Arterial embolization in bone pathology. Embolization of arteries in uterine myoma: indications, procedure, result Embolization syndrome

Embolization is a minimally invasive X-ray surgical procedure. Consists of selective occlusion (blockage) of blood vessels by specially introduced emboli.

Embolization is used to treat a wide range of pathologies of different organs:

arteriovenous malformations (AVM);

cerebral aneurysms;

gastrointestinal bleeding;

nosebleeds;

bleeding in the early postpartum period;

bleeding caused by failed surgery

neoplasms (treatment is used to slow down or stop the blood supply to the tumor, which leads to a decrease in its size, most frequent diagnosis - hepatocellular carcinoma);

neoplasms of the kidneys;

fibroids of the uterus.

portal vein embolization (portal venous embolization) prior to liver resection.

Embolization is a minimally invasive alternative to surgery. Treatment is aimed at preventing blood supply to certain organs, tissues, and structures of the body, which helps to shrink the tumor or block an aneurysm.

Embolization is performed endovascular by a radiologist using a unit for X-ray surgical (interventional) procedures. In most cases, it is done with minimal or no pain relief, although this depends on the organ being treated. Procedures such as embolization of a cerebral aneurysm or portal vein are usually performed under general anesthesia.

The embolized vessel is accessed using a catheter and a guide. After access to the vessel, the actual treatment begins. Usually, artificial emboli of the following types are used for this: spirals; particles; gelatinous sponge (“gel foam”); cylinders; cylinders.

Liquid embolizing materials used for AVM treatment can freely penetrate through complex vascular branches, which is very convenient for the surgeon: there is no need to install a catheter in each individual vessel. Examples of such fluids are lipiodol, ONYX.

Mechanical occlusion devices are suitable for all vessels. In addition, their advantage is the possibility of precise placement: during installation, they are placed directly in the place of the vessel where the catheter ends.

Embolizing coils can be used for arteriovenous malformations, aneurysms, traumatic injuries. They are very suitable for vessels with high blood flow, as they induce immediate thrombus formation. Available in platinum or stainless steel. The spiral itself is not capable of causing mechanical occlusion, but its installation leads to thrombus formation, which is largely facilitated by polyethylene terephthalate fibers ("dacron"), which are wrapped around the metal of the spiral.

11. X-ray endovascular neurosurgery (embolization of aneurysms, selective thrombolysis).

Embolization of aneurysms, AVMs, varicose veins, tumors (including chemoembolization).

Diseases caused not by narrowing or stenosis, but rather by the appearance of new, pathological vessels or changes in healthy vessels, occupy a key position in X-ray endovascular neurosurgery. X-ray surgery allows to embolize ("close", turn off from the bloodstream) these vessels, thereby restoring normal blood flow and ensuring recovery.

Embolization of arterial aneurysms with microcoils... An aneurysm is an expansion of the artery wall under the influence of high blood pressure, hereditary and anatomical factors. Over time, it can suddenly rupture - a hemorrhagic stroke will occur. A modern, low-traumatic method of treatment offered by X-ray surgery is aneurysm embolization with microcoils. The technique is as follows: according to the microcatheter, the aneurysm cavity is filled with special metal spirals. They seal the aneurysm tightly, as a result of which the blood flow in it stops.

Treatment of vascular malformations of the brain is best done in the early stages, when the anomaly is small, in the absence of bleeding and other associated symptoms. Just as in the treatment of cerebral aneurysms, the treatment of a malformation consists in its "exclusion" from the bloodstream by means of endovascular embolization, or its direct removal.

A technological breakthrough in the early 90s of the last century, associated with the emergence of microcoils and new types of microcatheters, along with the dynamic development of angiographic technology, gave impetus to the widespread use of the endovascular embolization method. This procedure is minimally invasive and is associated with a minimal risk of complications in comparison with surgical treatment (associated with craniotomy).

Before the embolization procedure, angiography is performed - an X-ray method that allows you to determine the exact location of the aneurysm, after which the embolization procedure begins.

During the embolization procedure, the surgeon gains access to the operation area through the vascular bed without opening the skull. In this case, the doctor uses a special technique that allows real-time visualization of the patient's vascular network using an X-ray angiographic system and performing an operation through the lumen of the vascular bed (artery). As with angiography, the embolization procedure begins with the introduction of a special catheter (a thin tube with a diameter of no more than 2 mm) into the femoral artery, followed by its passage through the arteries into the vessels of the brain to the body of the malformation.

Then a thin platinum thread - "spiral" is inserted through the catheter into the malformation, which blocks the blood flow in it.

Thrombolytic therapy.

The goal of thrombolytic therapy is to dissolve a blood clot that has closed the lumen of the vessel. Previously, drugs such as fibrinolysin, streptokinase, streptodecase and others were used for this purpose. However, their use was associated with a high risk of allergic complications. Therefore, a modern drug is currently used to dissolve a thrombus - tissue plasminogen activator (TTP). The tissue plasminogen activator is a powerful drug that does not just thin the blood, but acts on the formed thrombus, dissolving it. It is very effective method, but it has one drawback - it is effective only in the first 3-4 hours, when the thrombus is "fresh". In addition, the use of thrombolytic therapy may in itself carry risks of some complications. The main contraindications for such therapy are recent bleeding (gastric, intestinal, as well as cerebral hemorrhages, etc.).

