Since the surgeon considered surgery alone without prior embolization to be too risky, all patients with a uterus myomatosus that could be detected at navel height or higher were offered the option of combined treatment using UAE and surgery. The patients were hospitalized and initially received bilateral embolization of the uterine artery UAE after probing with a microcatheter.
The type of particle used was up to the examining physician: Three patients expressed the desire that resorbable gelatin sponge particles should be used instead of non-degradable embolization particles for their embolization. They felt that the safety, effectiveness, and temporary character of this embolizate were proven and they would not accept nonabsorbable particles [ 11 ].
The radiation exposure during the procedure was determined based on the fluoroscopy time and the dose area product using Dose Watch GE Health Care, Chalfont St. All patients received adequate opioid-based pain medication [ 12 ].
After 24 to 48 hours post-embolization, the patients underwent a longitudinal incision with the goal of preserving the uterus [ Fig. Between June and August , all 21 patients were surveyed using a mailed questionnaire we developed regarding post-surgical progression, complications, scar length, satisfaction and improvement in symptoms.
Those articles providing at least an English or German abstract were considered. The removed fibroids were primarily situated intramurally; some exhibited a broad submucosal component. The median fluoroscopy time was The mean dose area product was Primary uterus preservation was achieved in all 21 fibroid patients.
All interventions were performed by the same surgeon MD. One patient underwent hysterectomy 14 days postoperatively in another hospital due to heavy vaginal bleeding that could not be otherwise controlled.
None of the 21 planned myoma enucleations required the administration of erythrocyte concentrates EC immediately after UAE. One patient received a postoperative transfusion of two ECs after hemoglobin declined from Of the 21 patients, 11 responded to the questionnaire sent to them. Ten of 11 patients indicated a subjective improvement in symptoms, and 9 would recommend the combined intervention of embolization and surgery. The mean sick leave reported by the women was 31 days min. Ten of 11 patients were satisfied with the postoperative result of the incision. The first planned removal of a fibroid was probably performed by Kimball in By the end of the 19th century, this approach established itself as a standard gynecological-surgical method [ 13 ].
Today uterine artery embolization is a world-wide established procedure for treating fibroids as an alternative to surgery. However, the combination of both procedures is still subject to discussion.
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