then, using another, coaxial double-lumen catheter, an embolizate is fed into the blood vessel, which is a liquid substrate of particles, which, in fact, are designed to clog the capillaries diverging from this artery.

Embolization (embolotherapy) is a minimally invasive X-ray surgical endovascular procedure. The essence of such an operation lies in the selective occlusion (blockage) of the arteries with specially introduced emboli (special particles). Such surgery is performed by an endovascular surgeon or an interventional radiologist (X-ray surgeon).

When is an operation necessary?

The need for vascular occlusion may arise in the following situations:

If the patient has benign tumor with increased blood flow.
When pathologically altered arteries are found in the body.
With valvular incompetence of the spermatic vein (varicocele).
When there are zones of pathological blood flow (aneurysms).
With kidney damage.
With bleeding of the gastrointestinal tract.
With bleeding in the early postpartum period.

Vessels may also need to be embolized in a number of other cases.

How exactly does embolization take place?

Embolization intervention is minimally invasive, which means that there are no wide incisions and tissue trauma, the procedure is carried out in an outpatient setting and there is minimal risk to the patient.

Embolization actions are as follows:

the patient receives local anesthesia or anesthesia is not used (however, embolization of an aneurysm in the vessels of the brain or portal vein most often takes place under general anesthesia);
through a puncture with the help of a guide, a catheter is inserted into the patient's vessel;
special substances (emboli) or devices enter the artery in need of occlusion through a tube of minimum diameter.

At the end of the operation, a series of angiographic images are taken to check how successfully the embolization was carried out.

Products used

Specialists for embolization use a number of auxiliary structures and preparations, thanks to which it is possible to achieve rapid and reliable occlusion of blood vessels. The main embolization devices are:

Spirals. Introduced into a vein or artery, stop the blood flow in the installation area.
Plastic (gelatin) particles. Mixed with liquid, they are introduced into the vessel and clog it. During the operation, a large number of even small arterial branches can be closed.
Sclerosants. These fluids are injected into a vein or artery, where they cause blood to clot. Sclerosants are effective in areas with poor blood flow.

Artificial emboli of the following types are also in demand:

gelatin sponge ("gel foam");
cylinders;
cylinders.

Sometimes all of the listed embolizing agents and devices are used in combination. In this case, embolization is most effective.

Details of the embolotherapy procedure

Embolotherapy (blockage of the arteries) has the following features:

On average, embolization takes about thirty to forty minutes, complex procedures can last up to several hours. The time of the operation depends on many factors, one of the main ones is the professionalism of the surgeon. Experienced doctors usually carry out embolization fairly quickly.
Discomfort during embolization of any vessel is removed with special preparations, so the procedure is almost painless.
Minimally invasive intervention does not leave scars on the patient's body.
Always embolization of any vessel is carried out in a hospital. The patient will need to stay in the clinic for 1-2 days. In some cases (for example, to exclude possible or already existing complications), the period of hospitalization is increased.

Patient care after vessel embolization is provided by the specialists of the clinic in accordance with the type and degree of complexity of the minimally invasive intervention.

Within a week after the embolization operation, you can return to your normal life. The rapid recovery of patients who have undergone embolization is ensured by a combination of rest with several simple conditions. First of all, operated patients should adhere to the following rules:

Strengthen the drinking regime in the first 7 days after the operation.
Exclude water procedures- taking baths, swimming in the pool, visiting the bathhouse for 3-5 days. You can also take a shower.
Observe complete physical rest for 2-3 weeks after surgery. During this time, you should not lift weights and play sports.

The main advantages of the embolization method

Endovascular embolization is a minimally invasive procedure. It is fundamentally different from standard surgical interventions in the absence of large incisions. This reduces many of the risks associated with conventional surgery, including the risk of infection. In addition, embolization rarely requires the patient to be placed under general anesthesia.