Thanks to endovascular surgery, it has become possible to use interventional methods in the treatment of ischemic stroke.

Selective thrombolytic administration... Acute (fresh) occlusion caused by thrombosis can be controlled by selective thrombolysis. To do this, a special substance is injected into the affected vessel - a thrombolytic agent, which dissolves a blood clot. With this technique, the drug is not injected into a vein, but directly into the affected artery of the brain. This allows the drug to have a greater effect on the blood clot that clogs the lumen. For such an injection of the drug, a thin catheter is inserted into the femoral artery, which, under X-ray control, is brought to the affected cerebral artery. This method allows the use of thrombolytic therapy somewhat later than with the usual method of introducing the drug into a vein.

Mechanical removal of a blood clot (thrombectomy).

In some cases, direct removal of a thrombus from the lumen of the artery can also be used. The procedure is performed under X-ray control. A special catheter is inserted through the femoral arterial access, at the end of which there is a device in the form of a spiral. This coil plays the role of a trap, which captures the thrombus, and then, together with the catheter, is removed from the vessel. Mechanical removal of a thrombus shows good results in restoring blood flow in those patients for whom thrombolytic therapy is contraindicated for one reason or another.

Embolization (embolotherapy) is a minimally invasive X-ray surgical endovascular procedure. The essence of such an operation is the selective occlusion (blockage) of the arteries by specially introduced emboli (special particles). This surgery is performed by an endovascular surgeon or an interventional radiologist (fluorosurgeon).

When is the operation necessary?

The need for vascular occlusion may arise in the following situations:

1. If the patient has a benign tumor with increased blood flow.
2. When pathologically altered arteries are found in the body.
3. With valvular failure of the spermatic vein (varicocele).
4. When zones of pathological blood flow (aneurysms) occur.
5. With kidney damage.
6. With bleeding of the gastrointestinal tract.
7. With bleeding in the early postpartum period.

The vessels may also need embolization in a number of other cases.

How exactly does embolization take place?

The embolization intervention is minimally invasive, which means that there are no wide incisions and tissue trauma, the procedure is performed in an outpatient setting, and the risk to the patient is minimal.

Embolization actions are as follows:

• the patient receives local anesthesia or anesthesia is not used (however, embolization of an aneurysm in the vessels of the brain or portal vein is most often performed under general anesthesia);
• a catheter is inserted into the patient's vessel through a puncture with a guide;
• inside the artery in need of occlusion through a tube of minimum diameter, special substances (emboli) or devices enter.

At the end of the operation, a series of angiographic images is taken to check how successful the embolization was.

Products used

Specialists for embolization use a number of auxiliary structures and drugs, thanks to which it is possible to achieve fast and reliable vascular occlusion. The main embolization devices are:

1. Spirals. Injected into a vein or artery, they stop blood flow in the installation area.
2. Plastic (gelatinous) particles. Mixed with liquid, they are introduced into the vessel and sealed. During the operation, a large number of even small arterial branches can be closed.
3. Sclerosants. These fluids are injected into a vein or artery where they cause blood to clot. Sclerosants are effective in areas with poor blood flow.

Also in demand are artificial emboli of the following types:

• gelatinous sponge (“gel foam”);
• cylinders;
• cylinders.

Sometimes all of the listed embolizing agents and devices are used in combination. In this case, embolization is most effective.

Details of the embolotherapy procedure

Embolotherapy (blockage of arteries) has the following features:

• On average, embolization takes about thirty to forty minutes, complex procedures can last up to several hours. The operation time depends on many factors, one of the main ones being the professionalism of the surgeon. Experienced doctors usually perform embolization fairly quickly.
• Discomfort during embolization of any vessel is relieved by special preparations, so the procedure is practically painless.
• The minimally invasive intervention does not leave scars on the patient's body.
• Embolization of any vessel is always carried out in a hospital setting. The patient will need to stay at the clinic for 1-2 days. In some cases (for example, to exclude possible or existing complications), the hospitalization period is increased.

Patient care after vessel embolization is provided by the clinic's specialists in accordance with the type and degree of complexity of the minimally invasive intervention.

Within a week after the embolization operation, you can return to your normal life. Rapid recovery of patients who underwent embolization is ensured by a combination of rest with the observance of several simple conditions... First of all, operated patients need to adhere to the following rules:

1. Strengthen the drinking regime in the first 7 days after surgery.
2. Exclude water procedures - bathing, swimming in the pool, bathing for 3-5 days. You can also take a shower.
3. Maintain complete physical rest for 2-3 weeks after surgery. During this time, you should not lift weights and play sports.

The main advantages of the embolization method

Endovascular embolization is a low-traumatic procedure. It differs radically from standard surgical procedures in the absence of large incisions. This reduces many of the risks associated with routine operations, including the risk of infection. In addition, during embolization, it is extremely rare to enter the patient into general anesthesia.

