How effective is the uterine artery embolization procedure in treating uterine fibroids? Embolization of the uterine arteries for uterine fibroids and heavy bleeding Where to do embolization of the uterine arteries

Today, there is no alternative to UAE - uterine artery embolization. As clinical studies and the experience of doctors show, embolization is the only way to preserve not only the organ, but also to get a chance to give birth to healthy offspring. However, many women do not even suspect that such an effective method exists.

The reason that this method is not sufficiently popularized is the rigidity of some doctors who operate on fibroids, and the fact that the cost of UAE is quite high due to the high cost of the drug. However, it should be understood that UAE, the price of which, at first glance, seems high, is the only way to maintain health and prevent relapses of the disease. There are only two alternatives to UAE - complete removal of the uterus or myomectomy, surgical removal of fibroids. And if the first method today can be called barbaric because... While organ removal is a method that can only be used if there is an immediate threat to the patient’s life, the second method, myomectomy, has a number of significant disadvantages.

The main disadvantage of myomectomy is that it does not guarantee a complete cure. Since the surgeon removes only visible large nodes, smaller ones or nodes that have just begun to emerge remain unnoticed. As a result, after a few years, either a repeat operation or removal of the organ. Another disadvantage of myomectomy is that the consequences for young women can be irreversible - adhesions after surgery can become a serious obstacle to pregnancy. As a result, the cost of infertility treatment will be much higher than the cost of uterine artery embolization.

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Embolization method

The uterine arteries are the main source of blood supply to the uterus. However, the uterus receives nutrition not only from this source - an extensive arterial network goes to the organ. Therefore, when the flow of blood through the uterine arteries stops, the healthy tissue of the uterus does not suffer because receive food from other sources.

In the case when myomatous nodes form in the uterus, their nutrition comes from only one source - the uterine arteries, in isolated cases from the arteries feeding the ovaries and never from several sources. At the same time, thanks to the developed system of vessels and arteries, the organ itself can receive blood supply from other sources, while myomatous nodes are fed only from one source. the arteries of myomatous nodes are terminal and have no connections with other vessels supplying the organ.

What is the essence of the EMA method?

During the procedure, a specially developed drug containing spherical particles - emboli - is injected through a thin catheter with a diameter of no more than 1.5 mm. These particles are made from a specially developed polymer, which is biologically and chemically inert in relation to living tissues of the body. The embolic particles have a strictly defined size, due to which they selectively block the arteries feeding the myomatous nodes.

Particles may accidentally enter other vessels, but in such small quantities that they cannot affect the blood supply to the uterus because the size of the emboli is so small that it is not able to block the arteries supplying the organ, and the branched network of vessels of the uterus makes it possible to quickly restore nutrition to the organ.

Preparations for UAE are available with different sizes of emboli. They can vary from 500 to 900 microns. The required size is selected by the surgeon according to the characteristics of the vascular system of the uterus. After the drug with embolic particles is injected into the vessels, they clog the vessels feeding the uterus and remain there. Over time, the emboli are encased in fibrous tissue and, as the fibroid nodule dries out, they either collapse or remain enclosed in the connective tissue.

A few minutes after the drug enters the vessel, it is completely blocked by emboli and blood flow to the momatous nodes stops. It is worth noting that emboli that enter the vessel remain there and do not disappear anywhere, which is why the risk of relapse is minimal.

Over time, emboli may gradually come out with menstrual bleeding or simply break down. This process is similar to the gradual destruction of surgical threads that are used during surgery.

UAE for multiple fibroids

A feature of embolization is that the surgeon does not penetrate the catheter to each myomatous node and injects the drug into it. Due to the structure of the blood supply to the uterus and momatous nodes, during the intervention, the embolus is selectively in the mimoma arteries, without clogging the arteries feeding the healthy part of the organ.

Such a selective effect of drugs used for UAE is possible due to the following features:

• First, if there is no pregnancy, uterine fibroids are 90% supplied from the peripheral blood vessels, and not from the vessels that feed the healthy part of the organ.
• Secondly, the vessels of fibroids have low peripheral resistance, which allows emboli to penetrate primarily into these vessels.
• Third, myomatous vessels in most cases are thicker than the vessels feeding the healthy part of the organ, so emboli particles fall primarily into them and cannot pass to healthy tissues.

During the procedure, the solution with emboli in discrete waves is slowly fed into the uterine arteries until it reaches their end point, i.e. embolization of nodes. The end point, i.e., a certain set of signs that allows one to accurately determine that the arteries supplying the fibroids are blocked, is determined by the surgeon using a special contrast agent. If at the beginning of EME the arteries feeding the myoma are stained, then after embolization they are not visualized with the help of a contrast agent, which indicates their blockage by emboli.