Opportunities to eliminate tumors located in hard-to-reach places. A catheter inserted into an artery can penetrate where it is difficult to reach with a scalpel.
Decreased chance of relapse. The technique used to block the vessel allows you to quickly and reliably stop the blood flow.
No discomfort. During embolization of the vessel, the patient does not experience pain. All discomfort is eliminated with the help of special preparations.
Short recovery period. With minor interventions on the vessels, the patient can be discharged on the day of the procedure. At the same time, special care, complex treatment, regular dressings are not required.
The minimum number of contraindications and complications. The success of the operation largely depends on the professionalism of the doctor. That is why it is important to correctly approach the choice of a surgeon.
Opportunities for organ preservation. For example, embolization on the vessels of the uterus allows a woman to become a mother and bear a healthy child, even if there is a history of a large tumor.

Embolization measures, that is, the cessation of blood flow through the vessel, in some cases is the only possible medical solution to the problem in the presence of general contraindications to standard surgery.

Embolization Efficiency

For example, in the treatment of uterine fibroids, after 14 days, the process of replacing the muscle tissue of the nodes with connective tissue begins. In this case, the nodes are significantly reduced, are not able to grow again and provoke the progression of the disease. Nodule reduction takes approximately 6-8 months.

Note! The effectiveness of the method has been clinically proven. In addition, embolotherapy allows you to block a variety of vessels. Patients who have undergone an embolization procedure quickly forget about pain and discomfort, returning to their normal lives in the shortest possible time.

Benefits of visiting Professor Kapranov's clinic

At the Center for Endovascular Surgery Prof. Kapranova embolization of blood vessels is carried out according to the most modern methods and using the latest equipment. We offer patients to choose their own clinic for embolization intervention. This will take into account all the wishes of the patient:

to the conditions of stay in the hospital;
according to the qualifications of the personnel;
otherwise important factors treatment.

Today Professor S. A. Kapranov and highly qualified staff of the Center for Endovascular Surgery offer their patients:

targeted staged and partial embolization, taking into account the individual characteristics of the organism and the degree of development of the disease;
selection of drugs used depending on the size and shape of the arteries;
the use of only the most modern drugs, such as Contour (Boston Scientific), BeadBlock (Terumo, Japan) and Embosphere (Merit Medical, USA).

You can sign up for an operation to embolize uterine arteries, large fibroids, prostate vessels, and brain aneurysms. In our center professional health care appears in full.

All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

Uterine artery embolization (UAE) is a modern procedure that allows you to get rid of fibroids (benign tumors) without surgery. When it is carried out, plasticizer balls are introduced into the arteries that feed the neoplasm, which block the blood flow. As a result, the fibroids cells die. Complications after embolization are rare, during the first year after it, periodic monitoring of the state of the uterus by ultrasound is necessary.

Indications for embolization

Growing uterine fibroids;
Large neoplasms;
inaccessibility surgical methods intervention;
Abundant bleeding;
severe pain;
The desire of a woman to save an organ.

Contraindications

The procedure is not carried out when:

Inflammatory diseases;
Allergies to the drug used to block blood vessels;
pregnancy;
The presence of a malignant tumor in the body;
Renal failure (this makes it difficult to use a contrast agent).

Relative contraindications are:

Rapid growth of fibroids;
Subserous (superficial) node on a thin stalk.

Preparation for EMA

Before the procedure, the patient must undergo the following studies:

In the morning before hospitalization, you need to refuse food and water. Some experts advise not to eat the night before. Hair must be removed from the groin and thighs. If the patient has varicose veins, it is recommended that she start wearing compression stockings a week before embolization. If the patient is worried, she will be given an injection of a sedative half an hour before the procedure.

EMA move

The procedure is performed in an X-ray angiography room. Anesthesia is usually local. For large neoplasms, epidural anesthesia is prescribed. Sometimes, before UAE, curettage is performed (scraping from the entire inner surface of the uterus). The patient has a catheter placed in a vein in her arm bladder.

An incision is made in the woman's groin and a catheter is inserted into the femoral artery. Its diameter is only a few millimeters, so the scar will be almost invisible. First, a contrast agent is injected into it for better visualization of the vessels. Embolization takes place under X-ray control, the radiation dose is minimal.

