Zusammenfassung
Die transarterielle Embolisation von Uterusmyomen ist eine neue minimal-invasive Therapie
beim symptomatischen Uterus myomatosus und stellt eine gebärmuttererhaltende Behandlungsalternative
zu den gynäkologisch-operativen Verfahren dar. Die bisher vorliegenden mittelfristigen
Ergebnisse zeigen eine hohe klinische Erfolgsrate mit Verbesserung von myombedingten
Blutungsbeschwerden in 80 - 100 %, Verbesserung der Beschwerden durch raumfordernde
Wirkung der Leiomyome in 60 - 100 % der Fälle und Größenreduktion der Myomknoten um
durchschnittlich 36 - 78 % bei geringer Komplikations- und Nebenwirkungsrate. In der
vorliegenden Übersichtsarbeit soll anhand der aktuellen Literatur und eigener Erfahrungen
eine Übersicht zu Indikationen und Kontraindikationen, Technik und Pathophysiologie
der Embolisation, Materialauswahl, Ergebnissen und Komplikationen des Verfahrens gegeben
werden.
Abstract
Uterine fibroid embolization (UFE) is a new minimal-invasive therapy for the treatment
of symptomatic leiomyomata of the uterus and a uterine-sparing alternative to surgical
procedures. Short-term and mid-term results indicate a high clinical success rate
with improvement of fibroid-related bleeding symptoms in 80 - 100 % of cases, improvement
of bulk symptoms in 60 - 100 % of cases and reduction in fibroid volume at an average
of about 36 - 78 % combined with a low rate of complications and side effects. This
review discusses indications and contraindications, technique and pathophysiology,
choice of material, results and complications of UFE on the basis of the current literature
and our own results.
Schlüsselwörter
Interventionelle Radiologie - Vaskuläre Interventionen - Embolisation - Uterus - Leiomyome
Key words
Interventional radiology - vascular interventions - embolization - uterus - leiomyomata
Literatur
- 1
Stewart E A.
Uterine fibroids.
Lancet.
2001;
357
293-298
- 2
Farquhar C M, Steiner C A.
Hysterectomy rates in the United States 1990 - 1997.
Obstet Gynecol.
2002;
99
229-234
- 3
Greenberg M D, Kazamel T I.
Medical and socioeconomic impact of uterine fibroids.
Obstet Gynecol Clin North Am.
1995;
22
625-636
- 4
Ravina J H, Herbreteau D, Ciraru-Vigneron N, Bouret J M, Houdart E, Aymard A, Merland J J.
Arterial embolisation to treat uterine myomata.
Lancet.
1995;
346
671-672
- 5
Townsend D E, Sparkes R S, Baluda M C, McClelland G.
Unicellular histogenesis of uterine leiomyomas as determined by electrophoresis by
glucose-6-phosphate dehydrogenase.
Am J Obstet Gynecol.
1970;
107
1168-1173
- 6
Parker W H, Fu Y S, Berek J S.
Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing
leiomyoma.
Obstet Gynecol.
1994;
83
414-418
- 7
McLucas B, Adler L, Perrella R.
Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids.
J Am Coll Surg.
2001;
192
95-105
- 8
Goodwin S C, Walker W J.
Uterine artery embolization for the treatment of uterine fibroids.
Curr Opin Obstet Gynecol.
1998;
10
315-320
- 9
Pelage J P, Le Dref O, Soyer P, Kardache M, Dahan H, Abitol M, Merland J J, Ravina J H,
Rymer R.
Fibroid-related menorrhagia: treatment with superselective embolization of the uterine
arteries and midterm follow-up.
Radiology.
2000;
215
428-431
- 10
Belli A, Mehta H, Matson M.
Uterine artery embolisation in the treatment of fibroids: complications requiring
re-hospitalisation.
Cardiovasc Intervent Radiol.
2001;
24
S 141
- 11
Siskin G P, Tublin M E, Stainken B F, Dowling K, Dolen E G.
Uterine artery embolization for the treatment of adenomyosis: clinical response and
evaluation with MR imaging.
Am J Roentgenol.
2001;
177
297-302
- 12
Pelage J P, Le Dref O, Soyer P, Jacob D, Kardache M, Dahan H, Lassau J P, Rymer R.
Arterial anatomy of the female genital tract: variations and relevance to transcatheter
embolization of the uterus.
Am J Roentgenol.
1999;
172
989-994
- 13
Chait A, Moltz A, Nelson J H.
The collateral arterial circulation in pelvis. An angiographic study.
Am J Roentgenol radium Ther Nucl Med.
1968;
102
392-400
- 14
Nikolic B, Spies J B, Campbell L, Walsh S, Abbara S, Lundsten M J.
Uterine artery embolization: reduced radiation with refined technique.
J Vasc Interv Radiol.
2001;
12
39-44
- 15
Nikolic B, Spies J B, Abbara S, Goodwin S C.
Ovarian artery supply of uterine fibroids as a cause of treatment failure after uterine
artery embolization: a case report.