Thanks to the use of a contrast agent, the chances that a suspension with emboli will enter the wrong vessels is reduced to zero. Despite the apparent simplicity of the procedure, only very experienced endovascular surgeons can perform it correctly. Only thorough knowledge of the vascular system of the uterus and speed of manipulation allows for successful UAE.

What happens after EMA?

After blood stops flowing into the myomatous nodes, smooth muscle tissue begins to die in them, gradually being replaced by fibrosis - connective tissue. This is a gradual process and lasts about a year. During this time, the nodes decrease in size, as if drying out, and the remaining tissue ceases to be fibroids because It does not have a muscular structure, but a fibrous one. Such tissue in the uterine cavity is not a pathology and cannot cause any problems or manifest any symptoms.

Some nodes may not “dry out” but become detached from the uterus after the blood supply is cut off, which leads to the fact that when it gets into the cavity, it is pushed out. That is, a kind of “birth” of the node occurs and the uterus is independently freed from it.

As a result, after UAE, the nodes located in the walls of the uterus are reduced by 4 times, and the nodes located in the uterine cavity are pushed out by the uterus and completely disappear.

UAE is a method that subsequently does not require any additional procedures or drug treatment. This procedure allows you to get rid of fibroids or significantly reduce their size, get rid of most unpleasant and painful symptoms, including heavy menstruation and pressure on the bladder, and subsequently give birth to a healthy child.

Where is uterine artery embolization performed?

Embolization in Moscow is performed at the Center for X-ray Surgery. To meet the demand for embolization, we have connected several leading Moscow clinics to the program. Today, uterine artery embolization clinics:

• European Clinic
• Perinatal Medical Center
• Family Planning and Reproduction Center
• Clinical Hospital "Lapino"
• Clinic-31
• X-ray Surgery Center, located on the basis of N.I. Pirogov City Clinical Hospital No. 1

Uterine artery embolization cost

Since UAE is a minimally invasive and high-tech method, the procedure involves the use of a very complex, and most importantly, disposable instrument. For embolization of fibroids, the price includes the drug for embolization, microcatheter, catheters, and other instruments: introducers, hydrophilic guides, puncture kits.

How much embolization costs largely depends on the drug administered and its quality. Thus, PVA is an embolization drug that has been used for UAE for more than 30 years. However, as practice shows, variation in the size of emboli and their irregular shape can significantly reduce the accuracy of the procedure. For this reason, there is a risk of insufficient embolization, i.e. due to the fact that the particles can stick together, a “pseudo-embolization” effect may occur. This, in turn, can lead to a partial restoration of blood supply to myomatous nodes in some patients. This in turn will require additional embolization. However, it should be noted that this effect was observed in no more than 1-2% of patients.

In addition, this drug is more likely to affect healthy vessels supplying the uterus with blood. Another disadvantage of the drug is the possibility of an inflammatory process around the embolized vessel, which in turn leads to an unpleasant sensation after surgery.

The price for embolization of arteries in Moscow with such a drug is from 100 thousand rubles. The cost of the drug itself is 75 thousand rubles.

Embolization of the uterine arteries is done with more modern and expensive drugs. The embolization drug is a product of high technology. Thus, the Japanese drug Bead Block was developed specifically for embolization of the uterine arteries. This drug has been used since 2006. Bead Block has a number of important advantages. The main one is the structure of the emboli themselves - thanks to a softer core, spherical emboli are capable of compression and can even pass into a catheter with a thinner lumen. Due to its complete inertness, Bead Block does not cause an inflammatory reaction around the vessel, which in turn minimizes pain after embolization. Thanks to these properties, the drug is optimal even for the most difficult cases of fibroids, including if the patient is interested in pregnancy, as well as when it is necessary to carry out embolization of the arteries supplying the ovaries.

The manufacturer sells the drug for UAE at a price of 110 thousand rubles. Embolization in Moscow with such a drug can cost from 200 thousand.

The next effective embolization drug is Embozene, developed and manufactured in the USA. Embozene consists of spherical calibrated particles and is intended specifically for the treatment of uterine fibroids. The main advantage of the drug is the precise calibration of spherical particles - emboli. That is, depending on the patient’s blood vessels and indications, the drug is supplied with strictly specified parameters. Embozene is available with a specific size of emboli, while other drugs indicate only their approximate size, for example 700-900 or 500-700 microns. Bead Block, like Embozene, is biologically inert, therefore it cannot cause an inflammatory process around the embolized vessels. Today it is the most popular drug, which is highly appreciated by embolization specialists and patients. This drug is indicated in case of planning pregnancy and if embolization of the ovarian arteries is required. There are cases when it is they that feed uterine fibroids. The high contrast of the injected drug particles from the USA allows the surgeon to perform the intervention with pinpoint precision.

