Uterine artery embolization (UAE). Uterine embolization for myoma - stages of UAE, results of uterine artery embolization and price In which cities is ema done

The most common treatment for symptomatic cases is removal of the organ. This is motivated by traditional ideas about the lack of significance of the uterus in the body after the implementation of its reproductive function. In most cases, such a radical approach is not justified by anything, since there is practically no risk of malignancy of these neoplasms. At the same time, uterine artery embolization for uterine myoma (UAE) allows saving the organ.

Method principle

Many gynecologists still believe that the uterus is just a "fetus" and its removal does not entail any negative consequences. In connection with this approach, about 800 thousand operations to remove an organ are performed throughout the country within 1 year.

However, this routine representation is not consistent with scientific research. After a hysterectomy, the following consequences may develop:

• posthysterectomy syndrome (in 30%); it is characterized by the same symptoms that occur during a severe course of the postmenopausal period - a change in body weight, mood, psyche, pronounced vegetative disorders (sweating, rises in blood pressure, cardiac arrhythmias, etc.), an increase in the frequency of cardiovascular diseases, etc. ;
• increased risk of breast and thyroid cancer;
• negative impact on sex life.

Thus, the removal of an organ that, it would seem, no longer performs any functions, can lead to severe disorders in a woman's body. Of course, there are cases of disease in which there is no other alternative.

Another surgical treatment is to remove only the fibroids while preserving the uterus (conservative myomectomy). It is performed through laparoscopic, laparotomy, or hysteroresectoscopic myomectomy. The main goal is the temporary restoration of the uterus by completely or partially removing myomatous nodes, which can affect the processes of conception or pregnancy. This temporarily gives the woman the opportunity to exercise her reproductive function. A woman can become pregnant and give birth after such an operation in six months.

Myomectomy is a conservative (temporary) method because recurrence occurs in 5-7% after 1 year, in 14% after 2 years, and after 5 years, as a rule, new myomatous nodes appear in most operated patients.

A relatively new method is the treatment of fibroids using the UAE method. Embolization of the uterine arteries is the most promising and quite popular method. Its technology has been known since the 70s. In order to treat these tumor-like formations, since the year 2000, it has been used everywhere.

With uterine myoma, UAE is performed by a vascular surgeon in a specially equipped operating room, which is equipped with angiographic equipment. The operation is the introduction of microparticles of polyvinyl alcohol (emboli) with a size of 300-500 or 500-700 microns into the uterine arteries, the branches of which feed the myomatous nodes with blood.

Operation of uterine artery embolization

The operation is performed under local anesthesia with the addition of sedatives. A microcatheter is inserted into the femoral artery through a puncture in the thigh. Further, under the control of angiography and fluoroscopy, the latter is carried out precisely into the necessary uterine vessels. After that, emboli are slowly introduced along it, previously mixed with saline and a radiopaque substance to a state of suspension. Getting into the terminal small branches of the vessels, the particles block their lumen.

Polymer emboli are also produced for embolization of the uterine arteries, which contain 94% water. They almost do not cause an inflammatory reaction in the area of ​​the vessel into which they are injected, and also help to minimize the risks of affecting healthy areas of the uterus and restoring blood circulation in the myomatous nodes.

The introduction of the solution continues until the cessation of blood flow, as a result of which, after embolization of the uterine arteries, the supply of myomatous nodes with blood gradually stops. In the future, they undergo sclerosis (“drying out”), that is, replacement with connective tissue and a decrease in size. Small nodes (less than 3-4 cm) undergo myolysis, that is, complete dissolution and disappearance.

The duration of the operation itself is on average from 10 minutes to half an hour, but together with preliminary preparation, it takes about 1.5 hours. In order to reduce or eliminate pain after uterine artery embolization, non-narcotic analgesics and sedatives are re-introduced intravenously after the procedure is completed.

As a result of this operation, uterine bleeding and other symptoms of the disease stop. During the first six months after UAE, the number of nodes decreases by 40-60%, after which the dynamics of their reduction or myolysis slows down somewhat, but does not stop. Due to the decrease in blood supply and the uterus itself, it also decreases in size and, on average, acquires normal dimensions within 1 year.

