TRANSARTERIAL EMBOLIZATION OF THE UTERINE ARTERIES - PATIENT REACTIONS AND EFFECTS ON UTERINE VASCULATURE

Background. Therapeutic embolization of the uterine arteries has been successfully used to manage profuse gynecological hemorrhage. In the p resent study we aimed to investigate whether embolization of uterine a rteries may serve as a safe and effective alternative treatment in cas es of menorrhagia in fertile and perimenopausal women. As a first step , we have evaluated the methodology, patient reactions and effects on the uterine vasculature. Methods. The distal part of the uterine arter y was embolized with polyvinyl alcohol particles via catheterization o f the right femoral artery. Total abdominal hysterectomy was performed the next day. Results. Bilateral embolization in two patients resulte d in considerable pain that required morphine analgesic medication and epidural analgesia. One patient was embolized unilaterally and experi enced only slight discomfort with no need for analgesic medication at all, indicating that unilateral embolization is a well-tolerated metho d. After embolization, angiography showed stagnant flow in embolized v essels without contrast filling of distal branches. Angiography of the specimen showed normal vascular architecture in non-treated vessels. In treated vessels the main arterial trunks were patent but all smalle r branches were occluded. Histology showed that most of the particles lodged in small arteries and that arterioles never showed injected mat erial. Conclusion. The study indicates that the procedure involves an efficient occlusion of uterine vessels and that unilateral embolizatio n of uterine arteries is well tolerated.