Embozene costs from the manufacturer 155 thousand rubles, so prices in Moscow for embolization with this drug vary from 220 to 250 thousand rubles. Using Embozene reduces the risk of restoration of blood supply and unintentional exposure to the healthy part of the uterus to almost zero.

Today, the most modern emollizing drug in the world is HydroPearl. They are microspheres produced by Terumo with improved characteristics based on existing experience. Unlike other drugs, it has a wide range of sizes. The manufacturing company has developed a fundamentally new composition that gives microspheres excellent biocompatibility, elasticity and precision of calibration.

After embolization, the drug does not cause an inflammatory reaction, which indicates high vascular tolerance of the implant. Compressible microspheres provide rapid catheter delivery, vessel size adaptation, and selective embolization. Using HydroPearl reduces the risk of restoring blood supply and inadvertently affecting the healthy part of the uterus to almost zero. Studies have shown that HydroPearl microspheres provide greater calibration accuracy than Embosphere.

At the moment this is the best drug for all clinical situations, incl. for patients interested in pregnancy, as well as for non-standard situations (for example, embolization of the branches of the ovarian arteries supplying blood to the fibroid).

This drug is successfully used in European clinics. The cost of the EMA complex with HydroPearl is 240,000 rubles.

Bibliography

• Spies J. Ovarian Function after Uterine Artery Embolization for Leiomyomata: Assessment with Use of Serum Follicle Stimulating Hormone / J. Spies, A. Roth, S. Gonsalves et al. //JVIR. 2001. - Vol. 12. - P. 437-442.
• Kobayashi T.K. Cellular changes following uterine artery embolization for the treatment of adenomyosis / T.K. Kobayashi, M. Ueda, T. Nishino et al. // Cytopathology 2001; 12(4): 270-2.
• Tikhomirov A.J1. On the technique of embolization of uterine arteries / A.L. Tikhomirov // Medical newspaper. 2004. - No. 51. - P. 12.
• Savelyeva G.M. Embolization of the uterine arteries in patients with uterine fibroids / G.M. Savelyeva, V.G. Breusenko, S.A. Kapranov et al. // Obstetrics and gynecology. 2004. - No. 5.- P. 21-24.

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 fibroids is today one of the most common modern treatment methods, which allows minimal impact on the organs.

Gynecologists have been using a procedure such as UAE in their practice since 1979. It was originally used to stop bleeding following uterine surgery 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 was in 2001. The procedure is low-traumatic because it is performed using a microsurgical technique. The principle of action is to clog the blood vessels, which stops the nutrition of the neoplasm cells. Due to this, they die off and the node begins to shrink, and then disappears altogether.

The procedure is truly innovative, since previously the tumor was treated only by removal.

Moreover, the uterus and ovaries were often cut out along with the node. The main advantage of this treatment is the preservation of all organs and a high probability of complete restoration of the woman’s health. Therefore, first of all, EMA is indicated for those who dream of becoming pregnant, carrying 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 the tumor reoccurring is much lower than after surgery.

Indications and contraindications

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

• If there are contraindications to surgical interventions, for example, to anesthesia
• Education is growing in size
• If the node continues to grow after removal
• For bleeding after childbirth
• If the patient plans to have children in the future and needs to preserve the organ
• If you have adenomyosis and endometriosis

Although the procedure involves minimal intervention, it is not suitable for everyone. The following contraindications exist:

• Presence of multiple nodes
• Genital cancer
• Pregnancy

• Allergy to drugs that are 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 grows too rapidly.

Preparation and progress 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
• Smear for examination of vaginal microflora
• Colposcopy - examination of the cervix using a special optical device
• Oncocytology – examination for the presence of cancer cells

• Testing for sexually transmitted infections
• Conclusion of a therapist and other doctors (if the patient has chronic diseases).

You need to prepare for the manipulation. Within a week, start wearing compression garments. Since there will be an impact on the blood 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 area. You should not have breakfast directly on the day of the procedure. If the patient is very worried, he is given a sedative.

The procedure is performed in a lying 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 a catheter. It goes to the left uterine artery.

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

Various 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 manipulation is completed, a sterile pressure bandage is applied to the puncture site, which helps avoid 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 her 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 condition continues for several days.