Despite the cessation of blood supply to the myometrium by the uterine arteries, which subsequently are no longer restored, the blood flow in the uterus does not completely stop. It is compensated from other sources, due to the peculiarities of the vascular network of the organ. Due to the development of new vessels within, as a rule, 2-3 weeks, the blood supply to healthy tissue becomes the same.

This does not happen with myomatous nodes, since their vascular system is imperfect, and they become sclerotic. In the future, the uterus itself seems to “reject” the nodes that have decreased and become alien, especially the submucosal ones, which gradually move closer to its cavity, “flow out” or “are born”. The method can be used to treat nodes of any number and any size.

The expediency of its use is also explained by the fact that pregnancy after embolization of the uterine arteries is quite possible. Moreover, such an operation is an alternative to any other surgical methods, when there is a need to preserve the uterus in the reproductive age of a woman. This is especially true in those cases in which surgical myomectomy is difficult or associated with serious complications in terms of the possible loss of fertility.

Possible consequences of uterine artery embolization and rehabilitation

They consist in the development in the immediate postoperative period in 30-40% of women of post-embolic syndrome of varying severity, which manifests itself:

• "spilled" pain in the lower abdomen;
• fever and chills;
• general weakness or slight discomfort;
• nausea and vomiting;
• an increase in the number of leukocytes and ESR during a general blood test.

These symptoms reach their maximum within 6 to 8 hours. As a rule, their duration is 1-2 days. They are associated with malnutrition of individual sections of the uterus and a reaction to the introduction of a contrast agent into the vascular bed. Despite the fact that the patient can be discharged from the hospital home on the 2nd - 3rd day, when pain, nausea and vomiting stop, and the ability to take drugs inside is restored, some signs of post-embolic syndrome in some patients may persist with a progressive decrease up to 2 weeks.

rehabilitation period

Rehabilitation after em in the immediate postoperative period depends on the severity of post-embolic syndrome and is aimed at its relief. For these purposes, non-narcotic or narcotic short-acting analgesics are repeatedly introduced. With a significant pain syndrome, epidural prolonged analgesia is possible. In addition, antipyretics, desensitizing, antiemetics and sedatives are used intravenously or intramuscularly.

In order to more quickly remove the radiopaque solution from the body, reduce the severity of intoxication and improve the general condition, many hours of infusion therapy with electrolyte solutions in a volume of 3 or more liters is carried out for 1 day. This is done under the control of diuresis (daily urination) by inserting a catheter into the bladder.

Other negative consequences of uterine artery embolization are an anaphylactic reaction to a radiopaque drug and the addition of infectious endometritis. These complications can be avoided with proper examination and careful selection of patients for the procedure, and preventive antibiotic treatment is prescribed before and after the procedure to prevent infectious complications.

Sometimes the emerging temporary is not a complication, but a permanent one is possible in premenopausal women, which is a favorable factor in terms of stopping bleeding.

The main recommendations after the operation are abstinence from sexual intercourse, refraining from lifting weights, taking hot baths and visiting the bath, increasing the drinking regimen during the first week, as well as revisiting the surgeon after 7 days - 1 month and control ultrasound examinations after 1 month , six months and 1 year. Sex life after uterine artery embolization can be restored at the end of the first menstruation after the procedure.

Indications and contraindications

Indications for uterine artery embolization are:

1. The same indications that exist for the surgical treatment of poppy fibroids.
2. An isolated form of adenomyosis of the uterus, as well as its predominance when combined with fibroids. In this case, UAE is an alternative to hysterectomy.
3. in the late reproductive or early premenopausal periods. In this case, UAE is the initial stage of complex treatment carried out in order to preserve the organ.
4. Some cases of postpartum hemorrhage (dense accreta of the placenta).
5. Amyloidosis of the uterine arteries, as well as the pathological relationship of the arterial vessels of the small pelvis with the venous vessels, which is congenital (malformation).
6. Preparation for surgical myomectomy (removal of fibroids) in the presence of a very large node (more than 20-22 weeks) in order to reduce its volume to reduce the trauma of the operation, as well as anemia that occurred during myomatosis as a result of prolonged and/or heavy bleeding.
7. Palliative treatment of uterine cancer: UAE stops bleeding from cancer and increases the effectiveness of chemotherapy treatment.

