ORIGINAL ARTICLE

Technical success
rate of uterine

artery embolisation
for treatment of

uterine leiomyomas
at the University of

the Free State
H F Potgieter

MBChB

C S de Vries
MMedRad(D)

E Loggenberg
MMedRad(D)

Department of Diagnostic Radiology
University of the Free State

Bloemfontein

Abstract
The technical success rate of uter-

ine artery embolisations at the
Department of Diagnostic Radiology,
University of the Free State (UFS) is
reported. From November 1998 to
July 2001, 67 women, aged 35 - 75
years, received uterine artery emboli-
sation. The procedure was usually
performed through a single 4-French
sheath set which was introduced into
the right femoral artery using a 4-
French catheter and injecting PVC
particles (150 - 550 micron).
Embolisation was performed success-
fully in 85.5% of the women. The

mean total fluoroscopy time was 16.8
minutes, ranging from 4.8 minutes to
47.3 minutes.

Introduction
Uterine leiomyomas occur in 20 -

50% of women above the age of 40
years making it the most frequent
tumour of the female genital tract."
Metromenorrhagia, acute bleeding,
pelvic pain, heaviness and discomfort
are amongst the symptoms caused by
uterine leiomyomas.

Uterine artery embolisation has
been reported to be a minimally inva-
sive, safe and effective alternative to
traditional uterine leiomyoma treat-
ment. Traditional treatments include
the less invasive medical hormonal
therapy and the more invasive surgical
options such as myomectomy and
hysterectomy. Uterine artery emboli-
sation improved the clinical symp-
toms ofleiomyomas, reduced tumour
and uterine size, and caused few com-
plications in the follow-up period.':"

Uterine artery embolisation was
first used in the 1970s to treat post-

26 SA JOURNAL OF RADIOLOGY • June 2002

partum haemorrhage." In a bench-
mark study done in 1995, Ravina et
al.Ilproposed uterine artery embolisa -
tion as an alternative to surgery for
treating uterine leiomyomas.

Results published in 1999 were
very promising. A 30 - 60% reduction
in uterine size, and patient satisfaction
rates ranging from 80% to 90%
regarding reduction in uterine bulk
symptoms and menorrhagia were
reported. An estimated 6 000 proce-
dures were performed with minimal
serious infective morbidity and only
two reported deaths.":"

Patients and
methods

From November 1998 to July 2001
(33 months), 67 uterine artery
embolisations were performed at the
Department of Diagnostic Radiology
(UFS) by two invasive radiologists (Dr
E Loggenberg and Dr C S de Vries).
Women diagnosed with leiomyomas
and referred for uterine artery
embolisation by gynaecologists from
the Department of Obstetrics and
Gynaecology (UPS) were included in
the treatment. Magnetic resonance
imaging (MRl) was done before the
angiography and at 3 and 6 months
after the procedure.

The procedures were done on a
Siemens Multistar Angiography unit
(Siemens, Erlangen). All patients
underwent angiographies under local
anaesthesia. Routinely, puncture of
the right femoral artery with intro-
duction of a 4-French sheath was
used. A 4-French renal double curve
catheter with a 0.35 Terurno guide-
wire was used to select the left uterine
artery, which was then embolised with
PVA-particles (150 - 550 micron). The
catheter was then removed, flushed



ORIGINAL ARTICLE

and the right uterine artery selected
with repetition of the embolisation.
Embolisation was done until com-
plete cessation of blood flow in the
leiomyoma was achieved (Figs 1 - 4).

The patients then went back to the
ward for overnight observation and
were discharged the next day.

Results
Procedure

A total of 67 patients received uter-
ine artery embolisation over the 33-
month period and 5 patients were lost
to follow-up.

In 55 patients only a right femoral
artery puncture was needed. In 4
patients bilateral femoral artery punc-
tures were needed as it was difficult to
select the right uterine artery from the
ipsilateral side. The left femoral artery
approach alone was used in 2 patients
as 1patient had enlarged lymph nodes
on the right and there was difficulty in
palpating the right femoral pulse of
the other. The transbrachial approach
was used in 1 patient because of the
acute angle of the internal iliac artery,
the uterine arteries could not be
selected. The radiologist (Dr E
Loggenberg) performing the proce-
dure found the transbrachial approach
to be surprisingly easy.

Fluoroscopy time ranged from 4.8
to 47.3 minutes, with a mean of 16.8
minutes. Pulse fluoroscopy (15 pulses
per second) was used to minimise
radiation.

In all 67 patients the procedure
was performed with a 4-French
catheter and 0.35 Terumo guidewire.
Only 8 patients required an addition-
al 4-French catheter and in 4 patients
.an additional guidewire was used.

Fig. 1. Selection of left uterine artery showing the
blush of the fibroid and uterus.

Fig. 2. Arteriogram after embolisatlon.

r

Fig. 3. Selection of right uterine artery showing the
blush of the fibroid and uterus.

Analysis of outcome
In 2 patients it was impossible to

select either the right or the left uter-

27 SA JOURNAL OF RADIOLOGY • June 2002

Fig. 4. Arteriogram after embolisation.

ine artery. One patient had unusually
small uterine arteries and a micro-
catheter would have been helpful. The
other patient was a 75-year-old
woman with congestive heart failure,
type 2 diabetes mellitus, hypertension,
on warfarin therapy with dysfunc-
tional uterine bleeding. Both her iliac
arteries were very tortuous, she had a
tight stenosis of the left internal iliac
artery and plaques in the left uterine
artery. When the right internal iliac
artery was selected no right uterine
artery could be demonstrated.

The left uterine artery of 1 patient
could not be demonstrated by angiog-
raphy and therefore the radiologist
was unable to select it.

Inability to select the right uterine
artery occurred in 6 patients. In a 47-
year-old patient, the right internal
iliac artery was tortuous; however, the
case was completed successfully 2 days
later via the transbrachial approach.
Severe vasospasm occurred in 1
patient, and in another selection of
the uterine artery was successfully
done but no vessels supplying the
leiomyoma could be identified. In 1
patient, the procedure failed because
of the anatomical variation of where
the superficial femoral artery originat-
ed from the right internal iliac artery,
making the risk for embolisation to



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ORIGINAL ARTICLE

the foot substantial. In the last 2 patients it was impossible to
select the right internal iliac artery because of anatomical dif-
ficulties.

Conclusion
Successful embolisation of the uterine arteries was per-

formed in 85.5% of the patients. In 86.6% of the patients only
a single 4-French catheter was used and in only 2 patients, a
micro-catheter could have altered the outcome. The mean flu-
oroscopy time was 16.8 minutes.

An ordinary diagnostic 4-French catheter is sufficient for
uterine artery embolisation in the majority of cases. Use of
expensive micro-catheters, guidewires or glide-catheters
should not routinely be neccessary.

References
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