One of the most common causes of infertility is uterine fibroids. The disease is diagnosed in 30% of women whose age has not reached the mark of 45 years. A few years ago, the only consequence of pathology was the complete removal of the reproductive organs. Relatively recently, a procedure has appeared that allows you to save all organs and at the same time cure fibroids. In medical practice, it is known as uterine artery embolization (UAE).
What is a fibroid?
Myoma is a benign formation, the size of which can vary from a few millimeters to 10-15 centimeters. Despite the absence of a malignant nature, it negatively affects the functioning of the female reproductive system. Visually, the formation has an irregular shape, and consists mainly of smooth muscle tissue.
Myoma is manifested by profuse bleeding from the vagina, heaviness in the lower abdomen. In an advanced stage, pathology can lead to infertility andproblems with urination. Therefore, it requires close attention from gynecologists. In the last few years, the treatment of fibroids has been carried out using minimally invasive techniques. One of them is uterine artery embolization.
Features of the technique
This technique for our country is a kind of novelty. It is noteworthy that in Western medicine it has been successfully used since the 70s. Initially, embolization was used to stop bleeding in the uterine cavity during surgery. Over time, it has become a complete procedure for the treatment of various pathologies, in particular fibroids.
The growth of a benign formation in the uterine cavity depends on its blood supply. If the arteries fully nourish the fibroid, it will grow at a rapid pace. The EMA method involves the introduction through a puncture of the artery on the thigh into the vessels of particles of medical plastic - polyvinyl alcohol. As a result, the blood flow, and with it the nutrition of the neoplasm, stops. The embolizing agent used is absolutely safe, does not cause allergies and is biologically inert.
This procedure does not affect the vessels of a he althy endometrium. After the cessation of blood supply, the muscle elements gradually die. Over the next few weeks, they are finally replaced by connective tissue elements. As a result, there is a decrease in size or complete disappearance of fibroids.
Indications for the procedure
To get a positive treatment result withWith the help of uterine artery embolization, the procedure is recommended for a medium-sized neoplasm, when there are no indications for surgical intervention. An important condition for choosing a therapy option is the woman's desire to preserve the reproductive organ. EMA is indicated in the following cases:
- multiple fibroids with a knot about 6 cm;
- single knot no larger than 4 cm;
- the impossibility of removing the neoplasm through hysteroscopy;
- presence of contraindications to surgery.
The choice of treatment method can be considered a compromise between the desire of a woman and the possibilities of modern medicine.
Uterine artery embolization for fibroids is not recommended for the following pathologies:
- any acute infectious disease;
- liver or kidney failure;
- intolerance to iodinated contrast agents;
- inflammatory processes in the genitals;
- cancerous/precancerous conditions;
- Fluid growth too fast.
EMA is strictly contraindicated during pregnancy. Decreased blood flow to the myometrium can cause a miscarriage. In addition, during the operation, a contrast agent and X-ray radiation are used, which is extremely dangerous for the fetus developing in the womb.
Preparatory procedures
Obtaining a positive result from treatment during uterine artery embolization largely depends on the preparatory stage. So that the postoperative periodproceeded without complications, it is necessary to undergo a comprehensive examination. It consists of the following activities:
- blood biochemistry and general analysis;
- transvaginal ultrasound;
- ECG;
- urinalysis;
- vaginal swab for microflora;
- CT.
In the clinic, uterine artery embolization is usually carried out on the day of hospitalization. For 8 hours it is recommended to stop eating. During UAE, an artery is punctured in the upper thigh. Therefore, it is recommended to shave this area in advance. All patients are given a sedative injection before the intervention. Both legs are covered with elastic bandages. After the intervention, they must be worn for another week.
Steps of operation
Uterine artery embolization for fibroids is performed in a specially equipped operating room. It should be equipped with an angiographic device to help the doctor monitor the progress of the procedure inside the blood vessels. Embolization is exclusively within the competence of endovascular surgeons. Other specialists cannot perform this kind of intervention.
The patient is placed on the angiography table. A catheter is inserted into the vein to administer medication. Before starting the procedure, the specialist treats the right thigh and abdomen with an antiseptic, then covers this area with sterile sheets. After that, local anesthesia is performed for a painless puncture. Through a small incision in the skin of the upper thigh, the doctor inserts a thin catheter. He is under constant control.x-ray television passes to the uterine arteries. At the next stage, the specialist injects the smallest particles of the embolizing substance through the catheter, which block the vessels that feed the myoma.
The duration of the entire procedure is from 10 minutes to 2.5 hours. This variability is due to the qualifications of the specialist and the degree of neglect of the pathology. Arterial puncture is practically not accompanied by painful discomfort. However, do not be afraid of the appearance of a feeling of warmth, a slight burning sensation in the lower abdomen. Such symptoms are due to the action of the contrast agent, which the doctor uses to visualize the vessels.
After the uterine artery embolization operation, the doctor removes the catheter and presses the puncture area with his fingers for another 15-20 minutes to avoid the appearance of a hematoma. Then a bandage is applied to the right thigh. From this point on, the next 12 hours you can not bend your leg. The bandage is removed after about 3 hours if there are no complications.