In addition, compared with surgery, the treatment of fibroids by uterine artery embolization is more preferable in the presence of obesity, hypertension, varicose veins and diabetes mellitus.

The main contraindications to UAE:

1. Allergic or anaphylactic reactions in the past to the introduction of radiopaque drugs.
2. Pregnancy and the presence of an acute infection of the uterus and appendages.
3. and on a thin stem, since the former can be more easily removed by the affordable low-traumatic hysteroscopic method, and in the latter case there is a risk of subsequent separation of the node into the abdominal cavity.
4. Coagulopathy (blood clotting disorders) that are not amenable or difficult to correct.
5. Malignant neoplasms of the internal genital organs.
6. Severe chronic renal failure.
7. Autoimmune diseases of the connective tissue.
8. Condition after radiation treatment of the pelvic organs.

Thus, the prospects and benefits of treatment through uterine artery embolization are associated with:

• the possibility of preserving the organ;
• the short duration of the procedure and the long-term preservation of the effect obtained;
• with a rare number of relapses of the disease;
• with a high percentage of regression of myomatous nodes, symptoms and volume of the uterus;
• with no significant complications and side effects;

with the possibility of treatment in patients with concomitant pathology of other organs and systems.

Unfortunately, doctors have not yet come up with a 100% effective and most harmless way to treat fibroids. Despite the fact that this problem mainly occurs after 35, for many women it is very important to solve it without harm to reproductive function.

Uterine artery embolization (UAE) for uterine myoma today is one of the most common modern methods of treatment, which allows minimal impact on the organs.

A procedure such as UAE has been used by gynecologists in their practice since 1979. Initially, it was used to stop bleeding as a result of operations on the uterus or after childbirth. Since the 90s of the last century, doctors have begun to use it to treat fibroids. In Russia, it has been allowed for almost 10 years - since 1998.

The first time it was done in 2001. The procedure is less traumatic, as it is carried out according to the microsurgical technique. The principle of action is to clog the vessels, due to which the nutrition of the neoplasm cells stops. Due to this, they die off and the node begins to decrease, and then completely disappears.

The procedure is truly innovative, since before that the neoplasm was treated only by removal.

Moreover, along with the knot, the uterus and ovaries were often cut out. The main advantage of such treatment is the preservation of all organs and a high probability of a woman's full recovery of health. Therefore, first of all, UAE is indicated for those who dream of becoming pregnant, bearing and giving birth to a child.

• No scars or cuts left
• It is carried out without anesthesia, due to this, the recovery period is very short
• According to statistics, the method is effective in 95% of cases

• The likelihood of a tumor recurring is much lower than after surgery.

Indications and contraindications

Each case of the disease is individual, therefore, a doctor can prescribe a similar method of treatment only after a thorough diagnosis.

• If there are contraindications to surgical interventions, for example, anesthesia
• Education grows in size
• If the node continues to grow after deletion
• For bleeding after childbirth
• If the patient is going to have children in the future and she needs to save the organ
• If you have adenomyosis or endometriosis

Although the procedure involves minimal intervention, it can not be done by everyone. There are the following contraindications:

• The presence of multiple nodes
• genital cancer
• Pregnancy

• Allergy to drugs used to block blood flow
• Large tumor, from 25 weeks
• Inflammatory processes
• kidney failure

In addition, doctors may not undertake the procedure if the node is growing too fast.

Preparation and course of embolization

Embolization of uterine fibroids is prescribed after a thorough examination, which includes:

• Donation of urine and blood
• Blood test for the presence of hepatitis B and C viruses, HIV
• Electrocardiogram
• Ultrasound using a transvaginal probe
• A smear for the study of the microflora of the vagina
• Colposcopy - examination of the cervix using a special optical device
• Oncocytology - examination for the presence of cancer cells

• Study for sexual infections
• The conclusion of the therapist and other doctors (in case the patient has chronic diseases).

You need to prepare for manipulation. One week in advance, start wearing compression garments. Since there is an impact on the vessels, support for the veins in the legs is necessary. This underwear will need to be worn for about a week after. In addition, hair should be removed from the thighs and groin. Breakfast is not allowed on the day of the procedure. If the patient is very worried, he is given a sedative.