Often in public hospitals the patient is sent home after six days; in private hospitals they try to discharge her earlier. Sometimes this is possible even on the first day.

After the manipulation, you should not lift weights, engage in heavy physical work, go to baths or saunas, or take baths for a week. It is best to rest 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 medications.

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

In addition to the usual post-operative symptoms, complications may occur:

• Hematoma at the injection site. Goes away in a few days
• Perforation of the uterine arteries. Happens very rarely
• Getting infected. If this happens, the doctor administers antibiotic therapy.
• Intoxication with a substance with which the surgeon tracked the movements of the catheter. To eliminate it, infusion therapy is prescribed. It helps remove this drug from the body faster.
• Insufficient blood circulation in the uterus
• Cycle failure for about six months

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

Efficiency and result

Immediately after UAE, the node begins to dry out, and uterine fibroid cells are replaced by connective tissue. Over the course of a year, it can decrease by four times or disappear altogether. After a certain time, the cycle normalizes, and the feeling of compression of the internal organs disappears. When recovery occurs, the doctor may allow you to plan a pregnancy.

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

It is very important to protect yourself from pregnancy until your doctor gives the go-ahead, since 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 performed by vascular specialists. Not every clinic can offer treatment, since not everyone has 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 using expensive equipment, so the price of this method of treating uterine fibroids is quite high. In addition, expensive drugs are used for anesthesia and blockage 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 have this procedure done free of charge, under the compulsory medical insurance policy. But their number in each region is limited. First issued to certain groups of the population. Then - in order of priority.

To obtain a quota, you must contact the government agency that performs the procedure, or your gynecologist. Next, a special commission reviews the application and makes a decision.

Collapse

Myoma is a neoplasm in the wall of the uterus in the form of a node of smooth muscle fibers of a benign nature and of different sizes. Until recently, the only way to treat this disease was surgical excision of the tumors, often along with the uterus. A real breakthrough in gynecology was the development of a non-surgical method for removing myomatous nodes, which is not only less traumatic and less likely to cause unforeseen complications, but also allows a woman to maintain the ability to become pregnant and bear children. We are talking about embolization of uterine fibroids.

What is embolization and how will it help with fibroids?

Uterine artery embolization (UAE) is an effective way to get rid of fibroids without surgery. The essence of this technique is to inject a special substance into the arteries supplying blood to the tumor. As a result, blockage of blood vessels occurs and the nutrition of the fibroids is stopped. In this case, the fibroid cells die, the nodes become smaller, and sometimes disappear altogether. This procedure does not affect the uterus itself at all due to the difference in the structure of the blood supply.

Procedure diagram

Indications

In Russia, embolization of the uterine arteries for fibroids has been used for a relatively short time, but the number of procedures performed annually increases several times. This is explained not only by the advantages of this method over surgical treatment methods, but also by a wide number of indications. These include:

1. A woman’s desire to have children in the future;
2. Large tumor size and/or rapid growth;
3. Intense uterine bleeding of various etiologies;
4. Presence of contraindications for the operation.

Contraindications

Like all medical procedures, embolization of uterine fibroids has a number of contraindications:

Pedunculated fibroids are a contraindication to embolization

1. Severe allergic reactions (Quincke's edema, anaphylactic shock) to medications in the past;
2. Active infectious process;
3. Inflammatory diseases of the pelvic organs;
4. Malignant tumors of other locations;
5. Pregnancy.

Preparation for the procedure

Before performing UAE for uterine fibroids, you must undergo a medical examination, including:

• Blood test for general analysis and for syphilis, HIV, hepatitis;
• General urine analysis;
• Gynecological smear for microflora and STIs;
• Colposcopy;
• Ultrasound of the pelvic organs;
• Consultation with a therapist and doctors of relevant profiles in the presence of chronic pathologies.

The procedure is usually performed on the day of hospitalization. In the morning you must refrain from drinking water and food. The day before, you should shave the groin and thigh area on the right side, as the doctor will make a puncture in this place. If you have varicose veins, you need to purchase elastic stockings or bandages. On the day of the procedure, the doctor will also prescribe sedatives.