The catheter reaches the blood vessels that feed the myoma. Embolization preparation balls are introduced into it. They may consist of various materials, but the products of the company Biosfere Medical are most often used. These balls are made of gelatin coated acrylic. This ensures their elasticity and non-stickiness - important qualities for such drugs. The balls block the arteries, and the blood supply to them stops. The catheter is removed. A pressure bandage is applied to the puncture.

The node itself can be “born” after some time. Sometimes you have to use medical abortion to exit the tumor from the uterus. In some cases, after shrinking the fibroids, other methods of removal become possible, which will allow you to finally get rid of it.

Video: uterine artery embolization

Recovery period

After UAE, the patient is taken to the ward. On the first day, she is actively monitored. She periodically takes painkillers. A slight malaise is a normal reaction of the body to the death of fibroids. It usually goes away within 2-3 days. In public hospitals, hospitalization lasts an average of 6 days, in private hospitals they try to discharge the patient as soon as possible.

With severe intoxication, infusion therapy is performed. An electrolyte solution is inserted into a vein, and a catheter is inserted into the bladder. This helps to remove the contrast agent from the body and reduce the symptoms of intoxication.

Important! After discharge, the patient needs to limit physical labor for a week, exclude weight lifting, visiting a bath or sauna. The first ultrasound is performed after 7 days, the second - after a month. Further tactics are based on the response of the myoma to embolization. Sexual life is recommended to begin after the end of the first menstruation.

Complications

After uterine artery embolization for uterine fibroids, patients may experience the following consequences:

EMA results

Small tumors are removed immediately, large tumors after embolization gradually decrease in size. A year later, their size is reduced by 4 times. The cells of large fibroids themselves are replaced connective tissue. Sometimes a second UAE is required.

The most common concern for patients is the possibility of pregnancy after UAE. The procedure worsens the blood supply to the uterus, which can affect the condition of the fetus. Often you have to take special drugs until childbirth. In order for the blood supply to be restored, it is worth planning a pregnancy after a year after embolization.

The formation of adhesions after the procedure may prevent conception. Although such a risk exists when using any technique to combat fibroids. In some cases, the growth of the endometrium (the inner surface of the uterus) is disrupted as a result of a violation of its blood supply. This prevents the formation of the placenta when a fertilized egg is attached. As a result, pregnancy does not occur.

EMA Alternative

Arterial embolization is fraught with a number of complications, therefore, in modern practice, it is recommended if there are contraindications for hysteroscopy with resection or laparoscopy (removal of a tumor with access from the cervix or through a puncture in the abdominal cavity). On the one hand, stopping the blood supply to fibroids looks less traumatic, but in fact it is a more rude intervention in the body with consequences that are not always predictable.

The choice of technique often depends on the personal position of the gynecologist. rather than specific indications or contraindications. Therefore, before making a decision, it is important to find a specialist who inspires confidence, who has shown his competence. Doctors agree that embolization can definitely be recommended to women in the pre- and postmenopausal period who no longer plan to conceive.

The cost of EMA, the procedure for obtaining a quota

The procedure can be carried out free of charge under the CHI policy, because. it refers to high-tech types of assistance for which targeted funds are allocated. Since the amount of these funds is limited, the appointment of EMA is carried out according to quotas - first of all, certain groups of the population go, others receive assistance according to the queue.

The number of free procedures depends on the region. To obtain a quota, you must contact a consulting gynecologist or directly to the specialists of the state medical institution where UAE is performed. The conclusion is issued by a special commission.

The price for EMA is quite high and averages 100,000 - 200,000 rubles. This cost is associated with the use of expensive high-precision equipment, as well as with the need for hospitalization.

The best medical institutions performing UAE

Uterine artery embolization has been approved for use in Russia since 1998. The corresponding order was signed by the Ministry of Health of the Russian Federation. The first procedure was carried out in 2001 by Professor S.A. Kapranov. Today he is one of the best specialists in the country dealing with this issue. He receives in Moscow at the Center for Endovascular Surgery. The cost of EMA is 140,000 - 200,000 rubles.

Also in the capital is a student of S. A. Kapranova Boris Yuryevich Bobrov. He performed his first embolization in 2002. He has a number of publications and awards for his scientific developments. B. Yu. Bobrov receives patients and performs UAE at the European clinic. The total cost of the procedure is 215,000 - 225,000 rubles.