The procedure is performed in the supine position and takes about half an hour. The injection site - the inguinal fold - is anesthetized with a local anesthetic and treated with an antiseptic. The doctor then inserts the catheter. It goes to the left uterine artery.

A special substance is introduced into it, which allows you to monitor the movement of the catheter through an x-ray. If everything is done correctly, the surgeon begins the introduction of embolizing drugs that block the vessels of the artery. Thus, the blood supply to the cells of the node stops. The same steps are repeated on the right side. During the procedure, a woman may feel warmth in her legs and uterus.

Different substances are used to block the blood supply to fibroids. These may be non-spherical PVA particles. They are taken most often. However, due to the irregular shape, there is a risk that the blood will begin to feed the tumor cells again. Tissue inflammation may also occur. A more modern preparation is Bead Block spherical microparticles. It allows the use of a thin catheter, does not cause inflammation, and the risk of damage to healthy uterine cells is lower.

After the end of the manipulation, a pressure sterile bandage is applied at the puncture site, which avoids hematoma. It needs to be worn for about half a day. In addition, the patient should remain in a supine position for 5-6 hours and not bend the leg.

Complications and rehabilitation

Some time after the procedure, the patient experiences pain in the lower abdomen, which may be accompanied by weakness, fever and nausea. This state continues for several days.

Often, in public hospitals, the patient is allowed to go home after six days, while in private hospitals they try to discharge them early. Sometimes it is possible even on the first day.

After manipulation during the week, you can not lift weights, do hard physical work, go to baths or saunas, take baths. It is best to lie down during this period. It is recommended to drink more fluids.

Do not take blood thinners such as aspirin. In the first three months, it is forbidden to use tampons.

To facilitate rehabilitation, the doctor prescribes painkillers and anti-inflammatory drugs.

The first ultrasound is performed after seven days, the next - after a month. Then, depending on how the fibroid behaves, the doctor prescribes an individual observation. Sexual activity is allowed after menstruation.

In addition to the usual postoperative symptoms, complications may occur:

• Hematoma at the injection site. Passes in a few days
• Perforation of the uterine arteries. Happens very rarely
• Infection. If this happens, the doctor will treat with antibiotics.
• Intoxication with a substance with which the surgeon tracked the movements of the catheter. For elimination, infusion therapy is prescribed. It helps to quickly remove this drug from the body.
• Poor circulation in the uterus
• Cycle failure for about six months

If you turned to a good clinic for help, do not be afraid of complications. According to statistics, they occur in 1% of patients.

Efficiency and result

Immediately after UAE, the node begins to shrink, and the cells of the uterine fibroids are replaced by connective tissue. In a year, it can decrease by four times or completely disappear. After a certain time, the cycle normalizes, the sensation of squeezing the internal organs disappears. When recovery occurs, the doctor may allow planning a pregnancy.

Often you need to wait 1.5-2 years. You should be prepared for the fact that after the illness there are risks of miscarriage. Miscarriage or fetal complications often occur. Therefore, all nine months it is necessary to be under the close supervision of a doctor.

It is very important to prevent pregnancy until such time as the doctor gives the green light, as this condition can lead to severe hormonal stress, and a possible abortion will further aggravate it.

How much does EMA cost and where can it be done

UAE is done by vascular specialists. Not every clinic can offer treatment, since not everywhere there is angiographic equipment. In addition, not all doctors have the necessary experience. The procedure is performed by an endovascular surgeon.

In Russia, there are good specialists in this field in the Leningrad region, Moscow, Novosibirsk.

Embolization of the uterine arteries is done on expensive equipment, so the price of this method of treating uterine fibroids is quite high. In addition, expensive drugs are used for anesthesia and occlusion of blood vessels. Often the cost of the entire procedure exceeds 100 thousand rubles. In the capital, it can cost over 200 thousand rubles. Patients can do such a manipulation for free, under the MHI policy. But their number in each region is limited. First issued to certain groups of the population. Then, in order.

