Procedure: Uterine fibroid embolization/Uterine Artery Embolization   

Indication: Symptomatic leiomyomata.    

Date:    

Operators:  Drs.    

Medications: 1 gm IV Ancef. 4  mg IV Zofran.  60 mg IV Toradol.  800 mcg intra-arterial nitroglycerin.      mcg IV fentanyl and     mg Versed  

Contrast:  Approximately  ___cc nonionic

Embolic Agent:   ___vials 500-700 micron Embospheres  

Fluoro time:  __ minutes

Access site:  Right common femoral artery with ultrasound. The arteriotomy was closed with a StarClose device

Complications:  None immediate.

 

Technique:

The risks, benefits, and alternatives to the procedure and sedation were explained to the patient.  The specific risks of infection requiring hysterectomy, non-target embolization and early menopause were detailed and accepted. Written informed consent was obtained.  A timeout was performed.

The patient was assessed for conscious sedation and found to be an adequate candidate. A dedicated nurse monitored heart rate, blood pressure, and oxygen saturation throughout the procedure.

The right groin was prepped and draped in sterile fashion.   The femoral vessels were ultrasonographically evaluated. An appropriate entry site was chosen and under direct ultrasound guidance, the right common femoral artery was accessed with a 21 gauge needle. An image was stored to PACS. A 0.018″ wire was advanced centrally and the needle exchanged for a 5 French transitional dilator.

A 0.035” wire was advanced into the aorta and the dilator exchanged for a 6 French sheath. This was attached to flush.

A 5 French Omniflush catheter was advanced to the level of the renal artery origins. An arteriogram was performed centered over the pelvis to assess for ovarian flow to the fibroids.

The bifurcation was traversed with a guidewire and the catheter exchanged for a RUC catheter. This was used to select the contralateral, left internal iliac artery.  A 3 French microcatheter was introduced coaxially and a  0.018″ Glidewire was used to select the left uterine artery. Contrast injection confirmed appropriate position. Intra arterial NTG was administered.

The branch was subsequently embolized with     vials of 500-700 micron Embosphere particles.

The microcatheter was slightly withdrawn and a post embolization arteriogram performed to assess embolic effect. The microcatheter was removed. 

The ipsilateral/right internal iliac artery was selectively catheterized with the RUC.  Arteriography was performed.

The microcatheter was reintroduced and the right uterine artery selectively catheterized.  Arteriography was performed via hand-injection.  400 mcg intra-arterial nitroglycerin were injected.     vials of 500-700 micron Embosphere particles were used to embolize the right uterine artery.  

Post embolization arteriography was performed through the microcatheter.

The catheters were removed and the arterial access site evaluated with contrast.  The arteriotomy  was closed with the StarClose device.    

No immediate complication occurred, and the patient was discharged from the angiography holding area in satisfactory condition with a PCA pump initiated. 

 

Findings:  A recent MRI was reviewed.

  1. The uterine arteries are markedly enlarged bilaterally.
  2. Fibroid blush is noted on delayed images.
  3. There is no significant flow in fibroid branches post embolization on the left.
  4. There is no significant flow to fibroid branches post embolization on the right.
  5. There is no significant fibroid supply arising from the ovarian arteries.

 

Impression:

Enlarged uterine branches bilaterally with a leiomyomatous uterus.

Both uterine arteries were successfully embolized with particles as described.

 

Plan:

  1. The patient will be admitted for 23 hours observation to control post embolization syndrome.
  2. She will be discharged on Colace, Naprosyn, Phenergan suppositories, and a narcotic for pain control.
  3. She was instructed to call the office for a follow-up appointment once she begins her first post-procedure menstrual cycle.