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Uterine Artery Embolization in the Primary Treatment of Uterine Leiomyomas

Technical Features and Prospective Follow-Up with Clinical and Sonographic Examinations in 58 Patients

Laurent Brunereau1, Denis Herbreteau2, Sophie Gallas2, Jean-Philippe Cottier2, Jean-Luc Lebrun3, François Tranquart4, Florence Fauchier1, Gilles Body3 and Philippe Rouleau1

1 Service de Radiologie Adultes (Pr Rouleau), Hôpital Bretonneau, CHRU Tours, F.37044 Tours, Cedex 01, France.
2 Service de Neuroradiologie (Pr Herbreteau), Hôpital Bretonneau, Cedex 01, France.
3 Départment de Gynécologie-Obstétrique (Pr Lansac), Hôpital Bretonneau, Cedex 01, France.
4 Service de Médecine Nucléaire et Ultrasons (Pr Pourcelot), Hôpital Bretonneau, Cedex 01, France.



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  		Fig. 1A. —Left uterine artery embolization in 34-year-old woman with abnormal bleeding related to uterine leiomyomas. Angiogram obtained using right femoral artery approach shows selective opacification of left uterine artery. Typical abnormal vascular network supplying large uterine leiomyoma (arrowheads) can be seen.

 


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  		Fig. 1B. —Left uterine artery embolization in 34-year-old woman with abnormal bleeding related to uterine leiomyomas. Angiogram obtained after embolization with 150- to 250-µm particles and absorbable gelatin sponge shows opacification of anterior trunk of left hypogastric artery. Stagnation of contrast medium in left uterine artery (arrow) is evident. Note reflux of contrast medium in posterior trunk of left hypogastric artery (arrowhead).

 


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  		Fig. 2A. —Right uterine artery embolization in 41-year-old woman with abnormal bleeding related to uterine leiomyomas. Angiogram shows opacification of right uterine artery that was cannulated by means of Simmons shape applied to cobra catheter. Fibroid vasculature of uterus (arrowheads) is revealed.

 


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  		Fig. 2B. —Right uterine artery embolization in 41-year-old woman with abnormal bleeding related to uterine leiomyomas. Angiogram obtained after injection of contrast medium in right hypogastric artery reveals occlusion of ipsilateral uterine artery (arrow).

 


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  		Fig. 3A. —Uterine artery embolization in 49-year-old woman with abnormal bleeding and bulk-related symptoms related to fibroid uterus. Angiogram of left uterine artery obtained before embolization reveals abnormal vascular networks related to several leiomyomas (arrowheads). Sonogram obtained several weeks before treatment (not shown) revealed diameter of largest leiomyoma was 58 mm.

 


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  		Fig. 3B. —Uterine artery embolization in 49-year-old woman with abnormal bleeding and bulk-related symptoms related to fibroid uterus. Sonogram (abdominal approach) obtained 3 months after embolization reveals 19% reduction of largest leiomyoma (arrow).

 


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  		Fig. 3C. —Uterine artery embolization in 49-year-old woman with abnormal bleeding and bulk-related symptoms related to fibroid uterus. Sonogram (transvaginal approach) obtained 6 months after embolization reveals 27% reduction of largest leiomyoma (arrow).

 


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  		Fig. 3D. —Uterine artery embolization in 49-year-old woman with abnormal bleeding and bulk-related symptoms related to fibroid uterus. Sonogram (transvaginal approach) obtained 1 year after embolization reveals 40% reduction of largest leiomyoma (arrow).

 


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  		Fig. 3E. —Uterine artery embolization in 49-year-old woman with abnormal bleeding and bulk-related symptoms related to fibroid uterus. Sonogram (transvaginal approach) obtained 2 years after embolization reveals 42% reduction of largest leiomyoma (arrow).

 


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  		Fig. 4A. —Uterine artery embolization in 33-year-old woman with bulk-related symptoms related to uterine leiomyomas. Sonogram (transvaginal approach) obtained 1 year after treatment reveals residual interstitial leiomyoma (arrows).

 


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  		Fig. 4B. —Uterine artery embolization in 33-year-old woman with bulk-related symptoms related to uterine leiomyomas. Sonographic examination (transvaginal approach) obtained 2 years after embolization reveals occurrence of new small leiomyoma close to previously described lesion (arrowheads).

 

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