To get a quota, you need to contact the state institution that performs the procedure, or to your gynecologist. Further, a special commission considers the application and makes a decision.

uterine fibroids(leiomyoma, fibromyoma) is a benign tumor that develops in the walls of the uterus or on its neck and is non-oncological in nature.

Uterine fibroids happen:

Fibroids vary in size from a few millimeters to centimeters. In the latter case, the doctor easily finds a neoplasm during a gynecological examination.

In gynecology, the degree of development of fibroids is compared with the size of the uterus at a particular gestational age - 4, 12 weeks, and so on.

There is a classification of uterine fibroids depending on the location of the neoplasm:

Uterine fibroids develop for reasons:

Symptoms

Often, uterine fibroids develop asymptomatically, they are accidentally found during the next examination by a gynecologist. There are likely cases where there are symptoms, but they are not perceived as such. The most striking signs of the disease are observed with submucosal uterine myoma.

In general, the disease can indicate:

Diagnosis and treatment

Diagnosis of uterine fibroids is carried out using:

Uterine fibroids can be cured in a conservative, surgical or combined way.

For embolization, calibrated polyvinyl alcohol microspheres are used, which, when mixed with a solution or contrast, swell and stick together in the lumen of the vessel. The cessation of circulation in the distal vascular bed causes ischemia in the myomatous nodes to a greater extent, since the arteries in the nodes are terminal, and the myometrium has a rich collateral blood supply. Myoma nodes after embolization undergo coagulation aseptic necrosis, organization and sclerosis with calcification of the capsule.

Indications for embolization

Uterine artery embolization in myoma is used for interstitial and submucosal location of the tumor with a maximum node diameter of 7-8 cm and a total size of the uterus no more than 12-13 weeks. With large myomatous nodes and subserous localization of the neoplasm, endovascular embolization is used as a stage of preoperative preparation for laparoscopic myomectomy. The operation is indicated for the symptomatic course of fibroids in the form of menometrorrhagia, chronic pain syndrome, dysfunction and compression of adjacent pelvic organs. UAE is effective in the treatment of adenomyosis, which allows the use of the technique in comorbidities. Embolization is also recommended for infertile patients in whom uterine fibroids are the main cause of infertility.

Embolization Contraindications

Contraindications for uterine artery embolization in fibroids are:

• pregnancy;
• acute infectious diseases;
• renal and hepatic insufficiency;
• allergy to iodine;
• intolerance to radiopaque substances;
• diseases of the blood coagulation system.

On the part of the genitals, contraindications are:

• inflammatory processes in the area of ​​​​the external and internal genital organs;
• hyperplasia;
• endometrial cancer;
• precancerous and malignant lesions of the cervix and uterine appendages.

The procedure is not recommended in the presence of a single subserous node on the leg (high risk of developing peritonitis due to the migration of the node into the abdominal cavity), as well as in the case of rapid growth of fibroids with suspected uterine leiomyosarcoma.

Preparation for embolization

After consulting a gynecologist and an endovascular surgeon, the patient is assigned a list of laboratory and instrumental studies that she can perform in a polyclinic. The general preoperative examination includes:

• coagulogram, blood type and Rh factor;
• tests for syphilis, HIV, viral hepatitis;
• fluorography;
• examination by a therapist with an ECG;
• bacteriological examination of vaginal discharge;
• cytological analysis of smears from the vaginal part and endocervix of the cervix;
• colposcopy;
• Ultrasound of the pelvic organs with color Doppler mapping.

Before embolization of the uterine arteries in fibroids, an RDD with hysteroscopy or an aspiration biopsy of the endometrium with a histological assessment of the biopsy is mandatory. According to indications, magnetic resonance imaging is performed.

The patient needs to shave the area of ​​​​the right thigh and groin in advance. Embolization is performed on the day of hospitalization, so you need to enter the department on an empty stomach. Before intervention, an elastic bandage is applied to the lower limbs; medical compression stockings can be used. Direct preparation for the operation consists in the appointment of sedative, anti-inflammatory and analgesic drugs, preventive antibiotic therapy, emptying the bladder and its catheterization with a Foley catheter.

Methodology

The UAE procedure is performed by an angiosurgeon in an X-ray operating room equipped with a digital angiographic apparatus, under local anesthesia. The arterial access to the uterine vessels is often the right common femoral artery, which is punctured and catheterized according to the Seldinger technique.

