V. Uterine fibroid embolization: Management of complications☆

https://doi.org/10.1053/tvir.2002.124728Get rights and content

Abstract

Fortunately, the number of complications reported after uterine fibroid embolization (UFE) is extremely low. Angiographic mishap or drug reaction are probably more common than purely UFE-related complications. However, the possibility of infection or necrosis of the uterus, with their significant attendant morbidity, is a sobering reminder that embolotherapy can have a powerful impact on the target organ(s). Knowledge of the expected time course for symptom resolution and the often confusing imaging findings shortly after UFE are critical for avoiding unnecessary delay in surgical intervention or, perhaps more important, an inappropriate rush to surgery when antibiotics alone will suffice. Other complications include alteration of uterine physiology, which may disrupt sexual function, and menstrual irregularity and even premature menopause. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Keith M. Sterling

Complications of uterine fibroid embolization (UFE) can be divided into intraoperative (procedural) and postoperative. Intraoperative complications are extremely uncommon, probably on the order of less than 1% incidence. Complications related to arterial catheterization include hematoma, pseudoaneurysm, arteriovenous fistula, arterial thrombosis, and infection. Hematomas and pseudoaneurysms can certainly be managed conservatively if they are small, but occasionally, transfusions are needed for

Robert L. Vogelzang

Uterine fibroid embolization has achieved remarkable success in the relatively short period of time that it has been widely practiced. For the most part, procedural and postprocedural complications have been gratifyingly minimal. The major complications of UFE (those that have lead to major morbidity and even mortality) are usually the result of significant injury to the uterus and ovaries.1, 2, 3, 4 This subsection will focus on those potential major uterine complications of UFE, specifically

Howard B. Chrisman

The development of both temporary and permanent menopausal symptoms following UFE is well documented.3, 13, 14, 15, 16 It is not uncommon for patients to transiently develop one or more symptoms of ovarian insufficiency; namely, hot flashes, night sweats, mood swings, irritability, and vaginal dryness after the procedure. In contrast, the development of complete ovarian failure, defined as amenorrhea, elevated follicle-stimulating hormone, and the whole clinical picture of menopause, is an

Robert L. Worthington-Kirsch

Care should be always taken to minimize the likelihood that a patient planning UFE harbors a malignancy that goes undiagnosed. Pelvic malignancy, especially leiomyosarcoma, can mimic fibroid disease. Fortunately, malignant tumors are rare in premenopausal women and the incidence of malignancy found at pathologic evaluation of uteri removed for fibroids is about 3 in 1,000.25, 26, 27

Endometrial carcinoma can also coexist with fibroid disease and be a cause of menorrhagia. However, most patients

Lindsay S. Machan

The appearance of the uterus on CT scan immediately postembolization depends on the end point of embolization rather than the embolic agent used (Figs 1 through 3).

. Embolization using embospheres, with sparing of the main uterine artery. (A) The postembolization uterine arteriogram demonstrates no parenchymal opacification and preservation of flow within the main trunk of the artery. (B) Nonenhanted CT scan 1 hour postembolization. Note that contrast is seen only within the fibroids. (C)

Scott C. Goodwin

Female sexuality is complex and multifaceted. It is influenced by physiological, psychological, social, and emotional factors. It is well known that pelvic surgery can have a profound effect on sexual function, both positive32, 33, 34 and negative.35, 36, 37, 38, 39, 40, 41 By comparison, there is very little that is known about the potential impact of UFE in this respect.

In 1966, a major milestone in female sexual function was marked by Masters and Johnson, who were the first to describe the

Q: What instructions do you give to patients to alert them to potential complications?

Dr Andrews: I give every patient a page-long printed list of instructions and a description of the expected events after UFE. I make a particular point of describing the postembolization syndrome and the likely symptoms of delayed sloughing.

Dr Worthington-Kirsch: I tell patients to call me with ANY concerns or questions but particularly in case of vaginal discharge, passage of tissue from the vagina, temperature greater than 100.5°F, constipation, or headache.

Dr Goodwin: All patients are given

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    ☆

    Address reprint requests to David M. Hovsepian, MD, Mallinckrodt Institute of Radiology, Vascular and Interventional Section, 510 S. Kingshighway Boulevard, St. Louis, MO 63110.

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    Copyright © 2002 Elsevier Science (USA). All rights reserved.