J Vasc Interv Radiol.
1999;
10
1167-1170
- 16
Binkert C A, Andrews R T, Kaufman J A.
Utility of nonselective abdominal aortography in demonstrating ovarian artery collaterals
in patients undergoing uterine artery embolization for fibroids.
J Vasc Interv Radiol.
2001;
12
841-845
- 17
Pelage J P, Soyer P, Le Dref O, Dahan H, Coumbaras J, Kardache M, Rymer R.
Uterine arteries: bilateral catheterization with a single femoral approach and a single
5-F catheter - technical note.
Radiology.
1999;
210
573-575
- 18
Brunereau L, Herbreteau D, Gallas S, Cottier J P, Lebrun J L, Tranquart F, Fauchier F,
Body G, Rouleau P.
Uterine artery embolization in the primary treatment of uterine leiomyomas: technical
features and prospective follow-up with clinical and sonographic examinations in 58
patients.
Am J Roentgenol.
2000;
175
1267-1272
- 19
Nicholson A A, Ettles D E.
Anatomic abnormalities at the origin of the uterine artery. A cause of failure and
how to overcome it.
Cardiovasc Intervent Radiol.
2001;
24
S 141
- 20
Spies J B, Benenati J F, Worthington-Kirsch R L, Pelage J P.
Initial experience with use of tris-acryl gelatin microspheres for uterine artery
embolization for leiomyomata.
J Vasc Interv Radiol.
2001;
12
1059-1063
- 21
Pelage J P, Beregi J, LeDref O, Nonent M, Robert Y H, Rymer R.
Uterine artery embolization for fibroids using a different end-point for embolization:
preliminary results using calibrated microspheres.
Radiology.
2001;
221
(P)
356
- 22
Andersen P E, Lund N, Justesen P, Munk T, Elle B, Floridon C.
Uterine artery embolization of symptomatic uterine fibroids. Initial success and short-term
results.
Acta Radiol.
2001;
42
234-238
- 23
Andrews R T, Bromley P J, Pfister M E.
Successful embolization of collaterals from the ovarian artery during uterine artery
embolization for fibroids: a case report.
J Vasc Interv Radiol.
2000;
11
607-610
- 24
Pelage J.
Ovarian artery supply of uterine fibroids as a cause of treatment failure after uterine
artery embolization: a case report (letter, comment).
J Vasc Interv Radiol.
1999;
11
535
- 25
Sampson J.
The blood supply of uterine leiomyomata.
Am J Clin Pathol.
1912;
94
435-438
- 26
Casey R, Rogers P A, Vollenhoven B J.
An immunohistochemical analysis of fibroid vasculature.
Hum Reprod.
2000;
15
1469-1475
- 27
deSouza N M, Williams A D.
Uterine Arterial Embolization for Leiomyomas: Perfusion and Volume Changes at MR Imaging
and Relation to Clinical Outcome.
Radiology.
2002;
222
367-374
- 28
Katsumori T, Nakajima K, Hanada Y.
MR imaging of a uterine myoma after embolization.
Am J Roentgenol.
1999;
172
248-249
- 29
McCluggage W G, Ellis P K, McClure N, Walker W J, Jackson P A, Manek S.
Pathologic features of uterine leiomyomas following uterine artery embolization.
Int J Gynecol Pathol.
2000;
19
342-347
- 30
Katsumori T, Nakajima K, Mihara T, Takuhiro M.
Uterine artery embolization using gelatin sponge particles alone for symptomatic uterine
fibroids: midterm results.
Am J Roentgenol.
2002;
178
135-139
- 31
Lee P, Chang Y, Yoon J.
Preliminary experience with uterine artery ligation for symptomatic uterine leiomyomas.
J Am Assoc Gynecol Laparosc.
1999;
6
S 27-28
- 32
Liu W M, Ng H T, Wu Y C, Yen Y K, Yuan C C.
Laparoscopic bipolar coagulation of uterine vessels: a new method for treating symptomatic
fibroids.
Fertil Steril.
2001;
75
417-422
- 33
Hutchins F L, Worthington-Kirsch R.
Embolotherapy for myoma induced menorrhagia.
Obstet Gynecol Clin North Am.
2000;
27
397-405
- 34
Spies J B, Ascher S A, Roth A R, Kim J, Levy E B, Gomez-Jorge J.
Uterine artery embolization for leiomyomata.
Obstet Gynecol.
2001;
98
29-34
- 35
Worthington-Kirsch R, Fueredi G, Goodwin S, Machan L, Niedzwiecki G, Reidy J, Spies J,
Walker W.
Polyvinyl alcohol particle size for uterine artery embolization.
Radiology.
2001;
218
605-606
- 36
Bendszus M, Klein R, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L.
Efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles in the
preoperative embolization of meningiomas.
Am J Neuroradiol.
2000;
21
255-261
- 37
Deredeyn C P, Graves V B, Salamat M S, Rappe A.
Collagen-coated acrylic microspheres for embolotherapy: in vivo and in vitro characteristics.