1. Possibilities for eliminating tumors located in hard-to-reach places. A catheter inserted into an artery can penetrate where it is difficult to reach with a scalpel.
2. Reducing the likelihood of relapse. The technique used to seal the vessel allows the blood flow to be stopped quickly and reliably.
3. Lack of discomfort. During embolization of the vessel, the patient does not experience pain. All unpleasant sensations are eliminated with the help of special preparations.
4. Short recovery period. With minor interventions on the vessels, the patient may be discharged on the day of the procedure. With this special care, complex treatment, regular dressings are not required.
5. The minimum number of contraindications and complications. The success of the operation largely depends on the professionalism of the doctor. That is why it is important to correctly approach the choice of a surgeon.
6. Opportunities for organ preservation. For example, embolization on the vessels of the uterus allows a woman to become a mother and endure healthy child even with a history of a large tumor.

Embolization measures, that is, the cessation of blood flow through the vessel, in some cases is the only possible medical solution to the problem in the presence of general contraindications to standard surgery.

Embolization efficiency

For example, in the treatment of uterine fibroids, the process of replacing the muscle tissue of the nodes with the connective tissue begins after 14 days. In this case, the nodes are significantly reduced, are not able to grow again and provoke the progression of the disease. It takes about 6-8 months to shrink the nodes.

Note! The effectiveness of the method has been proven clinically. In addition, embolotherapy can block a wide variety of vessels. Patients who have undergone the embolization procedure quickly forget about pain and discomfort, returning to their usual life in the shortest possible time.

Benefits of contacting the clinic of Professor Kapranov

In the center of endovascular surgery prof. Kapranova, vascular embolization is performed on the very modern methodology and using the latest equipment. We offer patients to independently choose a clinic for embolization intervention. This will take into account all the wishes of the patient:

• to the conditions of hospital stay;
• personnel qualifications;
• other important treatment factors.

Today Professor S. A. Kapranov and highly qualified staff of the Center for Endovascular Surgery offer their patients:

• targeted staged and partial embolization, taking into account the individual characteristics of the organism and the degree of development of the disease;
• selection of the drugs used depending on the size and shape of the arteries;
• using only the most modern drugssuch as Contour (Boston Scientific), BeadBlock (Terumo, Japan) and Embosphere (Merit Medical, USA).

You can sign up for an operation to embolize uterine arteries, large fibroids, prostate vessels, and cerebral aneurysms. Our center has a professional health care turns out to be in full.

Modern gynecology does not offer any guaranteed and at the same time safe method of treating uterine fibroids. Hormone therapy does not always work, with surgical treatment sometimes it is necessary to remove the entire genital organ. To date, only one method can be recognized as effective, and this is uterine artery embolization (UAE). The operation has its own clear indications, so it cannot be used for all women without exception. In some cases, UAE is contraindicated, and then doctors have to use other available methods of treating the disease.

Embolization of the uterine arteries with uterine fibroids is an operation during which the blood supply to the myomatous nodes is cut off. The abnormal tissue dies off, while the healthy parts of the uterus are not damaged. This tactic allows not only to get rid of fibroids, but also with a high degree of probability to prevent a relapse of the disease in the coming years.

After blocking the blood flow in the myomatous node by emboli, the tumor begins to regress and decreases in size.

Reviews of this operation indicate that the operation is tolerated well enough, complications rarely occur, reproductive function in most cases does not suffer. UAE is the method of choice for young women planning future pregnancies.

Benefits of EMA

Embolization of the uterine arteries feeding the tumor compares favorably with other methods of treating fibroids:

• Effectiveness: relapse in less than 1% of cases;
• Fast relief from fibroid symptoms, visible reduction in the size of the nodes within the first three months;
• Safety: low risk of complications;
• Targeting effect only on myomatous nodes with maximum preservation of healthy tissues;
• Minimally invasiveness: performed without an incision, the patient quickly recovers after the procedure;
• The uterus is not removed, and the ability to bear a child is preserved;
• Ability to do without anesthesia.

UAE is a minimally invasive surgery that does not require an incision and is performed under local or spinal anesthesia.

The cost of an operation in Moscow ranges from 50 to 200 thousand rubles and depends on the volume of accompanying procedures (examination before and after UAE, follow-up observation, hospital stay). In St. Petersburg, the prices for embolization are not too different (the minimum cost of an operation in St. Petersburg is 45 thousand rubles). In the regions, the price is different, and the prices for the treatment of uterine fibroids using the UAE method start from 30 thousand rubles.

A uterine fibroid is a benign tumor of the myometrium (the muscle layer of the genital organ). According to autopsy (postmortem autopsy), pathology is detected in 80% of all women. Clinically, the disease manifests itself in only 35% of the fair sex. Usually myoma makes itself felt after 40 years, but the appearance of a tumor is possible at a younger age. Quite often, pathology is first detected during pregnancy or at the stage of planning a child.

Various methods are used to treat uterine fibroids, but UAE takes a special place among them. This manipulation is not new: the first attempts to embolize the branches of the uterine arteries were carried out back in 1979, but the procedure was not widely used. Only in the 90s of the last century, UAE began to be used to treat fibroids. Today, progressive clinics offer embolization as the most effective and at the same time the safest option for solving the problem.

