J Korean Soc Radiol.  2017 Jan;76(1):1-9. 10.3348/jksr.2017.76.1.1.

Uterine Artery Embolization: The Interventional Treatment of Female Genital Diseases

• Lee WH
• Yang SB
• Goo DE
• Kim YJ
• Lee JM
• Kang CH
• Ohm JY
• Kim YJ

• KMID: 2365045
• DOI: http://doi.org/10.3348/jksr.2017.76.1.1

Abstract

The uterus is the major female sex organ and is essential for pregnancy. The organ is located in the pelvic cavity. It is usually fist-sized with its volume changing from 75 to 200 cc depending on the menstrual cycle. There are various diseases associated with the uterus, including malignancy, uterine myoma, postpartum hemorrhage, and vascular malformation. The conventional surgical treatment for these diseases is hysterectomy. However, hysterectomy has some risk, and there may be complications associated with the surgery and anesthesia. In addition, hysterectomy results in loss of fertility and loss of female characteristics, both of which may lead to emotional problems. After uterine artery embolization (UAE) was performed for post-partum bleeding in 1979 and for uterine myoma in 1995, interventional treatment of UAE replaced the existing surgical treatment of hysterectomy. UAE is performed widely as a minimally invasive treatment modality that can preserve the uterus, make pregnancy and childbirth possible and resolve emotional problems. The interventional treatment has become increasingly popular to treat various female genital diseases.

MeSH Terms

Anesthesia
Female
Female*
Fertility
Genital Diseases, Female*
Hemorrhage
Humans
Hysterectomy
Leiomyoma
Menstrual Cycle
Parturition
Postpartum Hemorrhage
Pregnancy
Radiology, Interventional
Uterine Artery Embolization*
Uterine Artery*
Uterus
Vascular Malformations

Figure

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  Fig. 1 Diagram of uterine artery embolization.

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  Fig. 2 Uterine fibroid. A, B. Pre-procedural MRI on T2-weighted sagittal image (A) and gadolinium enhanced T1-weighted image (B). Intramutal type myoma is demonstrated in uterine fundus and body with contrast enhancement. C. Left internal iliac arteriogram shows marked hypertrophy of left uterine artery and increased vascularity. D. Following embolization with polyvinyl alcohol particles, left uterine arteries are occluded.

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  Fig. 3 Angiographic findings of post-partum hemorrhage. A. Right uterine angiogram shows contrast media extravasation (arrow) from right uterine artery branch. B. Left uterine angiogram shows no definite bleeding focus, but only visible hypervascularity of the uterine artery.

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  Fig. 4 Uterine vascular malformation. A. Color ultrasonogram shows turbulent flow lesion in uterine body. B. Uterine angiogram shows a tangle of vessels in the region of uterus fed by uterine artery. C. Post embolization state of uterine artery with polyvinyl alcohol particle.

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  Fig. 5 Cornual ectopic pregnancy. A. Gestational sac was surrounded by an asymmetric myometrial mantle. B. Right uterine angiogram before embolization. Increased vascularity at right uterine cornua is noted. C. Post embolization uterine arteriogram shows occlusion of right uterine artery. D. Transvaginal sonogram demonstrates collapsed gestational sac with normal endometrial stripe.

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