How effective is the nonsurgical management of uterine myomas? (original) (raw)

management (embolization, focused ultrasound surgery) of uterine myomas, shows promising results regarding safety (EMMY trial), quality of life (REST trial) and long-term outcome (FIBROID Registry) in carefully selected patients [1-3,5,8-14,18-23]. To begin with, uterine artery embolization (UAE) is a nonsurgical procedure that uses transcutaneous unilateral common femoral artery approach with the Seldinger technique. Both uterine arteries are selectively catheterized with a catheter or micro-catheter [11,22-24]. The tip of the catheter or microcatheter is placed beyond the origin of the cervicovaginal branch, in order to exclude it from embolization [22,24,25]. Subsequently and under angiographic control, an embolic agent (trisacryl gelatin microspheres, spherical polyvinyl alcohol) is injected and the UAE is completed [7,11,22-27]. The main role of UAE, is the essential reduction in uterine blood flow at the arteriolar level [22,23,26]. In this way, UAE causes irreversible ischemia and leads to necrosis and shrinkage of uterine myomas [11,22,23,26,28]. Τhe main target group for UAE, are patients who want to preserve their uterus and avoid any surgical procedure. Likewise, patients who reject blood transfusion for health concerns or religious reasons, are candidates for UAE [2,3,5,7,18,22-24,27,29,30]. Additionally, patients with relevant co-morbidities (obesity, coronary artery disease) and increased risk for perioperative complications, are also eligible for UAE [2,3,5,22,23,26]. The total number and the topography of uterine myomas play a crucial role, in patient selection process [2,3,5,22,26]. The main absolute contraindications for UAE, are: pregnancy, active pelvic inflammatory disease, genital cancer, previous pelvic radiation and impaired immune status [2,