Stages and technique of uterine artery embolization

Embolization of the uterine arteries for fibroids takes from half an hour to one and a half. It is carried out in an X-ray angiography room or in an operating room equipped with an appropriate apparatus. The procedure includes the following steps:

1. Anesthesia. Most often, UAE is performed under local anesthesia, but epidural anesthesia can be used as prescribed by a doctor.
2. Place a catheter in the cubital vein to administer the necessary medications.
3. Treating the puncture site on the thigh with antiseptic agents.
4. Insertion of a catheter into the right femoral artery. To do this, a small incision is made on the skin and a probe is inserted through it.
5. Next, they begin to inject a contrast agent into the tube to visualize the vessels in the light of X-rays. The radiation exposure is minimal.
6. When the catheter reaches the vessels feeding the tumor, an embolic agent is injected, most often in the form of beads. This procedure is performed on all myomatous nodes. The balls cause blockage in the arteries and blood flow through them stops.
7. After embolization of the required vessels, control angiography is performed to ensure that the blood supply to the neoplasms has ceased.
8. Then the catheter is removed, the puncture site is treated and a pressure bandage is applied, which will be removed after a day.

The patient is transferred to the ward as she needs bed rest and observation for the next twelve hours after the procedure.

What is the post-embolization period like?

After UAE, after a few hours, patients begin to feel pain in the abdominal area of ​​varying intensity. This is due to the death of fibroid cells. Most often, pain can be relieved with conventional painkillers. If they are severe, the doctor may prescribe analgesics intramuscularly or intravenously. The pain lasts from several hours to several days.

The first time after the procedure, there may be an increase in temperature to subfebrile levels. Normally, it returns to normal quickly. If this does not happen, or the temperature rises above 38, you need to inform your doctor.

In addition to these symptoms, weakness, nausea, and mild malaise may occur. These sensations, although unpleasant, do not pose a threat to life and health, so after three to four days patients are discharged home. But it is better to observe bed rest for seven days. Full recovery occurs after two weeks. During this period, you should avoid physical activity.

Is it possible to get pregnant after UAE and when?

Pregnancy after uterine artery embolization is quite possible, but it is advisable to plan it no earlier than a year after the procedure. When planning, you must inform your gynecologist about your disease and the treatment performed. This is important because after UAE, the blood supply to the uterus may be slightly reduced, which can affect the development of the fetus. In this case, it is necessary to take special medications. Most often this happens when the patient does not wait a year between the operation and pregnancy. Also during this period, the risk of spontaneous miscarriage is higher due to increased uterine tone. Therefore, it is very important to follow your doctor's recommendations and take your time.

What complications can there be?

The success of the procedure depends on the professionalism of the doctor, high-quality equipment and the characteristics of the development of the disease. As with any surgical intervention, some complications may develop after arterial embolization for uterine fibroids:

• Hematoma at the puncture site;
• Severe pain in the abdominal area;
• Puncture infection;
• Menstrual irregularities;
• Formation of adhesions in the pelvic area.

At the same time, the number of complications and the frequency of their development are several times less than with alternative surgical methods of treating uterine fibroids.

Where can I do it and how much will it cost?

Embolization of uterine fibroids is a complex procedure that requires not only expensive equipment, but also the presence of competent vascular surgeons on staff with experience in working with angiographic machines. In recent years, more and more women are choosing this treatment method, so the number of medical institutions providing it is growing.

In state clinics, EMA can be done free of charge under the compulsory medical insurance policy. But for this you will have to get a quota, since this technique is one of the high-tech types of medical care. Carrying out embolization of the uterine arteries on a paid basis will cost in Moscow and St. Petersburg, on average, 100-200 thousand rubles. The final cost will depend on the level of the institution, the qualifications of the doctor, the required examination and the materials used.

Examples of Moscow prices for UAE in various clinics:

Prices for medical services in St. Petersburg are lower than in Moscow:

In the regions, this procedure will cost 2-3 times less, but you need to choose a specialist there more carefully, since the outcome of the procedure depends on his professionalism.

Uterine artery embolization is a modern and effective method of treating uterine fibroids. Sometimes there are situations that require surgical removal of fibroids. In other cases, the method of choice should be a low-traumatic and organ-preserving procedure. The main disadvantage of this intervention is its price. But the opportunity to maintain health and life without pain justifies this disadvantage.

Treatment of uterine fibroids with uterine artery embolization in the largest and most modern gynecology clinic in Moscow at a very affordable price. Call!

Uterine artery embolization: what is it?

Embolization of the uterine arteries is one of the modern and effective procedures that allows non-surgical, i.e. without anesthesia and incisions, reduce the size of the uterus, myomatous nodes, reduce the amount of blood lost during menstruation, thereby preserving the organ and without injuring it. The first uterine artery embolization (UAE) was performed in the USA in 1979. In Russia, the operation has been used since 1998.