In the right inguinal region, the pulsation of the femoral artery is determined by palpation, the skin and underlying tissues are infiltrated with an anesthetic solution. The puncture needle is inserted into the lumen of the artery at an angle of 45 degrees. An introducer is installed along the guide system, through which a specially modeled catheter is inserted into the aorta.

For embolization of the uterine arteries in fibroids, a thin radiopaque catheter with a soft atraumatic tip is used.

First, selective catheterization and embolization of the contralateral (left) uterine artery are performed. The catheter is lowered along the conductor under the control of fluoroscopy into the left internal iliac artery. To assess the anatomy of the internal iliac artery and the nature of the blood supply to the uterus, the angiosurgeon performs selective angiography by injecting an iodine-containing contrast agent and taking a series of images.

Using a controlled hydrophilic conductor, the catheter is placed at the mouth of the uterine artery, the conductor is removed, and superselective arteriography of the pool of the left uterine artery is performed. On the obtained angiograms, the diameter of the uterine artery, the nature of the anastomoses (messages) with the ovarian arterial system, as well as the architectonics of the vessels in the nodes are evaluated to exclude atypia. The surgeon obtains an angiographic image of the vascular network of uterine fibroids, which has the appearance of a rounded perifibroid plexus surrounding the myomatous node.

The end of the catheter is maximally advanced in the distal direction, stepping back from the place of origin of the cervical-vaginal branch. Next, proceed directly to the stage of embolization.

A syringe with microspheres for embolotherapy is attached to the catheter, the embolizate is injected with a fractional movement until the arterial blood flow in the myomatous nodes is completely stopped. Moving with the blood flow, embolizing particles block the lumen of pathological vessels.

The effectiveness of endovascular intervention is assessed using control arteriography, which determines the break in the contrast of the uterine artery trunk. Similarly, manipulation is carried out from the ipsilateral (right) side. Upon completion of the operation, the catheter and introducer system is removed, hemostasis of the puncture site is performed by finger pressure and applying a pressure bandage. The duration of embolization of the uterine arteries in myoma is 20-40 minutes.

Postoperative rehabilitation

After the operation, the patient is taken to the ward on a gurney and allowed to get out of bed the next morning. Ice is applied to the puncture site, the punctured leg must be kept in a straightened position for 6 hours. The next day after the manipulation, the urinary catheter and pressure bandage are removed. Within 7-10 days it is necessary to maintain elastic compression of the veins of the lower extremities, limit physical activity.

Within 2-5 days after embolization of the uterine arteries in myoma, a specific clinical and laboratory symptom complex develops - post-embolic syndrome. It includes local pain of varying intensity, nausea, vomiting, fever, bleeding from the genital tract, dysuria, leukocytosis, and increased ESR. To stop the manifestations of symptoms of post-embolic syndrome, the patient is prescribed infusion, antiemetic, analgesic therapy, and continues treatment with antibacterial drugs. The duration of hospitalization is 2-5 days.

Normalization of the menstrual cycle occurs after 3 months. A week after UAE, a gynecological examination is prescribed. To assess the dynamics of regression of myomatous nodes and their migration, ultrasound monitoring is performed after 3, 6 and 12 months. A decrease in the size of the tumor and the volume of the uterus by 50% or more is observed during the first year, the symptoms of compression (squeezing of neighboring organs) disappear after 6 months. after operation. The dose of X-ray exposure that the patient receives during the procedure is minimal and acceptable.

Complications after UAE

Complications after uterine artery embolization in myoma are rare (less than 4% of cases). The most common side effect is hematoma of the right thigh in the area of ​​arterial puncture, which does not require additional therapy and resolves on its own. Other possible complications are associated with expulsion (migration) of the tumor into the abdominal cavity or uterine cavity:

• endometritis;
• pyometra;
• peritonitis.

With embolization of the proximal descending (cervicovaginal) branches of the uterine artery, sexual dysfunction and vaginal dryness are observed.

Embolization of the uterine artery for fibroids in Moscow is performed in clinics that are equipped with digital angiographic equipment and have specially trained endovascular surgeons on their staff.

