Korean J Radiol.  2019 Oct;20(10):1462-1473. 10.3348/kjr.2019.0205.

Uterine Artery Embolization for Leiomyomas and Adenomyosis: A Pictorial Essay Based on Our Experience from 1300 Cases

Affiliations
  • 1Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. mdkim@yuhs.ac

Abstract

Since its introduction in 1995, uterine artery embolization (UAE) has become an established option for the treatment of leiomyomas. Identification of a leiomyoma using arteriography improves the ability to perform effective UAE. UAE is not contraindicated in a pedunculated subserosal leiomyoma. UAE in a cervical leiomyoma remains a challenging procedure. A leiomyoma with high signal intensity on T2-weighted imaging responds well to UAE, but a malignancy with similar radiological features should not be misdiagnosed as a leiomyoma. Administration of gonadotropin-releasing hormone agonists before UAE is useful in selected patients and is not a contraindication for the procedure. The risk of subsequent re-intervention 5 years after UAE is approximately 10%, which represents an acceptable profile. UAE for adenomyosis is challenging; initial embolization using small particles can achieve better success than that by using larger particles. An intravenous injection of dexamethasone prior to UAE, followed by a patient-controlled analgesia pump and intra-arterial administration of lidocaine after the procedure, are useful techniques to control pain. Dexmedetomidine is an excellent supplemental sedative, showing a fentanyl-sparing effect without causing respiratory depression. UAE for symptomatic leiomyoma is safe and can be an alternative to surgery in most patients with a low risk of re-intervention.

Keyword

Uterine artery embolization; Leiomyoma; Adenomyosis; Uterus; MRI

MeSH Terms

Adenomyosis*
Analgesia, Patient-Controlled
Angiography
Dexamethasone
Dexmedetomidine
Gonadotropin-Releasing Hormone
Humans
Injections, Intravenous
Leiomyoma*
Lidocaine
Magnetic Resonance Imaging
Respiratory Insufficiency
Uterine Artery Embolization*
Uterine Artery*
Uterus
Dexamethasone
Dexmedetomidine
Gonadotropin-Releasing Hormone
Lidocaine
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