Indications for use of UAE

The technique is used in cases where a woman wants to preserve the uterus and avoid anesthesia and surgery., as well as in the presence of contraindications for surgical treatment. Basically, UAE is used for uterine fibroids, when hormonal therapy is contraindicated, there is rapid growth of nodes, and the menstrual cycle is disrupted.

Preparation for the procedure

Before carrying out the manipulation, you need to take a number of tests: blood and urine (general), blood for group and Rh factor, biochemistry, HIV and other infections, coagulability (coagulogram), and also do a pelvic ultrasound, fluorography, ECG, smear from the vagina for the degree of purity. Before the procedure, it is necessary to perform a histological examination of the mucous membrane of the uterus and cervical canal to exclude oncopathology, as well as obtain advice from a therapist, gynecologist and endovascular surgeon.

The UAE procedure is performed on the day of hospitalization. Before surgery, do not eat and preferably do not drink. It is necessary to prepare (shave) the groin area. Elastic bandages (or compression stockings) are applied to the lower limbs, which will need to be worn on the day of the intervention and for some time after.

Equipment for EMA

UAE is performed in an equipped operating room equipped with a special angiographic machine, which helps to see the vessels on an x-ray. The procedure is performed by an endovascular surgeon. The drug (emboli) injected into the vascular bed is completely safe and does not cause any allergic reactions.

The volume of the drug depends on the diameter of the vessel and most often does not exceed 500 mg. There are several types of medicine for UAE. The doctor usually decides which drug will be used.

How does the uterine artery embolization method work?

The main result of UAE is the cessation of nutrition of myomatous nodes through the uterine vessels. After surgery, the menstrual cycle changes: blood loss during menstruation is reduced, and the duration of menstruation is reduced. The pain caused by the syndrome of compression of surrounding organs by nodes disappears. The size and number of nodes are reduced. This process will last from 3 to 12 months after the procedure. Uterine artery embolization is a good alternative to hysterectomy (removal of the uterus). Especially in cases where it is possible to save it.

How the procedure works

After treatment with an antiseptic, the doctor gives an injection in the area of ​​the inguinal fold. A special catheter (flexible tube) is inserted through a needle into the femoral artery. Under the control of X-ray equipment, the surgeon guides the catheter through the artery to the uterus to a certain location.

The next step is an arteriogram. By injecting a radiopaque substance into the vessel, the doctor will see the vascular network clearly and brightly:

Then the surgeon injects a drug (polyvinyl alcohol is often used), which consists of plastic particles. Getting into the vessels that feed the uterus, it forms blood clots in them, disrupting blood flow.

The procedure is repeated on the other side to clog the vessels on both sides. The duration of the procedure is determined by the size, anatomical location of the vessels and the experience of the endovascular surgeon (usually 10–30 minutes). If the structure and location of the vessels is atypical, the operation may take up to 40–50 minutes.

Rice. Uterine artery embolization

After vascular embolization, an arteriogram is repeated to confirm the effectiveness of the intervention.

The needle is removed, the punctures are processed and a special sterile pressure bandage is applied to them for 10–12 hours.

During and after the uterine artery embolization procedure

During the operation, the woman feels almost nothing, because the puncture site is numbed. During embolization, the patient may sometimes feel a slight burning sensation and bloating. After surgery, there may be pain that is caused by impaired blood flow in the area of ​​the myomatous node. During this period, the woman is prescribed painkillers. Sometimes the temperature rises, to reduce which antipyretic and anti-inflammatory drugs are used. Discharge from the hospital in 1–3 days.

The first menstruation after UAE may come earlier or later than expected. The next menstruation is more indicative, when the pain subsides and the size of the myomatous nodes decreases. To assess the effectiveness of embolization (reduction in the size of the uterus and myomatous nodes), it is advisable to perform a pelvic ultrasound 3, 6 and 12 months after the manipulation.

EMA advantages:

• after the intervention, reproductive organs are preserved;
• the drug acts on all myomatous nodes;
• minimal trauma;
• no anesthesia;
• short hospital stays;
• the effectiveness of treatment is close to 90%;
• no relapses;
• There are no visible marks or scars after the operation.

Contraindications for uterine artery embolization:

• allergic reaction to iodine (the contrast agent injected into the vessels contains this microelement);
• the presence of acute or chronic infection;
• pregnancy;
• hormonal treatment;
• renal failure;
• presence of oncopathology.

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Zhumanova Ekaterina Nikolaevna

Head of the Center for Gynecology, Reproductive and Aesthetic Medicine, Candidate of Medical Sciences, doctor of the highest category, Associate Professor of the Department of Regenerative Medicine and Biomedical Technologies of Moscow State Medical University named after A.I. Evdokimova, board member of the Association of Aesthetic Gynecologists ASEG.