In theory, this operation can be performed for all patients, but in practice, everything is not so simple. There are certain indications in which EMA will bring the desired result:

• Single and multiple myomatous nodes of any size with good blood supply (except for intramural subserous tumors);
• Intramural subserous fibroids up to 8 cm in size;
• Large and / or subserous nodes with - as one of the stages of treatment (preparation for conservative myomectomy);
• Uterine bleeding with fibroids when other methods are not effective;
• Fibroids in a woman planning a pregnancy.

It's important to know

A prerequisite is the presence of adequate blood flow in the nodes planned for removal.

Normally, the uterine arteries are small in diameter and the introduction of a catheter into them is impossible, but when fibroids develop, their diameter increases in accordance with the size of the tumor.

EMA treatment of fibroids is clearly indicated in the presence of multiple nodes. with such a diagnosis, it is rather difficult to perform: the risk of damage to healthy tissue is too high. Before the introduction of UAE, the only treatment was to remove the uterus. Today, the doctor can cut off the blood supply to the tumor nodes and thereby solve the problem with minimal risk to the patient.

Contraindications to embolization

• Giant nodes larger than 20 weeks of pregnancy (especially against the background of multiple small tumors);
• Single subserous nodes on a thin pedicle;
• Intramural subserous fibroids larger than 8 cm.

Technically, UAE can be performed for any tumor, but it doesn't always make sense to expose a woman to such a risk. Reviews of practitioners indicate that giant fibroids are usually accompanied by the appearance of multiple small nodes. There is practically no normal myometrium, and in this case there is no point in preserving the uterus. The best option for guaranteed getting rid of the problem and avoiding complications is a hysterectomy.

The photo shows a uterus with multiple giant myoma after hysterectomy.

Single subserous nodes lend themselves well to embolization, but later on, many women note the appearance of constant pain in the lower back and perineum. Such nodes do not completely go away and remain in the uterus, creating significant discomfort. sizes of more than 8-10 cm practically do not decrease with EMA, therefore other methods are used to remove them.

Absolute contraindications for uterine artery embolization:

• Malignant and borderline uterine tumors (or suspicion of them);
• Acute inflammatory process genitals;
• Insufficient blood supply to myomatous nodes;
• Pregnancy;
• Iodine intolerance.

On a note

If fibroids are detected during pregnancy, the operation is postponed until the baby is born and lactation is complete.

During menopause, embolization of the vessels of the uterus is not performed. During this period, many nodes regress on their own and there is no need for surgery. If this alarming sign, talking about a possible malignant transformation. The growth of fibroids in women during menopause is a direct indication for removal of the uterus.

Myoma is a hormone-dependent tumor, so the increase and persistence of myomatous nodes in the climacteric period obliges them to be examined and treated.

UAE as a stage of myomectomy

Medium-sized uterine myoma is the most difficult case in the practice of a gynecologist. If the doctor unambiguously recommends UAE for small nodes, and hysterectomy for large nodes, then with a tumor about 7-10 cm in size, it is not so simple. Embolization can be tried, but the result may not be very good. It is impractical to remove the uterus with medium-sized fibroids, especially in nulliparous women. In this situation, various approaches are practiced, and among them a two-stage treatment regimen deserves attention:

• The first stage is embolization of the uterine arteries;
• The second stage is myomectomy.

First, the doctor performs UAE so that the size of the node decreases slightly, and only after a certain time, a conservative myomectomy, or open access, is performed. This tactic allows you to reduce the amount of bleeding in the second stage, reduce the risk of complications and increase the chances of a favorable outcome. As an alternative to UAE, hormone therapy can be used for the same purpose.

UAE is not necessarily an independent treatment for fibroids, it can be a stage before subsequent laparoscopic or open surgery.

On a note

Temporary embolization of the uterine arteries with myoma is not performed. The blockage of the lumen of the vessels supplying the tumor occurs completely and irreversibly. There is a technique of temporary embolization during operations on the uterus (to stop bleeding), but this manipulation has nothing to do with the treatment of fibroids.

Preparation for surgical treatment for uterine fibroids

Before undergoing UAE, the patient must undergo an examination by a gynecologist and a therapist, do an ECG, and take blood and urine tests. Full list can be obtained from your healthcare professional. At the same time, two specific examinations can be carried out immediately before the operation:

Ultrasound and dopplerometry of nodes: implications for embolization

Ultrasound examination is carried out to assess the number and size of nodes, to identify concomitant pathology. Based on the results of ultrasound, the question of the possibility of performing UAE or other methods of surgical treatment is being decided.

Doppler ultrasonography is an important study indicated for all patients before embolization. The technique allows you to assess the blood flow in the arteries supplying tumor nodes. Uterine fibroids are characterized by:

• Perifibroid plexus formation from radial or arcuate vessels;
• Low blood flow velocity in the leading artery of the node - from 0.12 to 0.25 cm 3 / s.

On ultrasound, the uterine myoma looks like a well-defined formation of various diameters.

Disguised as fibroids in women, especially during menopause, may hide malignant tumor - sarcoma of the uterus. Doppler ultrasonography allows you to distinguish one mass from another before the start of surgical treatment. With sarcoma, there is a high blood flow rate of the feeding artery and the appearance of heterogeneous echo structures in the uterine cavity.

