UTERINE FIBROID EMBOLIZATION.RIGHT UTERINE ARTERY DIGITAL SUBTRACTION ARTERIOGRAM.LEFT UTERINE ARTERY
DIGITAL SUBTRACTION ARTERIOGRAM.RIGHT COMMON FEMORAL ARTERY DIGITAL SUBTRACTION ARTERIOGRAM.INDICATI
ON: 42-year-old female with bulky uterine fibroids resulting in significant heavy menstrual bleed and
secondary anemia PROCEDURE:The risks, benefits and alternatives to the procedure were discussed in de
tail in a prior visit by the patient to the outpatient intervention radiology clinic. The risks of va
scular injury necessitating further intervention including surgery, inadvertent nontarget embolizatio
n with possible lower extremity ischemia, endometritis and infection to the uterus necessitating hosp
italization, intravenous antibiotics and remote possibility of hysterectomy, as well as premature men
opause were relayed to the patient. The benefits of a voiding hysterectomy and its complication were
discussed. The alternatives of oral medications, myomectomy and hysterectomy were discussed. Informed
consent was obtained after thorough discussion.The patient`s identity and procedure confirmed.Steril
e technique including hand hygiene, cap, mask, sterile gown, and sterile gloves are used. The patient
was placed in the supine position. The right groin was prepped and draped in a sterile fashion with
2% chlorhexidine and a large sterile sheet. The right common femoral artery was evaluated with real-t
ime ultrasound imaging and found to be patent. A hard copy image was obtained and sent to PACs.The lo
wer end of the right femoral head was identified by fluoroscopy and was marked on the skin using ster
ile marker.Under ultrasound guidance, the right common femoral artery was accessed using 21-gauge nee
dle followed by advancing in 018 mandrel wire into the aorta. The tract was then dilated with a 5 Fre
nch micropuncture sheath. An 035 Bentson wire was then advanced into the aorta over which the tract w
as dilated using a 5 French x 10 cm vascular sheath.The vascular sheath was then attached to a contin
uous pressurized heparinized saline throughout the exam.5 French Omni Flush catheter was then advance
d over the Bentson guidewire into the mid aorta. Next the Bentson guidewire was advanced into the lef
t femoral artery using Omni Flush catheter manipulation under fluoroscopic guidance. The Omni Flush w
as then exchanged for a 5 French uterine Roberts catheter. Using catheter and guidewire manipulation,
the Roberts uterine catheter was advanced into the left uterine artery where a digital subtraction a
rteriogram was performed. Following that Progreat microcatheter and 016 microwire were then advanced
through the Roberts catheter into the distal aspect of the transverse portion of the left uterine art
ery where embolization was performed.Next Roberts catheter was pushed back into the aorta and under f
luoroscopic guidance using catheter and Bentson guidewire manipulation, the catheter was advanced int
o the right uterine artery where a digital subtraction arteriogram was performed. Following that the
Progreat catheter and 016 microwire were advanced under fluoroscopic guidance into the distal aspect
of the transverse portion of the right uterine artery where the artery was embolized.At the completio
n of the embolization, the microcatheter and Roberts catheters were removed. Right common femoral art
ery arteriogram was then performed in the right and left oblique projections to determine the adequac
y of closure device use.FINDINGS:LEFT UTERINE ARTERIOGRAM: The cervicovaginal branch is identified. N
umerous tortuous corkscrew vasculature are seen supplying the enlarged uterus containing numerous fib
roids.RIGHT UTERINE ARTERIOGRAM: The cervicovaginal branch is identified. Numerous tortuous corkscrew
vasculature are seen supplying the enlarged uterus containing numerous fibroids.RIGHT COMMON FEMORAL
ARTERIOGRAM: No atherosclerotic disease is seen. No aneurysmal formation is identified. The puncture
site of the right common femoral arteries approximately 8mm superior to the bifurcation of the right
CFA into the SFA and DFA. The puncture site is favorable for closure device use.LEFT UTERINE ARTERY
EMBOLIZATION: With the Progreat microcatheter placed in the left mid uterine artery distal to the cer
vicovaginal branch, the left uterine artery was embolized using 500-700 microns of Embospheres under
fluoroscopic guidance until complete devascularization of the uterine fibroids. Meticulous technique
was used under fluoroscopic guidance to prevent reflux of embospheres into the branches of the left i
nternal iliac artery or left common iliac artery.RIGHT UTERINE ARTERY EMBOLIZATION: With the Progreat
microcatheter placed in the right mid uterine artery distal to the cervicovaginal branch, the right
uterine artery was embolized using 500-700 microns of Embospheres under fluoroscopic guidance until c
omplete devascularization of the uterine fibroids. Meticulous technique was used under fluoroscopic g
uidance to prevent reflux of embospheres into the branches of the right internal iliac artery or left
common iliac artery.At the completion of the exam, the right common femoral artery vascular sheath w
as removed and hemostasis was achieved using closure device.MEDICATIONS: - Moderate conscious sedatio
n using Versed and fentanyl for 150 minutes under the supervision of radiology nurse. The patient`s c
ardiopulmonary status was observed throughout the exam and remained stable.- Intravenous ketorolac du
ring the procedure for inflammation.- 25 mg of intravenous Benadryl for itching.- 1% lidocaine for lo
cal anesthesia.FLUOROSCOPY: 23 minutes of fluoroscopy was used.CONTRAST: 87 mL of Visipaque 320 admin
istered intra-arteriallyCONCLUSION: Successful bilateral uterine arteries embolization.Bilateral uter
ine and right common femoral arteriogram, as described above.DISPOSITION: The patient tolerated the p
rocedure with no immediate complications. The patient was admitted for overnight observation and pain
control during which the patient was placed on PCA pump and intravenous antiemetic. The patient left
the next day in stable condition.Thank you for this referral.
HELP! Fibroid embolization and arteriogram
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