• Graduated from the Moscow Medical Academy named after I.M. Sechenova, has a diploma with honors, completed clinical residency at the Clinic of Obstetrics and Gynecology named after. V.F. Snegirev MMA named after. THEM. Sechenov.
• Until 2009, she worked at the Clinic of Obstetrics and Gynecology as an assistant at the Department of Obstetrics and Gynecology No. 1 of the MMA named after. THEM. Sechenov.
• From 2009 to 2017 she worked at the Federal State Institution “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation
• Since 2017, he has been working at the Center for Gynecology, Reproductive and Aesthetic Medicine of Medsi Group of Companies JSC.
• She defended her dissertation for the degree of Candidate of Medical Sciences on the topic: “Opportunistic bacterial infections and pregnancy”

Myshenkova Svetlana Aleksandrovna

Obstetrician-gynecologist, candidate of medical sciences, doctor of the highest category

• In 2001 she graduated from the Moscow State Medical and Dental University (MGMSU)
• In 2003, she completed a course of study in the specialty “obstetrics and gynecology” at the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences
• He has a certificate in endoscopic surgery, a certificate in ultrasound diagnostics of pathologies of pregnancy, fetus, newborn, in ultrasound diagnostics in gynecology, a certificate of a specialist in the field of laser medicine. He successfully applies all the knowledge acquired during theoretical classes in his daily practice.
• She has published more than 40 works on the treatment of uterine fibroids, including in the journals “Medical Bulletin” and “Problems of Reproduction”. He is a co-author of methodological recommendations for students and doctors.

Kolgaeva Dagmara Isaevna

Head of pelvic floor surgery. Member of the scientific committee of the association for aesthetic gynecology.

• Graduated from the First Moscow State Medical University named after. THEM. Sechenov, has a diploma with honors
• She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov
• Has certificates: obstetrician-gynecologist, specialist in laser medicine, specialist in intimate contouring
• The dissertation is devoted to the surgical treatment of genital prolapse complicated by enterocele
• The sphere of practical interests of Dagmara Isaevna Kolgaeva includes:
  conservative and surgical methods of treating prolapse of the walls of the vagina, uterus, urinary incontinence, including the use of high-tech modern laser equipment

Maksimov Artem Igorevich

Obstetrician-gynecologist of the highest category

• Graduated from Ryazan State Medical University named after academician I.P. Pavlova with a degree in general medicine
• Completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology Clinic named after. V.F. Snegirev MMA named after. THEM. Sechenov
• Proficient in a full range of surgical interventions for gynecological diseases, including laparoscopic, open and vaginal access
• The scope of practical interests includes: laparoscopic minimally invasive surgical interventions, including single-puncture access; laparoscopic operations for uterine fibroids (myomectomy, hysterectomy), adenomyosis, widespread infiltrative endometriosis

Pritula Irina Alexandrovna

Obstetrician-gynecologist

• Graduated from the First Moscow State Medical University named after. THEM. Sechenov.
• She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
• She is certified as an obstetrician-gynecologist.
• Possesses the skills of surgical treatment of gynecological diseases on an outpatient basis.
• He is a regular participant in scientific and practical conferences on obstetrics and gynecology.
• The scope of practical skills includes minimally invasive surgery (hysteroscopy, laser polypectomy, hysteroresectoscopy) - Diagnosis and treatment of intrauterine pathology, cervical pathology

Muravlev Alexey Ivanovich

Obstetrician-gynecologist, gynecological oncologist

• In 2013 he graduated from the First Moscow State Medical University named after. THEM. Sechenov.
• From 2013 to 2015, he completed clinical residency in the specialty “Obstetrics and Gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University named after. THEM. Sechenov.
• In 2016, he underwent professional retraining at the State Budgetary Institution of Healthcare of the Moscow Region MONIKI named after. M.F. Vladimirsky, specializing in Oncology.
• From 2015 to 2017, he worked at the Federal State Institution “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation.
• Since 2017, he has been working at the Center for Gynecology, Reproductive and Aesthetic Medicine of Medsi Group of Companies JSC.

Mishukova Elena Igorevna

Obstetrician-gynecologist

• Doctor Mishukova Elena Igorevna graduated with honors from the Chita State Medical Academy with a degree in general medicine. She completed clinical internship and residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
• Mishukova Elena Igorevna has a full range of surgical interventions for gynecological diseases, including laparoscopic, open and vaginal access. He is a specialist in providing emergency gynecological care for diseases such as ectopic pregnancy, ovarian apoplexy, necrosis of myomatous nodes, acute salpingoophoritis, etc.
• Mishukova Elena Igorevna is an annual participant in Russian and international congresses and scientific and practical conferences on obstetrics and gynecology.