You can undergo embolization free of charge (according to a quota) at the Volyn Clinical Hospital No. 1. It is possible to carry out the procedure for a fee, the issue price is 40,000 rubles. Carries out embolization of the uterine arteries by the head of the department, Ph.D. Shelesko Andrey Anatolievich. He periodically undergoes internships abroad, participates in seminars and scientific sessions, which allows him to keep abreast of the latest methods and developments, both Russian and Western doctors.

In the Leningrad region (in the city of Sestroretsk), one can note the state hospital No. 40, deserving a lot positive feedback from patients. Many try to do all the research and the embolization itself in this institution. Hospital workers assist in obtaining quotas, but they work only with residents of St. Petersburg and the region. The institution has modern equipment, among the specialists working there, one can note Tsivyan Boris Lvovich, the head of the gynecological department. Embolization of uterine vessels is not directly within the scope of his scientific and applied interests, but for diagnosis and advice, many patients are advised to contact him. Conducts the procedure V.S. Vlasenko is a surgeon with great experience and experience.

Another expert in uterine artery embolization works in Novosibirsk, at the Institute of Clinical and Experimental Lymphology (NIIKEL). Member Russian Society Surgeons, surgeon of the highest qualification category, Shumkov Oleg Anatolyevich personally conducts EMA. The first type of such intervention was carried out by him in 2013. NIIKEL is a state institution, therefore reception and all necessary procedures for patients admitted under the quota are free of charge. It is important that Shumkov O.A. is a specialist in the field of vascular surgery, and not exclusively a gynecologist, this increases the effectiveness of his procedures and reduces the risk of complications.

Video: embolization of uterine fibroids in the perinatal center

One of the highly effective methods of treating fibroids in the uterine cavity is uterine artery embolization (UAE). The essence of the operation is the selective occlusion of the blood vessels that feed the neoplasm with the help of a liquid intravascular preparation containing biologically inert particles of a certain size (emboli). This method differs from other methods of treatment in low invasiveness and a small number of complications. The main advantage of UAE is that this operation allows you to save the uterus for those women who are indicated for its complete removal.

Show all

Description of the method

Uterine fibroids is one of the most common gynecological diseases among women. The prevalence of this pathology, according to various estimates, ranges from 30 to 80% among patients over the age of 30 years. Traditional treatments are as follows:

hormone therapy;
removal of fibroids by abdominal surgery(the most traumatic method);
laparoscopy - removal of the formation with the help of an endoscope (through punctures in the abdominal wall);
elimination of fibroids by the hysteroscopic method by introducing a special device through the vagina and cervical canal;
hysterectomy (removal of the entire uterus).

disadvantages conservative therapy are a high probability of repeated relapses, the risk of bleeding, the formation of residual scars and adhesions in the abdominal cavity. In the presence of large fibroids, most often women are prescribed a hysterectomy, which leads to a number of side effects- hormonal failure, premature aging of the woman's body, loss of reproductive functions, metabolic disorders.

Uterine artery embolization (UAE) is a relatively "young" way to treat uterine fibroids. The method was used to stop postpartum hemorrhage in women since the 80s. XX century, but its use as a therapy for fibroids in Russia began only in the late 90s. the last century.

The essence of the method lies in the fact that a small-diameter catheter is inserted through a puncture in the femoral artery. Through it, small plastic granules 300-700 microns in size are fed into the fibroid area, clogging the blood vessels that feed the tumor. As a result, the formation naturally dies off, since there is no blood supply to the muscle cells that form fibroids. Myoma cells are replaced by connective cells within a few weeks, leaving no scars behind. With necrotization of fibroids, its “birth” can occur through the vagina. In some cases, additional removal of the tumor is required.

During the operation, constant monitoring of the condition of the arteries and blood vessels in the uterine basin is performed. Monitoring is carried out using fluoroscopy - a radiopaque substance is injected into the artery through a catheter, and pictures are taken with an angiographic apparatus. The procedure is performed under local anesthesia (anesthetic injection into the thigh).

