- 期刊
- OpenAccess
Angiographic Features of Uterine Artery Relevant to Uterine Artery Embolization for Uterine Fibroid and Adenomyosis
子宮動脈栓塞時之子宮動脈特徵
並列摘要
To analyze uterine arteriographic features of patients with uterine myomas and adenomyosis that might facilitate transcatheter uterine artery embolization (UAE). Seventy-eight uterine arteriograms of 44 consecutive patients (mean age 38.8 year-old ± 6.8) (32 with uterine myoma, mean age of 38.6 ± 6.7 and 12 with uterine adenomyosis, mean age of 39.2 ± 7.1) treated with transcatheter uterine artery embolization were retrospectively reviewed by 2 radiologists in consensus. Ten uterine arteriograms were excluded because of poor diagnostic quality or incomplete visualization of uterine artery origins. The indication for UAE was symptomatic patients who refused or were not suitable for traditional surgery. UAE was performed via bilateral common femoral approach using two angiographic catheters. Simultaneous angiographic studies of both internal iliac arteries in AP, bilateral 25-degree oblique projections and selective uterine artery studies only in AP projections were obtained by injecting contrast medium into two angiographic catheters linked by a “Y” luer-lock connector. The arteriographic features thought relevant to UAE were the incidence of a typical “U” course, the radiographic projection that best demonstrated the origin of uterine arteries from internal iliac artery, and the average size of the uterine artery measured at the descending segment. Our analysis showed that the origin of uterine artery was best visualized in contralateral 25-degree oblique projection in 67% (52 of 78) arteriograms, ipsilateral anterior oblique in 17 % (13 of 78) and straight A-P in 17%. The classic “U” configuration occurred in 100% of uterine arteries. The average size of the uterine artery at the descending segment measured 2.9 mm for uterine myomas and 2.4 mm for uterine adenomyosis. Selective catheterization of the uterine artery was successful in 87% of cases using a 4.2-French Shepard hook angiographic catheter (equivalent to 1.4 mm in outer diameter). Transient uterine artery spasm occurred in 13% of uterine arteries (10 of 78) with all but one could be relieved by intra-arterial injection of 25 μg of nitroglycerin. Microcatheter was used in 17% (6 of 44) of patients, but all during our early experience. Uterine artery embolization was technically successful in 100% of our patients and no miscannulation of arteries other than the uterine arteries was noted. Our study revealed that a proper knowledge on the typical uterine arteriographic features facilitated proper and safe performance of transcatheter uterine artery embolization.