Am J Neuroradiol.
1997;
18
647-653
- 38
Davidson G S, Terbrugge K G.
Histologic long-term follow-up after embolization with polyvinyl alcohol particles.
Am J Neuroradiol.
1995;
16
843-846
- 39
Bradley E A, Reidy J F, Forman R G, Jarosz J, Braude P R.
Transcatheter uterine artery embolisation to treat large uterine fibroids.
Br J Obstet Gynaecol.
1008;
105
235-240
- 40
Günther R, Klose K, Thelen M, Jacobi G.
Superselektive Embolisation mit Gewebekleber im Urogenitaltrakt.
Fortschr Röntgenstr.
1981;
134
536-539
- 41
Ravina J, Merland J, Herbetreau D, Houdart E, Bouret J, Madelenat P.
Embolisation pré-opératoire des fibromes utérins.
Presse Med.
1994;
23
1540
- 42
Goodwin S C, Vedantham S, McLucas B, Forno A E, Perrella R.
Preliminary experience with uterine artery embolization for uterine fibroids.
J Vasc Interv Radiol.
1997;
8
517-526
- 43
Ravina J H, Bouret J M, Ciraru-Vigneron N, Repiquet D, Herbreteau D, Aymard A, le
Dreff O, Merland J J, Ferrand J.
Recourse to particular arterial embolization in the treatment of some uterine leiomyoma.
Bull Acad Natl Med.
1997;
181
233-246
- 44
Worthington-Kirsch R L, Popky G L, Hutchins F L.
Uterine arterial embolization for the management of leiomyomas: quality-of-life assessment
and clinical response.
Radiology.
1998;
208
625-629
- 45
Spies J B, Scialli A R, Jha R C, Imaoka I, Ascher S M, Fraga V M, Barth K H.
Initial results from uterine fibroid embolization for symptomatic leiomyomata.
J Vasc Interv Radiol.
1999;
10
1149-1157
- 46
Burn P, McCall J, Chinn R, Healy J.
Embolization of uterine fibroids.
Br J Radiol.
1999;
72
159-161
- 47
Hutchins F L, Worthington-Kirsch R, Berkowitz R P.
Selective uterine artery embolization as primary treatment for symptomatic leiomyomata
uteri.
J Am Assoc Gynecol Laparosc.
1999;
6
279-284
- 48
Siskin G P, Stainken B F, Dowling K, Meo P, Ahn J, Dohlen E G.
Outpatient uterine artery embolization for symptomatic uterine fibroids: experience
in 49 patients.
J Vasc Interv Radiol.
2000;
11
305-311
- 49
Matson M, Nicholson A, Belli A M.
Anastomoses of the ovarian and uterine arteries: a potential pitfall and cause of
failure of uterine embolization.
Cardiovasc Intervent Radiol.
2000;
23
393-396
- 50
Andrews R T, Bromley P J, Pfister M E.
Successful embolization of collaterals from the ovarian artery during uterine artery
embolization for fibroids: a case report.
J Vasc Interv Radiol.
2000;
11
607-610
- 51
Binkert C A, Andrews R T, Kaufman J A.
Utility of nonselective abdominal aortography in demonstrating ovarian artery collaterals
in patients undergoing uterine artery embolization for fibroids.
J Vasc Interv Radiol.
2001;
12
841-845
- 52
Nikolic B, Abbara S, Levy E, Imaoka I, Lundsten L, Jha R C, Spies J B.
Influence of radiographic technique and equipment on obsorbed ovarian dose associated
with uterine artery embolization.
J Vasc Interv Radiol.
2000;
11
1173-1178
- 53
Rasuli P, Lavoie C, Hammond I, French G J.
Uterine artery embolization for fibroids: measurement of radiation dose.
Radiology.
1999;
213
(P)
133
- 54
Chrisman H B, Saker M B, Ruy R K, Nemcek A A, Gerbie M V, Milad M P, Smith S J, Sewall L E,
Omary R A, Vogelzang R L.
The impact of uterine fibroid embolization on resumption of menses and ovarian function.
J Vasc Interv Radiol.
2000;
11
699-703
- 55
Spies J B, Roth A R, Gonsalves S M, Murphy-Skrzyniarz K M.
Ovarian function after uterine artery embolization for leiomyomata: assessment with
use of serum follicle stimulating hormone assay.
J Vasc Interv Radiol.
2001;
12
437-442
- 56
Vashisht A, Studd J, Carey A, Burn P.
Fatal septicaemia after fibroid embolisation.
Lancet.
1999;
354
307-308
- 57
Godfrey C D, Zbella E A.
Uterine necrosis after uterine artery embolization for leiomyoma.
Obstet Gynecol.
2001;
98
950-952
Dr. med. Thomas J. Kröncke
Institut für Radiologie, Universitätsklinikum Charité, Campus Mitte,
Humboldt-Universität zu Berlin
Schumannstraße 20/21
10117 Berlin
Phone: + 49/30/450/527194
Email: thomas.kroencke@charite.de