Post-op recovery
After embolization, the woman is wheeled to the ward. Ice will be put on the puncture area, perhaps a dropper will be installed for several hours. After about 1-2 hours, the uterus may begin to whine a lot. This symptom is a consequence of ischemia of neoplasm cells. Painful sensations most often last several hours and are well stopped by analgesics.
In some patients in the postoperative period, the temperature rises to subfebrile marks. Others are weak andmalaise, chills. The listed conditions are a variant of the norm. They do not pose a threat to a woman's he alth.
Approximately on the third day the woman is discharged home. For the next week, it is recommended to limit physical activity, visits to saunas and baths. Intimacy will also have to be abandoned. It is better to provide yourself with bed rest during the rehabilitation period. Full recovery occurs only after 14 days. An examination by a gynecologist to evaluate the results is recommended 10 days after the intervention.
EMA results
According to reviews, uterine artery embolization gives the first results very quickly. The most active decrease in fibroids is observed in the first 6 months. Further, this process continues, but at a slower speed. As a rule, by the year the size of the neoplasm is reduced by 4 times, and the uterus returns to its previous shape.
Sometimes myomatous nodes, located close to the cavity of the reproductive organ, are separated from its wall and come out on their own. This is a favorable phenomenon that contributes to a quick recovery after the procedure. In 99% of women, the female cycle is normalized, the volume of monthly bleeding decreases.
Possible Complications
EMA is a fairly safe procedure. Due to the lack of a large number of specialists who own the technique, many gynecologists are hostile to uterine artery embolization. The consequences of a negative nature, the risk of resumption of growth of the neoplasm - these pathologies scare doctors, not verycompetent in this matter. In fact, the risk of complications after UAE is reduced to zero. Below are just the most common problems:
- Formation of a hematoma at the site of catheter insertion. However, the bruise resolves quickly enough. After 3-4 days, there is no trace of him.
- Irregular female cycle. In fact, the disorder is considered standard, since the genital organ is affected during the procedure.
- Infection. In this case, antibiotics are prescribed. The course of treatment is no more than 2 weeks.
It is worth noting that the listed complications occur in one patient out of 800. Therefore, agreeing to the operation, you should not be afraid of it.
Where is uterine artery embolization done?
EMA is a complex procedure that requires not only special equipment but also qualified specialists in the clinic. Recently, an increasing number of women are choosing this method of treatment. Therefore, the number of medical institutions with this profile is growing in our country.
In state medical institutions, EMA is carried out free of charge under the compulsory medical insurance policy. However, initially you will have to get a quota, since this technique belongs to the category of high-tech types of medical care. To this end, a woman needs to visit a gynecologist and get a referral to a center for the restoration of reproductive he alth.
In Moscow, uterine artery embolization on a paid basis will cost 100-200 thousand rubles. fin althe cost of the procedure depends on several factors: the qualifications of the doctor, the prestige of the institution, the availability of the necessary equipment, the need for a preliminary examination.
EMA and pregnancy
Uterine artery embolization for uterine fibroids does not deprive a woman of her ability to have children. For example, after a hysterectomy, there is no question of childbearing. In addition, women who have undergone myomectomy are often diagnosed with infertility against the background of adhesions in the pelvis. Therefore, UAE is chosen if pregnancy is planned in the future.
It is recommended to plan conception one year after the intervention. During this time, the process of fibroid tissue death should be completed, and the uterine circulation has time to recover. If this rule is neglected, the pregnancy may end in a miscarriage.
After 12 months, a complete gynecological examination is recommended. It is possible to carry a pregnancy after UAE, but the risk of termination is still quite high at any time.
Opinions of women and doctors
What do doctors say about uterine artery embolization for uterine fibroids? Reviews of specialized specialists in most cases are met with a positive color. Experts note the following advantages of the procedure:
- minimum surgery resulting in low complication rates;
- no need to use general anesthesia;
- high efficiency;
- short rehabilitation period, no need to stay in hospital;
- preserving fertility.
This procedure allows not only to remove the neoplasm in less than one hour, but also to enable a woman to try on the role of a mother in the future. In addition, a relatively safe technique can be used to treat fibroids of various forms.
Patients are more categorical in the issue of uterine artery embolization in myoma. Patient reviews are often met with a negative connotation. Most of them are associated with the high cost of the procedure. Quite often you have to wait for a quota for a free operation for several months. Sometimes such a delay can cost a lady reproductive he alth. Therefore, many are forced to turn to paid services. Note that the price of the procedure varies between 100-200 thousand rubles.
Also, women say that it is not always possible to completely eliminate fibroids. In some cases, UAE can only slow down the growth of the neoplasm and reduce the nodes. Another negative point is considered severe pain in the postoperative period. It is possible to stop unpleasant symptoms only through strong analgesics. Many are concerned about the restoration of the female cycle after the procedure. According to reviews, normal discharge appears only after 4 months or later. Severe bleeding is possible at the time of the “birth” of the node. If the patient is close to menopause and is planning surgery, it may occur immediately after embolization.