In the event of a diagnostic error, UAE will not fatally affect a woman's health. After the operation, the sarcoma of the uterus will decrease somewhat in size, but after a while it will begin to grow again. This feature is optional. diagnostic criterion and can be used in cases where by other methods to distinguish benign tumor from malignant fails.

Separate diagnostic curettage of the uterine cavity (WFD)

The procedure is not mandatory, but it can be assigned in the following situations:

• Continued uterine bleeding;
• Suspicion of other pathological processes in the uterus (hyperplasia, adenomyosis).

In this case, and make the right decision on the further management of the patient.

RFE allows you to obtain cellular material and judge histological structure pathological changes in the uterine cavity.

Preparation before surgery:

1. Antibacterial drugs (ornidazole) are prescribed 5 days before UAE. After embolization, tissue ischemia is noted, which contributes to the development anaerobic infection... The use of antibiotics can reduce the risk of bacterial complications;
2. Another antibiotic (ceftriaxone) is given immediately 2 hours before the operation;
3. A day before the procedure, a cleansing enema is performed;
4. Before manipulations, bladder catheterization is performed;
5. According to indications, sedatives can be prescribed;
6. If a woman is taking medications that affect blood clotting, she should inform her doctor about it;
7. Eating and drinking is prohibited on the day of surgery;
8. During the procedure, the woman's legs should be bandaged with elastic bandages. Compression tights can be worn to prevent thromboembolic complications.

UAE can be performed on any day of the cycle, but more often in the first phase. It is not recommended to perform the procedure during menstruation.

Uterine artery embolization technique

The essence of UAE is the blockage of the vessels that feed the fibroids. For this, special balls (emboli) with a size of 500-900 microns are used. The type and size of the embolus will depend on the characteristics of the arteries supplying the tumor. The material from which the balls are made (inert) does not cause allergic reaction and rejection. Emboli penetrate into the uterine vessels and remain there, blocking blood flow. The myoma stops feeding and the node necrotizes. The tumor significantly decreases in size, stops growing, gradually resolves or becomes covered with a connective tissue capsule.

Emboli inserted into a vessel obstruct blood flow.

On a note

Small emboli can eventually pass with menstrual blood. It is not dangerous and does not cause the slightest discomfort to the woman.

Operation stages:

1. UAE is performed under local anesthesia;
2. The surgeon accesses the uterine vessels by puncture of the right femoral artery;
3. The catheter is gradually advanced towards the uterus. An iodine-based preparation introduced into the vessel helps to monitor its movement. A special X-ray unit allows you to see how the catheter passes through the femoral artery and gradually comes to the right place. The radiation dose received by the patient at this moment is insignificant and does not exceed the standard irradiation with FOG;
4. The catheter is passed into the left uterine artery. Emboli are inserted and the vessels feeding the tumor are blocked. The procedure is repeated with the right uterine artery.

The duration of all manipulations is 15-30 minutes.

According to the reviews of patients who received treatment for fibroids with uterine artery embolization, the operation is well tolerated. This minimally invasive procedure is performed under local anesthesia and the woman does not experience significant discomfort. Dizziness, weakness, and mild nausea are noted. All unpleasant sensations persist for a day, after which the woman's condition improves. There may be pains in the hip, lower abdomen, which persist for 3-7 days.

UAE is performed by an endovascular surgeon under the control of an X-ray unit, which allows you to see the localization of the catheter.

UAE results: what to expect after surgery

After completing the procedure, control Doppler will be performed. Further, regular examinations are shown after 3, 6 and 12 months. The following results are expected during the year:

• Reduction of dominant (up to 47%) and non-dominant (52% of the previous volume) myomatous nodes after 12 months;
• Reduction of the size of the uterus by 58%;
• The disappearance of symptoms accompanying myoma (bleeding, pain) - 98% of cases (including signs of compression pelvic organs tumor - after 6 months);
• Fibroids located on the back of the uterus are less treatable;
• Submucous and isthmus nodes after embolization leave the uterus (expulsate);
• Normalization menstrual cycle in women under 45 years of age - after 3 months in 100% of cases;
• Recurrence of the disease - 2%.

The maximum regression of nodes is observed in the first three months after UAE. In the future, the tumor decreases in size, but not so rapidly. In this regard, gynecologists recommend not to postpone the conception of a child for women of reproductive age. Pregnancy planning after UAE is possible after 3-6 months, provided that the postembolization period is adequate and menstrual function is restored.

Angiography of the right uterine artery. On the left - the state before the embolization of the vessels (the blood supply to the fibroid is clearly visible). On the right is the state after the procedure.

It's important to know

The absence of the effect of UAE 3 months after the operation indicates the presence of endometrial pathology or malignant degeneration of the tumor. Consultation of a gynecologist is required.

Rehabilitation after surgery

After the completion of embolization, the patient remains in the operating room for some time, after which she is transported on a gurney to the ward. Installation of a dropper with medicinal solutions (according to indications). Ice is applied to the puncture site. All this time, the patient should be under the supervision of a doctor to identify possible complications.

In the first hours after the operation, severe pain in the lower abdomen is noted. This is a natural phenomenon, indicating the onset of ischemia of the myomatous node. During this period, analgesics and antispasmodics are prescribed. After a few hours, the pain subsides. An increase in body temperature is possible, general weakness, nausea and vomiting. Gradually, the condition improves, and after 1-2 days the woman can be discharged home.