Cost of uterine artery embolization for myoma in Moscow

The price of the operation is determined by several factors. In public medical institutions, this intervention, as a rule, costs less than in private clinics.

When the procedure is carried out by a highly qualified specialist, the cost of embolization increases. The price of uterine artery embolization for fibroids in Moscow is affected by:

• the number of laboratory and instrumental studies;
• volume of preoperative drug preparation;
• the amount of iodine-containing contrast agent used in the selective angiography process.

All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

Uterine artery embolization (UAE) is a modern procedure that allows you to get rid of fibroids (benign tumors) without surgery. When it is carried out, plasticizer balls are introduced into the arteries that feed the neoplasm, which block the blood flow. As a result, the fibroids cells die. Complications after embolization are rare, during the first year after it, periodic monitoring of the state of the uterus by ultrasound is necessary.

Indications for embolization

• Growing uterine fibroids;
• Large neoplasms;
• Unavailability of surgical methods of intervention;
• Abundant bleeding;
• severe pain;
• The desire of a woman to save an organ.

Contraindications

The procedure is not carried out when:

1. Inflammatory diseases;
2. Allergies to the drug used to block blood vessels;
3. pregnancy;
4. The presence of a malignant tumor in the body;
5. Renal failure (this makes it difficult to use a contrast agent).

Relative contraindications are:

• Rapid growth of fibroids;
• Subserous (superficial) node on a thin stalk.

Preparation for EMA

Before the procedure, the patient must undergo the following studies:

In the morning before hospitalization, you need to refuse food and water. Some experts advise not to eat the night before. Hair must be removed from the groin and thighs. If the patient has varicose veins, it is recommended that she start wearing compression stockings a week before embolization. If the patient is worried, she will be given an injection of a sedative half an hour before the procedure.

EMA move

The procedure is performed in an X-ray angiography room. Anesthesia is usually local. For large neoplasms, epidural anesthesia is prescribed. Sometimes, before UAE, curettage is performed (scraping from the entire inner surface of the uterus). The patient is placed in a catheter into a vein in her arm and into her bladder.

An incision is made in the woman's groin and a catheter is inserted into the femoral artery. Its diameter is only a few millimeters, so the scar will be almost invisible. First, a contrast agent is injected into it for better visualization of the vessels. Embolization takes place under X-ray control, the radiation dose is minimal.

The catheter reaches the blood vessels that feed the myoma. Embolization preparation balls are introduced into it. They can consist of various materials, but the products of the Biosfere Medical company are most often used. These balls are made of gelatin coated acrylic. This ensures their elasticity and non-stickiness - important qualities for such drugs. The balls block the arteries, and the blood supply to them stops. The catheter is removed. A pressure bandage is applied to the puncture.

The node itself can be “born” after some time. Sometimes you have to use medical abortion to exit the tumor from the uterus. In some cases, after shrinking the fibroids, other methods of removal become possible, which will allow you to finally get rid of it.

Video: uterine artery embolization

Recovery period

After UAE, the patient is taken to the ward. On the first day, she is actively monitored. She periodically takes painkillers. A slight malaise is a normal reaction of the body to the death of fibroids. It usually goes away within 2-3 days. In public hospitals, hospitalization lasts an average of 6 days, in private hospitals they try to discharge the patient as soon as possible.

With severe intoxication, infusion therapy is performed. An electrolyte solution is inserted into a vein, and a catheter is inserted into the bladder. This helps to remove the contrast agent from the body and reduce the symptoms of intoxication.

Important! After discharge, the patient needs to limit physical labor for a week, exclude weight lifting, visiting a bath or sauna. The first ultrasound is performed after 7 days, the second - after a month. Further tactics are based on the response of the myoma to embolization. Sexual life is recommended to begin after the end of the first menstruation.

Complications

After uterine artery embolization for uterine fibroids, patients may experience the following consequences:

EMA results

Small tumors are removed immediately, large tumors after embolization gradually decrease in size. A year later, their size is reduced by 4 times. The cells of large fibroids themselves are replaced by connective tissue. Sometimes a second UAE is required.

