Author + information
- Tasheva Iveta1,
- Ivo Petrov2,
- Zoran Stankov2,
- Silvia Alexandrova Pavlova2 and
- Galina Georgieva Kozareva2
Patient initials or identifier number
Relevant clinical history and physical exam
This case represents a 40 years-old female patient. She referred for surgery-hysterectomia, due to uterine fibroids. Her complaints consisted of pelvic pain with irradiation to hips, heavy metrorrhagia, with optimal medical treatment. She had no concomitant diseases.
Relevant test results prior to catheterization
Pelvic ultrasound showed 7 intramural nodules with different sizes and volumes. She was referred for an MRI which confirmed fibroid of varying sizes, the two largest in diameter 43 and 30 mm. Laboratory investigations-complete blood count, tumor markers showed no anemia or high possibility for neoplastic process. Regarding the age, symptoms and favorable anatomy and localization of the fibroid, the patient was sent for uterine embolization.
Relevant catheterization findings
Local anesthesia with ropivacaine trough epidural catheter was used. A right brachial access was of choice. An arteriogram was performed to provide a road map of the blood supply to the uterus and fibroids from both the left and right uterine arteries.
A single-stage embolization of both uterine arteries was performed with microparticles sized between 700 and 900 mc. There were no periprocedural complications. The patient discharged from hospital on the third day without any early complications and complaints. Follow up of the patient was done with MRI on the third month. A significant reduction in number and size of the larger nodules (respectively 30 and 22 mm), as well as in the contrast intensity was seen. Control MRI on the 6th month, showed reduced diameter of the largest nodules to 22.47 and 23.73 mm. The patient had a significant reduction of pain, bleeding and increased quality of life.
Embolization is a gentle method, related to fewer risks to the patient, faster recovery and a shorter hospital stay. Clinical trials comparing the effect of embolization and surgery (hysterectomy or myomectomy) show similar results, regarding clinic, quality of life and prognosis with lower perioperative risk.