Myoma processes in the uterus occur mainly in patients over 35. Although the tumor is benign, it can significantly affect the reproductive functions of patients, up to infertility, therefore such formations necessarily need treatment.
One of the newest methods of myomatous therapy is EMA, i.e. embolization of uterine arteries.
What is uterine artery embolization in uterine myomas?
Arterial embolization is a low-traumatic microsurgical technique, which consists in the artificial blockage of blood vessels that supply nutrition to myomoneous tumors.
As a result of such a procedure, the nodes "shrink".
Such a technique will gradually gain popularity in Russian clinics. This is greatly facilitated by the increased incidence of myomoneous lesions in modern women.
There are a lot of speculations around arterial embolization: someone refers it to the most effective antimiom therapy, and someone, on the contrary, believes that such treatment is not as effective as it is said.
Meanwhile, this method of therapy is notable for its contraindications and indications, it has certain disadvantages and advantages. In addition, arterial embolization is not suitable for every patient with myomatous nodes.
Indications and contraindications
In general, uterine embolization is indicated in the presence of such factors:
- If the miomnoe formation does not exceed the size of a 12-week pregnancy;
- When a patient plans to become pregnant in the future, therefore, she needs to keep the reproductive organs;
- If there are contraindications to surgical interventions, anesthesia, etc.;
- If after removal of the node myoma continued its growth;
- The presence of adenomyosis or endometriosis;
- Postpartum hemorrhages;
- If there is a rapid growth in education, etc.
Like any medical procedure, uterine embolization has characteristic contraindications like:
- Excessively large sizes of myomas nodes, when the uterus exceeds the size of a 25-week pregnancy;
- Availability of a set of different-sized nodes;
- Inflammatory vaginal pathologies;
- Kidney failure;
- Pregnancy period;
- Violation of myomonic blood flow;
- Presence of concomitant oncology of genital organs, etc.
Usually, if there are contraindications, arterial occlusion is performed, which is performed with the help of laparoscopic technique.
Sometimes occlusion is temporary, then the blood supply is blocked for a certain period of time with the help of artificially created blood clots, gelatin preparations and other devices and substances. However, temporary occlusion is rarely used.
Pros and Cons of
Like other medical procedures, uterine embolization in the treatment of myomatous formations has its disadvantages and advantages.
Among the main shortcomings can be allocated high costs of equipment necessary for the procedure.
Therefore, not all clinics specialists can provide such a service.
Yes, and specialist surgeons of the endovascular profile, capable of carrying out such an operation, today is still too little among Russian doctors.
The disadvantage of EMA in uterine myoma is considered to be the X-ray irradiation used during the procedure, although the devices are characterized by low radiation indices. In fact, during embolization, the patient receives an X-ray dose similar to a fluorographic study.
The inability to take biomaterial for biopsy diagnostics is also considered as a minus of EMA.However, angiographic diagnosis completely eliminates this drawback.
Among the advantages of EMA specialists distinguish:
- Safety and minimally invasive technique, which requires no anesthesia;
- Minimal risks of recurrence of myomas nodes, whereas in myomectomy such risks reach 35-40%;
- Instant results, the patient's condition begins to improve soon after the procedure;
- Short-term stay in the clinic, which is not more than a day;
- The risk of complications is minimal if the surgeon performing the surgery is highly qualified. Risks are twenty times lower than in any surgical operations;
- Uterine embolization is an organ-preserving intervention, thanks to which it is possible to preserve the uterus and reproductive functions.
If the fibroid is the size of a 4-5 week pregnancy, then the EMA is not performed, because the vessels are too small to accurately get into them by a catheter.
Before performing a procedure for uterine embolization, an accurate diagnosis must be made. When confirming the myomatous process, specialists determine the nature and localization, tumor parameters and other features of the pathology, after which the appropriate therapy is selected.