In order for the postembolization period to pass without undesirable consequences, the patient should adhere to all the doctor's recommendations:

All phenomena that occur after surgery are called postembolization syndrome. The duration and severity of this condition does not depend on the number and size of the nodes and is determined only by the individual sensitivity of the patient.

Complications after UAE

In rare cases, embolization of the branches of the uterine arteries can have the following negative consequences:

• Hematoma at the puncture site of the femoral artery;
• Deep vein thrombosis (if you refuse to use compression underwear);
• Severe post-embolization syndrome ( strong pain on the first day after surgery, fever);
• Amenorrhea due to dysfunction of the ovaries (mainly in women after 45 years) - the onset of menopause is possible;
• Adhesion process in the pelvic organs;
• Embolization of adjacent organs.

The last two complications are extremely rare. IN modern conditions when using high-quality equipment, the risk of such negative consequences is minimal.

Uterine artery embolization is a relatively safe and effective treatment for fibroids. In 98% of cases after UAE, the node is completely necrotic and additional therapy is not required.

An interesting video about the treatment of uterine fibroids by uterine artery embolization

Alternative treatments for uterine fibroids. Features of the operation of UAE

A benign tumor that grows due to connective tissue and develops in the uterine cavity, the walls of an organ or in the neck, called myoma.

After 35 years, almost half of the female population is faced with this ailment.

Symptoms of the disease may not appear immediately, but only after the tumor increases significantly in size.

The uterine myoma has tumor signs, however, it is more correct to consider it not a tumor, but a tumor formation.

Causes of fibroids

The benign nature of myomatous nodes does not reduce the problems and dangers of formation, since fibroids are often accompanied by bleeding and problems with conception and miscarriage of a child.

The more advanced the disease is, the more difficult it is to treat, therefore it is necessary to diagnose fibroids as early as possible. The formation of fibroids begins with the mutation process of one cell, it is influenced by a failure in the balance of hormones - an imbalance of progesterone and estrogen.

IN menopause estrogen production is reduced, which in most cases leads to degradation and complete.

The reasons for the occurrence of myomatous node lie in the following:

• imbalance of hormones;
• lack of regular sex life;
• ovarian disease;
• stress;
• an inactive lifestyle and heavy physical activity;
• chronic infectious diseases;
• ailments of the endocrine glands;
• disruptions in lipid metabolism;
• mechanical damage - abortion, traumatic childbirth, curettage, the consequences of surgical intervention;
• genetic factor.

NOTE!

Scientists have shown that women who have a history of childbirth are less likely to develop myomatous formations. But, late pregnancy and childbirth is more likely a provoking factor, not a factor that reduces the likelihood of developing the disease.

Modern methods of treatment

Treatment can be:

• combined.

Removal of the uterus during menopause is most often carried out with the simultaneous removal of the ovaries. This is due to the prevention of oncological processes in the reproductive system.

Uterine artery embolization

EMA gynecologists have been using in their practice for a long time - since the 80s of the last century... It was originally used to stop bleeding after childbirth or during surgery. After 10 years, the method began to be used to treat myomatous formations.

The procedure is carried out using a microsurgical technique, therefore it is less traumatic. The mechanism of the procedure is to block the vessel that feeds the tumor cells... Accordingly, the cells die, and the node itself begins to degrade.

In Russia, such operations began in 2001, before that, almost all patients had fibroids removed with a scalpel, and sometimes together with the uterus. An innovative technique has made it possible to maintain female organs intact, which allows you to safely get pregnant, carry and give birth to a healthy baby.

Advantages and disadvantages

The first and most important advantage of such an operation is undoubtedly the preservation reproductive function patients.

In addition, embolism with fibroids has the following advantages:

• no scars;
• the procedure is performed without the use of anesthesia;
• efficiency is 95%;
• the patient's condition begins to improve literally immediately;
• stay in the hospital for no more than a day;
• the risk of recurrence is significantly lower than after surgery.

Among the disadvantages of EMA are the following:

• equipment for carrying out such manipulations is quite expensive, so not all clinics can afford to install it;
• lack of specialists who can carry out such manipulations;
• x-ray radiation that the patient receives during the procedure. Although this point cannot be called a significant drawback, since the radiation dose during UAE is similar to a fluorographic examination,
• the inability to collect biological material for biopsy. But this drawback is completely neutralized by angiography;
• high price.

Indications

Embolization can be used strictly according to indications. The main of these indications is saving the patient's life.... If the uterus bleeds a lot, it can threaten the woman's life.

In addition, the indications for embolization are as follows:

• desire to become a mother in the future;
• the size of the mime is large and it is actively growing;
• contraindications for the behavior of other surgical procedures;
• the patient's desire to maintain the integrity of the uterus.

Sometimes embolization is performed just before surgery... Immediately after UAE, the myomatous formation is removed. Thus, the risk of bleeding is minimized.

How is the operation performed

The whole procedure takes from 30 minutes to 1.5 hours. It is carried out either in the operating room, which is equipped with the necessary equipment, or in the X-ray room.

The steps of the procedure are as follows:

1. Local anesthesia. If the patient wishes or as directed by a doctor, epidural anesthesia can be used.
2. Introduction of a catheter into the ulnar vein.
3. Treatment of the site of the future puncture with antiseptics.
4. Introduction of a catheter into the femoral artery. A probe is inserted through a small incision.
5. Introduction contrast agent so that the vessels are visible on X-ray equipment.
6. After the catheter enters the vessels that provide nutrition to the tumor, the embolizing substance itself is injected directly - as a rule, these are balls. This procedure is carried out with all the available myomatous nodes. The injected balls block the arteries, as a result of which the blood flow through them stops.
7. Angiography is done to confirm that the blood supply to the tumor has been cut off.
8. The catheter is removed, and a pressure bandage is applied to the puncture site for a day.
9. The patient is transferred to the ward, since in the next 12 hours she will need complete rest and medical supervision.

Contraindications

Contraindications to such a procedure are:

• the presence of negative reactions to contrast radiological preparations;
• malignant processes in the uterus or ovaries;
• renal failure;
• coagulopathy;
• pregnancy;
• acute infectious processes in the uterus and appendages;
• radiation treatment;
• autoimmune connective tissue diseases.

Preparing for surgery

Before performing UAE, the patient must complete the course of hormone therapy, which was prescribed by the doctor.... The effectiveness of the method decreases when taking hormonal drugs.

If a woman accepts any other medicines, the doctor must know about it.

Most of them will have to be canceled about a week before the procedure.

You also need to pass the following tests:

• blood test for protein, sugar, clotting, electrolytes, liver and kidney disease;
• blood test for hepatitis, HIV and syphilis;
• clinical analysis of urine;
• vaginal smear;
• scraping from the cervix;
• Ultrasound, and if necessary, MRI of the pelvic organs;
• cardiogram.

Directly on the day of manipulation, it is better to refuse breakfast, you need to stop drinking water a couple of hours before the intervention. The woman is hospitalized the day before the scheduled procedure.

Complications

After the procedure, a woman may experience the following complications:

1. Hematoma in the femoral artery - resolves independently or with the help of special ointments.
2. Infection - stops antibacterial drugs... A temperature that does not decrease for several days after the procedure is a serious reason to see a doctor.
3. Pain in the uterus - relieved by analgesics. Essentially it is normal phenomenonassociated with the death of tumor cells, which, like normal cells in the body, have contact with nerve endings.
4. Intoxication processes are eliminated by anti-inflammatory drugs. This phenomenon indicates the body's reaction to the contrast agent and directly to the embolization agent.
5. The appearance of adhesions is a rare complication that occurs in no more than 4% of cases.
6. Lack of menstruation - the cycle will recover on its own after a while.
7. Ovarian depletion - observed in 12-14% of cases.

Recovery period

After discharge from the hospital, a woman is forbidden to engage in heavy physical labor, visit baths and saunas for a week. A week later, the first ultrasound is done, and a month after the ultrasound procedure, the second time is performed. Subsequent treatment tactics depend on the test results and the response of myomatous formation to UAE.

Cancer embolization refers to minimally invasive methods of cancer treatment, is used in many types cancerous tumor, but in most cases - at malignant neoplasms liver. The purpose of the procedure is to clog (block) blood vesselsfeeding the oncological focus. Without circulation, atypical cells stop spreading, leading to shrinkage, destruction and death of the tumor.

Cancer embolization is a modern progressive method of dealing with metastases in hard-to-reach places, when surgical removal of the tumor presents certain difficulties. The technique is actively used for large cancers, during preparation for surgery.

Types of embolization

Cancer embolization is done in three ways:

1. Arterial or transarterial (TAE) embolization - used for tumors of the liver and uterus. A catheter is inserted into the artery through which an embolizing agent is delivered, resulting in obstruction of the vessel.
2. Chemoembolization - a combination of TAE and chemotherapy is performed in one of two ways. First, cytostatics are pre-coated with particles of an embolizing substance. Second, a chemotherapy drug is injected into the artery through a catheter, then the vessel lumen is clogged.
3. Radioembolization - a combination of embolization and radiation consists in the delivery of microspheres (radioactive particles) to the artery, which settle next to the oncological focus, emitting radioactive radiation for several hours or days.

Cancer embolization is used in three ways:

• The main independent method of treatment.
• - on the last stages oncological process to eliminate pain, stop bleeding, reduce side effects and complications of the disease.
• Preoperative embolization - used for large tumor volumes to reduce its size and improve surgical access, as well as to reduce blood loss during surgery.

It is used both as a separate method and as part of complex treatmentcombining with radiation or chemotherapy

Advantages and disadvantages

Cancer embolization is a promising alternative surgical intervention in oncology due to its advantages:

• Low-traumatic technology that does not leave scars like after surgery.
• Minimal risk of infection and other complications.
• No bleeding after the procedure.
• There is no particular need for general anesthesia. This is especially true for people with drug intolerance.
• Recovery in the shortest possible time.
• High efficiency.
• Preservation of tissue integrity.
• The possibility of using inoperable forms of cancer.
• Minimal toxic effects.
• The possibility of selecting doses of the embolizing agent individually, depending on the type of neoplasm, localization, stage.
• The likelihood of developing side effects is minimized.
• Long-term hospitalization is not required.
• The ability to perform manipulations several times before receiving therapeutic effect without harm to other organs and the body as a whole.