Embolization drug

Cerebral vascular shunting - how is the operation performed and what could be the consequences?

Indications and contraindications

Indications for UAE are the same as for the treatment of fibroids by other surgical methods:

fibroids growing into the uterine cavity and intermuscular formations larger than 2 cm;
failure of conservative treatment;
symptomatic fibroids, accompanied by heavy bleeding (often anemia occurs in women against their background), pain syndrome, squeezing of neighboring organs;
infertility as a result of the presence of fibroids;
the presence of contraindications for surgical intervention under general anesthesia;
high risk of complications for other methods (cardiovascular or pulmonary insufficiency, adhesions in the abdominal cavity).

UAE avoids hysterectomy in the presence of advanced tumors. In addition to removing myomatous nodes, this technique is also used to treat other diseases - germination of the endometrium in the muscular layer of the uterus, placenta ingrowth, with the development of a fetal egg in the cervical canal.

The contraindications for the operation are the following factors:

pregnancy;
immunopathological vascular inflammation;
last phase menopause- postmenopause;
impaired patency of the arteries;
malignant neoplasms in the uterus and ovaries;
disorders in the hematopoietic system associated with poor blood clotting;
previous radiation therapy of the pelvic organs in history;
infectious and inflammatory diseases of the uterus, appendages (or past illnesses less than 3 months old);
fibroids, the growth of which is directed into the abdominal cavity, or formations on a thin stalk, since in this case there is a high risk of complications;
atypical location of the neoplasm;
liver and kidney failure;
tortuosity of the iliac vessels;
autoimmune connective tissue diseases;
allergy to the contrast agent.

Advantages and disadvantages

UAE is a minimally invasive treatment for uterine fibroids. The circulatory arrest in the vessels is carried out only locally, selectively and does not affect healthy endometrial tissues.

Embolization has several advantages over other methods:

no injury to the bladder, ureters (unlike abdominal surgery);
no need for general anesthesia;
absence of surgical injuries (after UAE there is a small incision of about 2 mm in the area of the femoral artery) and adhesions;
rapid recovery in the postoperative period (on average, hospital stay lasts 3 days);
the possibility of preserving the uterus in the presence of a large node;
a small number of complications and repeated relapses after the procedure;
preservation of reproductive function.

The operation is effective for the treatment of fibroids - a change in the blood supply in the nodes is recorded in 97% of patients. The size of the fibroids is reduced by 30-70% of the original, and the volume of the uterus is reduced by 40-70%.

The disadvantages of the method include the following:

The cost of treatment. This is due to the need to use expensive consumables - high-quality imported embolizing compounds cost from 70 thousand rubles. and higher.
The need to install special equipment for radiographic control of blood vessels. This equipment is also not cheap, so not every clinic can afford it.
The operation is performed only by an endovascular surgeon; high qualifications and experience are also required.

Preparing for the operation

Before the procedure, it is necessary to pass tests and undergo examinations by specialists:

Laboratory research:
- General, hormonal and biochemical analyzes blood.
- Coagulogram (blood clotting test).
- General urine analysis.
Gynecological examination:
- Bimanual palpation.
- Taking a smear for the presence of infectious diseases, sexually transmitted diseases.
- If cancer is suspected - scraping for a histological, cytological examination.
Ultrasound of the pelvic organs (using dopplerography, transvaginal, three-dimensional scanning).
Consultation of a radiologist, angiosurgeon.
If necessary, additional types of examinations are prescribed - magnetic resonance imaging of the pelvic organs, endometrial aspiration biopsy, and others.

Since the operation is performed on an empty stomach, a few hours before it starts, food and drink stops. In some cases, in a few days, patients are prescribed antibacterial drugs(Augmentin, Amoxicillin, Potassium clavulanate and others).

On the eve of surgery, it is necessary to shave the perineum and thighs. A few hours before the embolization, compression stockings are put on the legs of the woman, which must then be worn for several days. Immediately before the procedure, patients are given an injection of a sedative drug (Seduxen and others), a catheter is installed in the bladder.