The patient undergoes a preliminary examination, gives laboratory tests, undergoes instrumental diagnostics, which allows doctors to determine the exact state of the patient.
To conduct an EMA, the patient needs to go to the clinic. The procedure is usually carried out on the same day, so before going to treatment it is necessary to refuse breakfast. With the femoral and inguinal area, you must first shave your hair.
Approximately one week before embolization and within a week after the procedure, the patient is recommended to wear compression linen to support the veins of the legs.
How the operation is performed
The patient is placed on the angiographic table lying on her back. At the injection site, the catheter is anesthetized and treated with an anesthetic.
The catheter is then inserted, advanced to the left artery of the uterus, in which the occlusion of the vessels of myomoneous formation is performed. Similar actions are carried out in relation to the right artery of the uterus.
Embolization takes place without anesthesia and takes about half an hour. In exceptional cases, embolization takes longer, which is determined by individual clinical features. For blockage of the vessel during embolization, preparations such as spherical hydroparticles "Bid Block" or non-spherical PVA particles are used.
An obvious advantage of uterine embolization is bloodlessness, however, procedures and disadvantages are available in the form of complications such as:
- Formation of a hematoma at the site of insertion of the catheter;
- Hyperthermal symptomatology;
- Symptoms of nausea and vomiting;
- Soreness in the uterine region;
- Penetration of infection in the uterus;
- Cardiovascular malformations;
- Pulmonary arterial thromboembolism;
- Necrotic processes on the walls of adjacent tissues in the event of adhesions.
Similar complications in arterial embolization are considered rare, because the procedure of EMA is becoming increasingly popular in gynecology. Many patients after embolization decreased menstrual flow, some early came to menopause.
The effect of embolization on the reproduction of a woman has not been fully studied.
Although pregnancy usually occurs safely in most cases, they often end in miscarriages or any complications in the fetus, so these patients are necessarily under the scrutiny of specialists when planning and carrying a child.
Postoperative recovery of
From the angiographic operating table, the patient on a gurney is moved to the ward. After some time, the patient begins to feel a pronounced soreness, for the relief of which anesthetic therapy is indicated.
Often soreness in the uterus is supplemented with nausea, severe weakness, minor hyperthermia, etc. Such a state can last for a day or two, sometimes longer. When the condition stabilizes, the patient is discharged. Another week she is forbidden to lift and drag weights, engage in physical labor.
Almost all patients experience stable cycle normalization, the compression of neighboring structures is eliminated. About planning pregnancy you can think about when menstruation normalizes. If there is an infection of myomatous formation, then antibiotic therapy is prescribed.
Immediately after the introduction of the drug, the node gradually begins to degenerate, the myomatous fibers are replaced by connective tissue, about a year after the EMA the uterus acquires standard dimensions.
After a year and a half or two, the patient is able to give birth to the baby on her own.
So, the procedure of embolization can save a significant number of uterine pathologies of different etiology, while hormone therapy and other methods can not cope with them.
The main and indisputable advantage achieved as a result of uterine embolization is low invasiveness, no need for anesthesia and high therapeutic efficacy.
Where and by whom is the
produced Unfortunately, the technique of arterial embolization is not available today in all clinics.
It requires expensive specialized equipment, which not every medical institution can afford, so embolization is usually carried out in specialized regional medical centers.
Undoubtedly, there are much more opportunities for such treatment in the Russian capital.
I was terribly afraid of surgery, so I saved two years for embolization, good, myoma did not grow and did not bother. After the procedure( about a year later) she got pregnant, she gave birth safely. There was no trace of myoma.
Useless waste of money. At me after an EMA such terrible znanenie has begun, that then deleted all laparotomically, and together with a uterus. I admit that the doctors are to blame, however, the result of the EMA can not be corrected.
The average cost of embolization of uterine arteries in uterine fibroids in Russian clinics is about 44 000-99 000₽.
Pros and Myths of Embolization of Uterine Arteries in Hysteromyoma: