Uterine Artery embolization Flashcards
age range most women are typically affected by symptomatic adenomyosis
41-45 years old
long term symptom relief (12 months or more) after UAE for patients with purely adenomyosis
74%
de Brujin et al Uterine artery embolization for the treatment of adenomyosis JVIR 2017
circumstances where the junctional zone is difficult to visualize
- postmenopausal - myometrium looks like junx zone
- pregnancy - junx zone looks like myometrium
- premenarche
https://ajronline.org/doi/epdf/10.2214/AJR.10.4877
during which part of the menstrual cycle is the junctional zone at its maximal thickness
menstrual phase
phases of the menstrual cycle
- menstrual phase (1-4)
- early proliferative (5-9)
- late proliferative (10-14, estrogen effects dominate, trilaminar endometrium)
- secretory (15-28, progesterone effects dominate)
minstrels, prolife rally, secretary
if you see a thickened junx zone in a postmenopausal patient, you should ask if they are on ….
hormone replacement therapy
The types of adenomyosis seen on MRI
- Diffuse adenomyosis - entire junx zone is thickened
- focal adenomyosis - part of the junx zone is involved
- adenomyoma
risk factors for adenomyosis
- prior endouterine surgery
2. multiparity
Direct signs on MRI for adenomyosis diagnosis
- submucosal microcysts - usually located within the junx zone (but can also be found in outer myometrium)
- adenomyoma - well-delineated myometrial mass distinct from the junx zone
way to distinguish adenomyoma from leiomyoma
adenomyoma often will have high-signal intensity foci on T2
Indirect signs on MRI for adenomyosis
thickness of the junx zone
junctional zone thickness used when establishing the presence of adenomyosis
greater than 12 mm
what non-surgical or procedural treatment has found to be effective for treating adenomyosis
Mirena IUD, which is a levonorgestrel-releasing intrauterine system (lng-IUS)
what are the side effects for treating adenomyosis with a Mirena IUD
- weight gain (28.7%)
- ovarian cyst (22.3%)
- Lower abdominal pain (12.8%)
- Acne (6/4%)
The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis
when is Mirena IUD unlikely to work
when the uterine volume is larger than 150 mL
Relationship between uterine volume and discontinuation of treatment with levonorgestrel-releasing intrauterine devices in patients with adenomyosis
is sloughing normally an issue for adenomyosis
no
according to a 2017 meta-analysis, what is the long-term (>12 month) success rate for UAE in treating adenomyosis
74% (318/430)
Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis
according to a 2017 meta-analysis, what is the long-term (>12 month) success rate for UAE in treating adenomyosis and fibroid
85.4%
Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis
in the 2017 meta-analysis, what was the secondary hysterectomy rate after treating adenomyosis with UAE
only 7.2%
Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis
according to the article “long-term durability of UAE for treatment of symptomatic adenomyosis,” what was the overall “success” rate at 52 months
80% of 115 patients remained symptom free
10% recurrence rate in 5 years
how often do endometriosis and adenomyosis co-exist
80% of the time
if a patient no longer has menorrhagia but still has dysmenorrhia after UAE for adenomyosis, what should you do
refer for laparoscopy for possibly endometriosis
does adenomyosis negatively affect fertility and pregnancy
YES
other than a Mirena IUD, what other medication can be used for adenomyosis
GnRH agonists - can produce a “medical menopause” and induce amenorrhea
***can only use for 6 months max
what is the rate of ovarian failure for women younger than 40 after UAE
1-3%
what is the overall rate of ovarian failure after UAE in the FIBROID registry
7% (almost all were >45)
is there any change in timing of menopause in women <45 years old after UAE
NO
The timing of natural menopause after uterine fibroid embolization: a prospective cohort study
volume of blood loss in post partum hemorrhage
> 500 cc after vaginal delivery or >1000 cc after cesarean delivery
uterotonic drugs used in postpartum hemorrhage
oxytocin, methylergonovine, prostaglandin analogs
Clue on angiography that there may be clinical failure of embolization of a post-partum hemorrhage
- A narrow uterine artery (ascending branch equal to or smaller than 4Fr catheter diameter)
- Or branches to the uterine body that are smaller than a microcatheter
- these indicate vasospasm
JVIR Jan 2023 CME
in what percentage range do the ovarian arteries supply uterine fibroids
5-10% of the time