The disadvantages of embolization are few. The procedure is prescribed individually and is not suitable for all cases. The manipulation should be carried out by a highly qualified experienced specialist. If the surgeon is inexperienced, the embolus can penetrate into healthy tissue and lead to complications.

Embolization in some types of cancer

Chemoembolization is effective due to anatomical features. The branches of the hepatic artery supply blood to liver neoplasms. Transarterial embolization clogs the branches, while not disrupting the work of healthy tissues that are supplied with blood by another source (branches of the portal vein). For some types of liver tumors, complete recovery can be expected with TAE.

Embolization in cervical cancer is often combined with chemotherapy and radiation therapy, and includes three stages. The first stage is two courses of chemotherapy. The second stage - bilateral embolization of the uterine arteries for cervical cancer, is performed a day or two after the second course of chemotherapy in the operating room X-ray. The third stage - irradiation is performed a week after TAE. The disadvantage of this method is the systemic effect of the cytostatic on the body.

Embolization is indicated when the patient has hemoptysis, or there are contraindications for surgery or radiation. For mechanical occlusion, mainly microscopic fibers of Teflon velor are used. For chemical - hypertonic solution or ethanol... Embolization of bronchial arteries is carried out for hemostatic purposes and for the purpose of introducing chemotherapy drugs into the tumor area. Improvement is seen in 90% of patients.

Embolization in kidney cancer is indicated when it is impossible to carry out a full-fledged surgical intervention for one reason or another. An embolus (gelatinous, plastic ball) is injected through a catheter attached to the vessels of the affected kidney, which clogs the vessel. Tumor development slows down or stops completely. When the patient's condition allows nephrectomy. In some cases, the technique is used before surgical intervention to reduce the level of blood loss.

Indications and contraindications

Embolization is used in different areas medicine, for example, in vascular vein surgery lower limbs, in gynecology with uterine myoma, but in oncology this technique is considered experimental. There are still no sufficient studies, long-term forecasts, therefore, the possibility of carrying out this minimally invasive operation is considered for each patient separately.

Restrictions on performing the procedure are associated with a specific diagnosis. Contraindications are mostly relative:

• Hepatitis, cirrhosis.
• Decompensated renal, hepatic, cardiac, respiratory failure.
• Venous bleeding with varicose veins.
• Bronchopulmonary embolism.
• Volumetric decay cavities in the oncological focus.
• Inability to securely fix the catheter.
• Generalized oncological process.
• Intolerance to a radiopaque substance.
• Arterial anomalies.
• Acute infectious process.
• Pregnancy.
• Diseases associated with bleeding disorders.
• Operable uterine cancer.

The question of the advisability of embolization is decided in each case and depends on the patient's condition.

Embolization

Cancer embolization is carried out mainly on an outpatient basis. Preliminary diagnostics are carried out. The main examination method is contrast-enhanced angiography, which makes it possible to assess the state of the vessels, to identify the sources of blood supply to the cancer focus.

No special preparation is required, but the patient should not eat or drink 4–5 hours before surgery. To perform the manipulation, general anesthesia is rarely used, more often local anesthesia. After anesthesia, an artery is punctured in the right place, a microcatheter is inserted through which an embolus is launched. The following are used as embolizing materials:

• Liquid substances are convenient because they freely penetrate through the vascular branches.
• Glue-like substances - converted into polymer after reaction with ions.
• Viscous materials - are used as chemoembolization mainly for liver cancer.
• Sclerosing - seals the endothelium, used for embolization of medium-sized vessels.
• Microparticles - needed to occlude small vessels.
• Gelatin Sponge or Gel Foam - Causes temporary blockage.
• Acrylic Microspheres - Cause permanent occlusion.
• Spirals - lead to instant thrombus formation.

To prevent complications after embolization, it is carried out against the background of antibiotic therapy.

Embolization efficiency

According to research and observation data, if the procedure was successful, and it was possible to clog the vessel through which the tumor circulates, then the patient begins to feel better, there is a decrease in pain syndrome. In some patients, the pain goes away rather quickly if it is possible to completely clog all the vessels that feed the tumor. In some cases, if the formation receives a blood supply from several branches or collaterals are well developed, the manipulation is ineffective.

The effectiveness of embolization is assessed according to the following criteria:

• Complete regression - disappearance of disease manifestations, recovery.
• Partial regression - a decrease in the size of the oncological focus by 50% or more, the absence of other lesions.
• Stabilization - the volume of the affected organ is reduced by less than half, the absence of new foci.
• Progression - an increase in the volume of the affected organ by 25% or more, the appearance of new cancer foci.

The ineffectiveness of embolization can be associated with anatomical features, the form of a cancerous tumor, and a lack of experience with a doctor. Some types of tumors during metastasis can transform into a fast-growing form, therefore, a thorough examination of the patient should be carried out before the procedure.

The embolization method is researched and tested by medical researchers different countries... Experts believe that soon with the development of microendoscopic technology, it can be used to treat cancer different localizations... Already now, leading cancer centers use the latest equipment that works on the principle of MRI in real time to visualize the bloodstream. This makes the procedure easier and more effective.