Rumyantseva Yana Sergeevna

Obstetrician-gynecologist of the first qualification category.

• Graduated from the Moscow Medical Academy named after. THEM. Sechenov with a degree in general medicine. She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University named after. THEM. Sechenov.
• The dissertation is devoted to the topic of organ-preserving treatment of adenomyosis using FUS ablation. He has a certificate as an obstetrician-gynecologist and a certificate in ultrasound diagnostics. Proficient in the full range of surgical interventions in gynecology: laparoscopic, open and vaginal approaches. He is a specialist in providing emergency gynecological care for diseases such as ectopic pregnancy, ovarian apoplexy, necrosis of myomatous nodes, acute salpingoophoritis, etc.
• Author of a number of published works, co-author of a methodological guide for doctors on organ-preserving treatment of adenomyosis using FUS ablation. Participant of scientific and practical conferences on obstetrics and gynecology.

Gushchina Marina Yurievna

Gynecologist-endocrinologist, head of outpatient care. Obstetrician-gynecologist, reproductive specialist. Ultrasound diagnostics doctor.

• Gushchina Marina Yurievna graduated from Saratov State Medical University. V.I. Razumovsky, has a diploma with honors. She was awarded a diploma from the Saratov Regional Duma for excellent achievements in studies and scientific activities, recognized as the best graduate of Saratov State Medical University named after. V. I. Razumovsky.
• She completed a clinical internship in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the First Moscow State Medical University. THEM. Sechenov.
• He is certified as an obstetrician-gynecologist; ultrasound diagnostics doctor, specialist in laser medicine, colposcopy, endocrinological gynecology. She has repeatedly completed advanced training courses in “Reproductive Medicine and Surgery” and “Ultrasonic Diagnostics in Obstetrics and Gynecology.”
• The dissertation work is devoted to new approaches to differential diagnosis and management tactics for patients with chronic cervicitis and early stages of HPV-associated diseases.
• Proficient in the full range of minor surgical interventions in gynecology, performed both on an outpatient basis (radiocoagulation and laser coagulation of erosions, hysterosalpingography) and in a hospital setting (hysteroscopy, cervical biopsy, cervical conization, etc.)
• Gushchina Marina Yurievna has more than 20 scientific published works, is a regular participant in scientific and practical conferences, congresses and conventions on obstetrics and gynecology.

Malysheva Yana Romanovna

Obstetrician-gynecologist, gynecologist for children and adolescents

• Graduated from the Russian National Research Medical University. N.I. Pirogov, has a diploma with honors. She completed clinical residency in the specialty “obstetrics and gynecology” at the Department of Obstetrics and Gynecology No. 1 of the Faculty of Medicine of the First Moscow State Medical University. THEM. Sechenov.
• He is certified as an obstetrician-gynecologist, ultrasound diagnostics doctor, specialist in laser medicine, pediatric and adolescent gynecology.
• Proficient in the full range of minor surgical interventions in gynecology, performed both on an outpatient basis (radiocoagulation and laser coagulation of erosions, cervical biopsy) and in a hospital setting (hysteroscopy, cervical biopsy, cervical conization, etc.)
Abdominal organs
• She completed clinical residency in the specialty “Obstetrics and Gynecology” on the basis of the department of the Federal State Budgetary Educational Institution of Additional Professional Education “Institute for Advanced Training of the Federal Medical and Biological Agency”.
• He has certificates: obstetrician-gynecologist, specialist in the field of colposcopy, non-operative and operative gynecology of children and adolescents.

Baranovskaya Yulia Petrovna

Ultrasound diagnostics doctor, obstetrician-gynecologist, candidate of medical sciences

• Graduated from the Ivanovo State Medical Academy with a degree in general medicine.
• Completed an internship at the Tambov Regional Clinical Hospital, specializing in obstetrics and gynecology.
• He is certified as an obstetrician-gynecologist; ultrasound diagnostics doctor; specialist in the field of colposcopy and treatment of cervical pathology, endocrinological gynecology.
• Repeatedly took advanced training courses in the specialty “obstetrics and gynecology”, “Ultrasonic diagnostics in obstetrics and gynecology”, “Fundamentals of endoscopy in gynecology”
• Proficient in the full range of surgical interventions on the pelvic organs, performed by laparotomy, laparoscopic and vaginal approaches.