Unexpected outcome of uterine artery embolization (Clinical observation)
Yu.E. Dobrokhotova1, I.I. Grishin1, D.M. Ibragimova1, V.A. Roshchina1, O.I. Causewa2, T.N. Sotnikova1, O.V. Borisova2, D.A. Pastukhova1
1 Pirogov Russian National Research Medical University, Moscow
2 Pirogov City Clinical Hospital No.1, Moscow
Uterine Artery Embolisation (UAE) is one of the new directions of non-invasive treatment of uterine fibroid, allowing to save the reproductive organ. This operation is an effective alternative to surgical methods of treatment. However, UAE can lead to adverse events. This article discusses an unexpected outcome of UAE. Despite the failures, the incidence of serious adverse events and complications after UAE is significantly lower than after traditional surgical procedures. Patient warning of this potential risk, timely detection of uterus blood supply features using ultrasound and angiography, an adaptation of these methods and techniques of UAE, rational management of the postembolization period, early recognition of infectious complications and necessary control in long-term periods are crucial for almost complete elimination of the risk of complications after UAE.
This article describes a clinical case of a fistulous passage occurrence between the myomatous nodule and the uterine cavity in a patient who had previously undergone UAE of the arterial branches of the perifibroid plexus. According to our clinical observation, it can be concluded that excision of the fistulous passages, with subsequent repeated reconstructive surgery, allows preserving the organ and the reproductive function of patients.
Key words: uterine artery embolization, uterine fibroid, UAE, uterine artery embolization outcomes, uterine artery embolization complications, fistulous passage.
For citation: Dobrokhotova Yu.E., Grishin I.I., Ibragimova D.M. et al. Unexpected outcome of uterine artery embolization (Clinical observation) // RMJ. Medical Review. 2018. № 10. P. 26–28.
References
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11. Vural B., Ozkan S., Ciftci E. et al. Spontaneous vaginal expulsion of an infected necrotic cervical fibroid through a cervical fistula after uterine artery embolization: a case report // J. Reprod. Ved. 2007. Vol. 52(6). P. 536–566. https://www.ncbi.nlm.nih.gov/pubmed.
12. Price N., Golding S., Slack R.A. et al. Delayed presentation of vesicouterine fistula 12 months after uterine artery embolization for uterine fibroids // J. Obstet. Gynaecol. 2007. Vol. 27(2). P. 205–207. DOI: 10.1080/01443610601157273.
13. Donnez O., Jadoul P., Squifflet J. et al. Unusual complication after uterine artery embolization and laparoscopic myomectomy in a woman wishing to preserve future fertility // Fertil. Steril. 2008. Vol. 90(5). P. 2007.e5-9. DOI: 10.1016/j.fertnstert.2008.05.091.
14. Хачатрян Д.М. Анализ ошибок и осложнений лечения миомы матки методом эмболизации маточных артерий: Автореф. дисс. … к.м.н. М., 2013 [Khachatryan D.M. Analiz oshibok i oslozhneniy lecheniya miomy matki metodom embolizatsii matochnykh arteriy: Avtoref. diss. ... k.m.n. M., 2013 (in Russ.)].
2. Ravina J.N., Merland J.J., Ciraru-Vigneron N. et al. Arterial embolization: a new treatment of menorrhagia in uterine fibroma // Presse Med. 1995. Vol. 37(24). P. 1754.
3. Spies J., Ascher S., Roth A. et al. Uterine artery embolization for leiomyomata // Obstet. Gynecol. 2001. Vol. 98(1). P. 29–34.
4. Доброхотова Ю.Э., Кнышева И.Г., Гришин И.И. и др. Эмболизация маточных артерий в акушерстве и гинекологии // Российский медицинский журнал. 2014. № 1. C. 42–47 [Dobrokhotova Yu.E., Knysheva I.G., Grishin I.I. i dr. Embolizatsiya matochnykh arteriy v akusherstve i ginekologii // Rossiyskiy meditsinskiy zhurnal. 2014. № 1. S. 42–47 (in Russian)].
5. [No authors listed]. Fatal nontarget embolization via an intrafibroid arterial venous fistula during uterine fibroid embolization // J. Vasc. Interv. Radiol. 2009. Vol. 20(3). P. 419–420. DOI: 10.1016/j.jvir.2008.12.412.
6. Gavrilescu T., Sherer D.M., Temkin S. et al. Small bowel volvulus after uterine artery embolization requiring bowel resection: a case report // J. Reprod. Med. 2006. Vol. 51(9). P. 739–741.
7. Dewdney S.B., Mani N.B., Zuckerman D.A. et al. Uteroenteric fistula after uterine artery embolization // Gynecol. Obstet. 2011. Vol. 118(2 Pt, 2). P. 434–436. DOI: 10.1097/AOG.0b013e31821082a3.
8. Marín-Sánchez P., Sánchez-Ferrer M.L. Conservative management of vesical-vaginal fistula after uterine and partial bladder necrosis due to embolization as a treatment for postpartum hemorrhage. // Int. Urogynecol. J. 2015. Vol. 26(5). P. 773–774. DOI: 10.1007/s00192-014-2617-1.
9. Pillai A.K., Kovoor J.M., Reis S.P. et al. Expulsion of a Uterine Fibroid into the Small Bowel through Uteroenteric Fistula Presenting with Bowel Obstruction after Uterine Fibroid Embolization: Case Report with Histopathologic Correlation // J. Vasc. Interv. Radiol. 2016. Vol. 27(5). P. 762–764. DOI: 10.1016/j.jvir.2015.11.047.
10. Ogliari K.S., Mohallem S.V., Barrozo P. et al. A uterine cavity-myoma communication after uterine artery embolization: two case reports // J. Fertil Steril. 2005. Vol. 83(1). P. 220–222. DOI: 10.1016/j.fertnstert.2004.08.019.
11. Vural B., Ozkan S., Ciftci E. et al. Spontaneous vaginal expulsion of an infected necrotic cervical fibroid through a cervical fistula after uterine artery embolization: a case report // J. Reprod. Ved. 2007. Vol. 52(6). P. 536–566. https://www.ncbi.nlm.nih.gov/pubmed.
12. Price N., Golding S., Slack R.A. et al. Delayed presentation of vesicouterine fistula 12 months after uterine artery embolization for uterine fibroids // J. Obstet. Gynaecol. 2007. Vol. 27(2). P. 205–207. DOI: 10.1080/01443610601157273.
13. Donnez O., Jadoul P., Squifflet J. et al. Unusual complication after uterine artery embolization and laparoscopic myomectomy in a woman wishing to preserve future fertility // Fertil. Steril. 2008. Vol. 90(5). P. 2007.e5-9. DOI: 10.1016/j.fertnstert.2008.05.091.
14. Хачатрян Д.М. Анализ ошибок и осложнений лечения миомы матки методом эмболизации маточных артерий: Автореф. дисс. … к.м.н. М., 2013 [Khachatryan D.M. Analiz oshibok i oslozhneniy lecheniya miomy matki metodom embolizatsii matochnykh arteriy: Avtoref. diss. ... k.m.n. M., 2013 (in Russ.)].
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