The most common concern for patients is the possibility of pregnancy after UAE. The procedure worsens the blood supply to the uterus, which can affect the condition of the fetus. Often you have to take special drugs until childbirth. In order for the blood supply to be restored, it is worth planning a pregnancy after a year after embolization.

The formation of adhesions after the procedure may prevent conception. Although such a risk exists when using any technique to combat fibroids. In some cases, the growth of the endometrium (the inner surface of the uterus) is disrupted as a result of a violation of its blood supply. This prevents the formation of the placenta when a fertilized egg is attached. As a result, pregnancy does not occur.

EMA Alternative

Arterial embolization is fraught with a number of complications, therefore, in modern practice, it is recommended if there are contraindications for hysteroscopy with resection or laparoscopy (removal of a tumor with access from the cervix or through a puncture in the abdominal cavity). On the one hand, stopping the blood supply to fibroids looks less traumatic, but in fact it is a more rude intervention in the body with consequences that are not always predictable.

The choice of technique often depends on the personal position of the gynecologist. rather than specific indications or contraindications. Therefore, before making a decision, it is important to find a specialist who inspires confidence, who has shown his competence. Doctors agree that embolization can definitely be recommended to women in the pre- and postmenopausal period who no longer plan to conceive.

The cost of EMA, the procedure for obtaining a quota

The procedure can be carried out free of charge under the CHI policy, because. it refers to high-tech types of assistance for which targeted funds are allocated. Since the amount of these funds is limited, the appointment of EMA is carried out according to quotas - first of all, certain groups of the population go, others receive assistance according to the queue.

The number of free procedures depends on the region. To obtain a quota, you must contact a consulting gynecologist or directly to the specialists of the state medical institution where UAE is performed. The conclusion is issued by a special commission.

The price for EMA is quite high and averages 100,000 - 200,000 rubles. This cost is associated with the use of expensive high-precision equipment, as well as with the need for hospitalization.

The best medical institutions performing UAE

Uterine artery embolization has been approved for use in Russia since 1998. The corresponding order was signed by the Ministry of Health of the Russian Federation. The first procedure was carried out in 2001 by Professor S.A. Kapranov. Today he is one of the best specialists in the country dealing with this issue. He receives in Moscow at the Center for Endovascular Surgery. The cost of EMA is 140,000 - 200,000 rubles.

Also in the capital is a student of S. A. Kapranova Boris Yuryevich Bobrov. He performed his first embolization in 2002. He has a number of publications and awards for his scientific developments. B. Yu. Bobrov receives patients and performs UAE at the European clinic. The total cost of the procedure is 215,000 - 225,000 rubles.

You can undergo embolization free of charge (according to a quota) at the Volyn Clinical Hospital No. 1. It is possible to carry out the procedure for a fee, the issue price is 40,000 rubles. Carries out embolization of the uterine arteries by the head of the department, Ph.D. Shelesko Andrey Anatolievich. He periodically undergoes internships abroad, participates in seminars and scientific sessions, which allows him to keep abreast of the latest methods and developments, both Russian and Western doctors.

In the Leningrad region (in the city of Sestroretsk), one can note the state hospital No. 40, deserved a lot of positive feedback from patients. Many try to do all the research and the embolization itself in this institution. Hospital workers assist in obtaining quotas, but they work only with residents of St. Petersburg and the region. The institution has modern equipment, among the specialists working there, one can note Tsivyan Boris Lvovich, head of the gynecological department. Embolization of uterine vessels is not directly within the scope of his scientific and applied interests, but for diagnosis and advice, many patients are advised to contact him. Conducts the procedure V.S. Vlasenko is a surgeon with great experience and experience.

Another expert in uterine artery embolization works in Novosibirsk, at the Institute of Clinical and Experimental Lymphology (NIIKEL). A member of the Russian Society of Surgeons, a surgeon of the highest qualification category, Shumkov Oleg Anatolyevich personally conducts EMA. The first type of such intervention was carried out by him in 2013. NIIKEL is a state institution, therefore reception and all necessary procedures for patients admitted under the quota are free of charge. It is important that Shumkov O.A. is a specialist in the field of vascular surgery, and not exclusively a gynecologist, this increases the effectiveness of his procedures and reduces the risk of complications.

Video: embolization of uterine fibroids in the perinatal center