Embolization

For embolization, the woman is placed on a special table of the angiographic apparatus, covered with sterile linen, and the puncture site in the area of the femoral artery is lubricated with an antiseptic. The surgeon injects an anesthetic injection into the thigh and punctures the artery. An introducer is inserted into the puncture - a hollow plastic tube of small diameter, which serves as a guide for surgical instruments and prevents reverse blood flow from the wound. Depending on where the fibroid is located, a puncture of the right or left femoral artery is performed, in rare cases both.

The surgeon's next steps are as follows:

Under x-ray control, a catheter is inserted into the aorta.
Angiography is performed - a radiopaque substance is injected, and the condition of the aorta, iliac vessels and the location of blood vessels is monitored on the screen of the angiographic apparatus.
A catheter is installed in the uterine artery so as to prevent the special solution from entering other blood vessels.
A solution with embolizing granules is injected through a syringe.
A control angiography is performed using a contrast agent. With successful embolization, the contours of the vessels and fibroids become fuzzy, blurry, and poorly visualized. This indicates the cessation of blood flow in them. In some cases, the introduction of an additional amount of embolizing granules is required.
If necessary, the catheter is transferred to the opposite side, and the procedure is repeated for the second aorta.
The catheter is removed, and the puncture site is pressed for 10 minutes.

Introducers

During the procedure, the patient is conscious and can observe the process on the screen of the angiographic device. X-ray control is performed continuously.

Angiogram

Depending on the complexity of the operation and the qualifications of the surgeon, the total duration of the work is 20-40 minutes. A pressure bandage is applied to the puncture site, and the patient is transported to the ward. During the day, a rest mode is required to exclude the appearance of a hematoma or thrombosis at the puncture site. When using the modern ExoSeal hemostatic device, which “welds” a puncture in the artery with a biologically inert substance, the required rest period is reduced to two hours.

Hemostatic device ExoSeal

Postoperative period

The embolization procedure itself is painless, the only discomfort in women is associated with the introduction of an anesthetic. In the postoperative period, observation in the hospital is required for 3-5 days, depending on concomitant diseases and the volume of embolized tissues. The patient's blood and body temperature are monitored, and anticoagulants are administered according to indications to prevent thrombotic complications.

Full recovery may take up to 7 days. During this period, most women experience pain, which is associated with the cessation of blood supply to the fibroids. Regular anesthesia is required (Analgin, Diphenhydramine, Ketoprofen and other drugs). Pain subside after a few hours, but can periodically intensify during a month with weight lifting, hypothermia and other provoking factors.

The natural "birth" of a necrotic node, observed in every fourth operated woman, is accompanied by pain, as in labor pains, and blood discharge. The exit of the node can occur during the first day after the operation or after a few weeks. At small size Myomas are destroyed and replaced by connective tissue. Sometimes, as a second step, removal of the fibroid by one of the traditional surgical methods is required.

As a systemic manifestation of the body on ongoing processes in the uterus, the temperature may rise to 38 degrees within 1-3 days after embolization. This is normal and does not require therapeutic measures.

A week after the operation, it is necessary to undergo an examination by a gynecologist. Over the next 12 months, ultrasound monitoring of the state of the uterus is carried out (every 3 months). The degradation of fibroids lasts an average of 6-8 months. In the case of natural rejection of large nodes in the uterine cavity, it is necessary to perform an operation to remove them. If necessary, anti-inflammatory or antibiotic therapy may be prescribed.

Your first period may come earlier or later than usual. Clots may be present in the discharge, soreness increases. Over time, the cycle of menstruation normalizes. Immediately after the operation, there is a decrease in the volume of blood menstrual flow.

