Uterine Artery embolization

Question 1

age range most women are typically affected by symptomatic adenomyosis

Answer 1

41-45 years old

Question 2

long term symptom relief (12 months or more) after UAE for patients with purely adenomyosis

Answer 2

74%

de Brujin et al Uterine artery embolization for the treatment of adenomyosis JVIR 2017

Question 3

circumstances where the junctional zone is difficult to visualize

Answer 3

1. postmenopausal - myometrium looks like junx zone
2. pregnancy - junx zone looks like myometrium
3. premenarche

https://ajronline.org/doi/epdf/10.2214/AJR.10.4877

Question 4

during which part of the menstrual cycle is the junctional zone at its maximal thickness

Answer 4

menstrual phase

Question 5

phases of the menstrual cycle

Answer 5

1. menstrual phase (1-4)
2. early proliferative (5-9)
3. late proliferative (10-14, estrogen effects dominate, trilaminar endometrium)
4. secretory (15-28, progesterone effects dominate)

minstrels, prolife rally, secretary

Question 6

if you see a thickened junx zone in a postmenopausal patient, you should ask if they are on ….

Answer 6

hormone replacement therapy

Question 7

The types of adenomyosis seen on MRI

Answer 7

1. Diffuse adenomyosis - entire junx zone is thickened
2. focal adenomyosis - part of the junx zone is involved
3. adenomyoma

Question 8

risk factors for adenomyosis

Answer 8

1. prior endouterine surgery

2. multiparity

Question 9

Direct signs on MRI for adenomyosis diagnosis

Answer 9

1. submucosal microcysts - usually located within the junx zone (but can also be found in outer myometrium)
2. adenomyoma - well-delineated myometrial mass distinct from the junx zone

Question 10

way to distinguish adenomyoma from leiomyoma

Answer 10

adenomyoma often will have high-signal intensity foci on T2

Question 11

Indirect signs on MRI for adenomyosis

Answer 11

thickness of the junx zone

Question 12

junctional zone thickness used when establishing the presence of adenomyosis

Answer 12

greater than 12 mm

Question 13

what non-surgical or procedural treatment has found to be effective for treating adenomyosis

Answer 13

Mirena IUD, which is a levonorgestrel-releasing intrauterine system (lng-IUS)

Question 14

what are the side effects for treating adenomyosis with a Mirena IUD

Answer 14

1. weight gain (28.7%)
2. ovarian cyst (22.3%)
3. Lower abdominal pain (12.8%)
4. 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

Question 15

when is Mirena IUD unlikely to work

Answer 15

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

Question 16

is sloughing normally an issue for adenomyosis

Answer 16

no

Question 17

according to a 2017 meta-analysis, what is the long-term (>12 month) success rate for UAE in treating adenomyosis

Answer 17

74% (318/430)

Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis

Question 18

according to a 2017 meta-analysis, what is the long-term (>12 month) success rate for UAE in treating adenomyosis and fibroid

Answer 18

85.4%

Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis

Question 19

in the 2017 meta-analysis, what was the secondary hysterectomy rate after treating adenomyosis with UAE

Answer 19

only 7.2%

Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis

Question 20

according to the article “long-term durability of UAE for treatment of symptomatic adenomyosis,” what was the overall “success” rate at 52 months

Answer 20

80% of 115 patients remained symptom free

10% recurrence rate in 5 years

Question 21

how often do endometriosis and adenomyosis co-exist

Answer 21

80% of the time

Question 22

if a patient no longer has menorrhagia but still has dysmenorrhia after UAE for adenomyosis, what should you do

Answer 22

refer for laparoscopy for possibly endometriosis

Question 23

does adenomyosis negatively affect fertility and pregnancy

Answer 23

YES

Question 24

other than a Mirena IUD, what other medication can be used for adenomyosis

Answer 24

GnRH agonists - can produce a “medical menopause” and induce amenorrhea
***can only use for 6 months max

Question 26

what is the rate of ovarian failure for women younger than 40 after UAE

Answer 26

1-3%

Question 27

what is the overall rate of ovarian failure after UAE in the FIBROID registry

Answer 27

7% (almost all were >45)

Question 28

is there any change in timing of menopause in women <45 years old after UAE

Answer 28

NO

The timing of natural menopause after uterine fibroid embolization: a prospective cohort study

Question 29

volume of blood loss in post partum hemorrhage

Answer 29

> 500 cc after vaginal delivery or >1000 cc after cesarean delivery

Question 30

uterotonic drugs used in postpartum hemorrhage

Answer 30

oxytocin, methylergonovine, prostaglandin analogs

Question 31

Clue on angiography that there may be clinical failure of embolization of a post-partum hemorrhage

Answer 31

1. A narrow uterine artery (ascending branch equal to or smaller than 4Fr catheter diameter)
2. Or branches to the uterine body that are smaller than a microcatheter
   - these indicate vasospasm

JVIR Jan 2023 CME

Question 32

in what percentage range do the ovarian arteries supply uterine fibroids

Answer 32

5-10% of the time