Complications

In rare cases, the following phenomena are observed as complications after surgery:

Pronounced necrosis of the uterus, requiring its complete removal. This complication was observed in the past, during the clinical trials of the method, and was associated with the use of too small embolizing particles, leading to blockage of intact uterine arteries.
Premature cessation of menstruation in women at the beginning of menopause.
Thrombosis of the artery, which was subjected to puncture. This happens if the patient has increased blood clotting, atherosclerosis. This complication requires surgical intervention.
Allergic reaction due to intolerance to the radiopaque substance.
Acute renal failure.
Purulent-septic complications appear in the presence of infectious diseases in the female genital organs.
Movement of necrotic fibroids into the abdominal cavity.
Disruption of the ovaries due to unintentional embolization of their arteries.
Blockage of the pulmonary artery or its branches (extremely rare).
Temporary absence of menstruation (within 2-3 months). Usually, the menstrual cycle recovers on its own, but hormonal therapy may be required.
With a low qualification of the surgeon and rough manipulations, perforation of the pelvic arteries or embolization of non-target arteries is possible.

Most often, the only complication of the operation is the appearance of a hematoma at the puncture site. A hematoma is formed as a result of a violation of bed rest, displacement of the bandage, or due to overweight of the patient. It resolves on its own within 2 weeks and does not require treatment.

According to medical statistics, today the total number of complications does not exceed 1% of the number of operations performed.

Modern angiographic devices are characterized by a low dose of x-ray radiation. Therefore, the total dose received by the patient during the operation does not exceed that during fluorography. chest.

Is it possible to get pregnant after the operation?

Embolization allows you to save the uterus without leaving cicatricial changes. The general blood supply of the endometrium after the operation is restored within a few days. Therefore, there is no reason not to use this method of treating fibroids for women planning a pregnancy.

Extensive studies on the relationship of UAE and subsequent pregnancy have not yet been conducted. To date, the nature of the course of pregnancy after transvaginal removal of fibroids and embolization is the same. The hormonal functions of the ovaries are disturbed due to changes in blood flow, but their recovery occurs within a year. Women of childbearing age are recommended to plan pregnancy one year after the operation, and if a second stage of treatment is required for the mechanical removal of fibroid remnants, after one and a half years.

The considered method of treatment of uterine fibroids is minimally invasive. After such a procedure, reproductive and menstrual functions are preserved, which is especially important for young women. Like any other operation, UAE has specific indications and contraindications, positive sides and disadvantages.

The essence of uterine artery embolization in the treatment of uterine fibroids - why is the operation performed?

The manipulation in question in some medical sources is also called embolization.

The purpose of the procedure is blocking the flow of blood to the fibroid which favors its reduction. To do this, a microscopic particle is introduced into the uterine artery - embolus.

Often prefer emboli that are made of medical plastic. Although in practice, particles from other hypoallergenic and body-safe materials can be used.

After entering the blood vessel, the specified particle clogs its lumen, blocking the flow of blood to the myoma. At the same time, the uterus retains its viability: it is supplied by the ovarian arteries, and the muscle components of the fibroids, after a certain period of time, are replaced by connective tissue. Fibrous formations self-destruct over time.

Video: Uterine artery embolization (UAE) for uterine fibroids

UAE is used regardless of the number of pathological nodes and their parameters. Through the manipulation under consideration, it is possible to significantly reduce the size of myomatous nodes, and in some cases even get rid of them.

In extremely rare cases, additional therapeutic measures may be applied.

Intervention in the reproductive system of the patient during this procedure is minimal.

In addition, if there were difficulties with conception against the background of fibroids, after embolization of the uterine artery, a woman has every chance of becoming pregnant.

Indications and contraindications for UAE

This procedure can be assigned under the following conditions:

Large parameters of the uterus: as in women at the 9th and more weeks of pregnancy.
Abundant menstruation.
The desire of the patient to preserve the viability of the uterus.
The presence of contraindications to surgical intervention, as well as to hormonal therapy.
Regular pain.
Malfunctions of the pelvic organs and / or their squeezing.
Diagnosis of multiple / single myoma nodes, the diameter of which is not more than 8 cm. If the size of the pathological nodes is higher, the doctor may decide to conduct UAE as a preparatory manipulation before removing the fibroids by an invasive method.
Infertility caused by uterine fibroids.

This type of treatment cannot be prescribed for the following pathologies:

The period of bearing a child.
body infection.
Serious malfunctions of the liver and / or kidneys.
Allergic reactions to iodine-containing, radiopaque substances.
Inflammatory phenomena in the genital area.
Blood clotting disorders.
A significant increase in the volume of the uterus (as in women at 20 weeks of gestation), associated with a giant diameter of myomatous nodes.
Oncological diseases of the uterus or a precancerous condition.
In addition, in the case of UAE in the presence of subserous nodes on a thin stalk, there is a risk of developing peritonitis in the future. Therefore, for the treatment of such neoplasms, the doctor makes a choice in favor of other methods.

How is uterine embolization performed - video and stages of UAE operation

Preparing for the operation:

5 days before the manipulation, the patient should drink antibacterial agents.
Women with low pain threshold they are prescribed sedatives, and on the day of the UAE, they are given an additional dose of painkillers.
On the day of the operation, it is forbidden to consume any food and liquid.
You also need to shave the groin area and bring elastic bandages or compression stockings with you.
At least two hours before surgery, the patient is given an intravenous infusion of an antibiotic to prevent infection of the body. Ceftriaxone is often used.

Video: Uterine artery embolization

Algorithm for uterine artery embolization:

The result of uterine embolization - what happens to fibroids?

In the first few hours after surgery there is a death of muscle cells of fibroids, which is accompanied by pain syndrome.
The most active decrease in pathological nodes is observed in the first six months after the manipulation in question.
Often in a year the uterus acquires normal parameters, and the myomatous nodes are reduced by 4 times.

The speed and nature of the regressive phenomena will be determined by the parameters and location of the nodes. If these nodes are located in the region of the posterior wall of the uterus, their size will decrease slowly. With close localization to the uterine cavity, the nodes on the leg are able to come off and migrate outward.

To control the process of transformation of fibroids, one should undergo ultrasound procedure pelvic organs 3 months, six months and a year after embolization.

In the future, it is necessary to be examined by a gynecologist every 6 months in order to exclude relapse.

Video: Uterine fibroid artery embolization

The first 8 hours after the end of the procedure, the patient needs rest. The bandaged leg must be held in horizontal position, and an ice pack is applied to the place of manipulation for the first couple of hours. This helps to reduce swelling and relieve pain.

The patient should wear compression stockings on her legs for the first few days.

In the absence of exacerbations, after 1-3 days it is allowed to go home. Before discharge from the hospital, the doctor performs an ultrasound examination.

After embolization of the uterine arteries, the following phenomena may disturb:

Slight increase in body temperature.
Prostration.
Pain in the lower abdomen. In order to eliminate them, painkillers are prescribed.
Nausea.
Vomit. This postembolization syndrome is stopped with the help of antiemetic therapy.
Bloody discharge from the vagina. Menstrual cycle fully improved within 3 months after UAE.

Such phenomena can take place from several days to several weeks.

Within a month after this procedure, patients are prohibited from:

Visit saunas, as well as stay in direct sunlight for a long time.
Undergo any physiotherapy in the area of \u200b\u200bthe uterus.
Study active species sports.
Take baths.
Have vaginal sex.

Side effects with this procedure are extremely rare - but they do occur.

These include:

The appearance of a hematoma in the area of piercing the artery. No therapeutic measures are required to eliminate it - it resolves on its own.
Migration of the node into the peritoneum or uterus.
Embolization of nearby organs as a result of emboli entering the blood vessels that supply them. A similar condition can develop against the background of individual anatomical features.
Inflammatory processes in the uterus, accumulation of purulent masses in its cavity. These negative conditions can occur with extensive death of myometrial cells. In this case, the uterus is removed urgently.
Drying out of the vagina, lack of sexual desire. Occurs when the cervico-vaginal vessels are blocked.

Cost of uterine embolization in Russian clinics

The cost of the manipulation under consideration will be determined by several factors:

The status of a medical institution. The amount for such an operation in public clinics is often lower than in private ones.
The experience and authority of the surgeon.
The number of tests that the patient needs to undergo. In the presence of concomitant diseases, the examination will be more extended, and therefore financial resources more will be spent.
A variety of medications that must be drunk or punctured before embolization of the uterine artery.
Volume of stain for angiography.
postoperative activities. This includes the number of days spent in the hospital; list of instrumental and laboratory examinations; number of consultations with a doctor.