Clinical aspects of uterine artery embolization Smeets, AJ

159 Pages·2010·3.87 MB·English

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Clinical aspects of uterine artery embolization
Smeets, A.J.
Publication date
2010
Document Version
Final published version
Link to publication
Citation for published version (APA):
Smeets, A. J. (2010). Clinical aspects of uterine artery embolization. [Thesis, fully internal,
Universiteit van Amsterdam].
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Download date:07 Jan 2023
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CLINICAL ASPECTS OF UTERINE
ARTERY EMBOLIZATION

Albert J. Smeets
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CLINICAL ASPECTS OF UTERINE
ARTERY EMBOLIZATION

ACADEMISCH PROEFSCHRIFT

ter verkrijging van de graad van doctor
aan de Universiteit van Amsterdam
op gezag van de Rector Magnificus
prof.dr. D.C. van den Boom
ten overstaan van een door het college voor promoties
ingestelde commissie,
in het openbaar te verdedigen in de Agnietenkapel
op woensdag 30 juni, te 13.00 uur

door

Albert Joseph Smeets
geboren te ’s-Gravenhage

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Promotores

Prof.dr. W.J.J. van Rooij
Prof.dr. J.A. Reekers

Copromotores

Dr. P.N.M. Lohle
Dr. P.F. Boekkooi

Overige leden
Prof.dr. G.J.den Heeten
Prof.dr. M.J. Heineman
Prof.dr. H.A.M. Brölmann
Prof.dr. L.J. Schultze Kool
Prof. dr. M. Wieringa-de Waard
Dr. O.M. van Delden

Faculteit der Geneeskunde

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CONTENTS

Chapter 1
General introduction 7

Chapter 2 23
Uterine fibroids: targeted embolization, an update on technique.
Abdom Imaging 2004;29:128-31

Chapter 3 37
Embolization of uterine fibroids with Polyzene F coated hydrogel
microspheres: initial experience.
J Vasc Interv Radiol in press

Chapter 4 49
Limited uterine artery embolization for leiomyomas with
tris-acryl gelatin micropheres: 1-year follow-up
J Vasc Interv Radiol 2006;17:283-7

Chapter 5 55
Mid-term clinical results and patient satisfaction after uterine artery
embolization in women with symptomatic uterine fibroids.
Cardiovasc Intervent Radiol 2006;29:188-91

Chapter 6 79
Long-term outcome of uterine artery embolization for
symptomatic uterine leiomyomas
J Vasc Interv Radiol 2008;19:319-26

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Chapter 7 101
Safety and effectiveness of uterine artery embolization in patients
with pedunculated fibroids
J Vasc Interv Radiol 2009;20:1172-5

Chapter 8 113
Is an Intra Uterine Device a contraindication for
Uterine Artery Embolization?
A Study of 20 Patients
J Vasc Interv Radiol 2009 Dec 23 (Epub ahead of print)

Chapter 9 123
Uterine artery embolization in patients with a large fibroid burden:
Long-term clinical and MR follow up.
Cardiovasc Intervent Radiol 2010 Jan 12. (Epub ahead of print)

Chapter 10 139

General discussion and Summary

Chapter 11 147
Algemene discussie en Samenvatting
Dankwoord
Curriculum Vitae

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1

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INTRODUCTION
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Uterine fibroids are the most common benign tumors in the female genital tract and
consist of a proliferation of smooth muscle cells with an extracellular matrix of collagen.
Growth of fibroids is influenced by estrogen, progesterone, and a variety of growth
factors (1,2). After menopause, fibroids tend to regress. Fibroids may be located in an
intramural, submucosal or subserosal position and they may be pedunculated on a thin
stalk.

Incidence of uterine fibroids

Although the true incidence of fibroids is unknown due to the high prevalence of
asymptomatic patients, it is generally reported as 20% to 40% in women of
reproductive age (3,4). Black women have three times more often fibroids than white
women (5). Most fibroids are asymptomatic, but a substantial proportion of women with
fibroids have significant and sometimes disabling symptoms such as heavy menstrual
bleeding, pelvic pain and pressure, dyspareunia, and urinary frequency and urgency.
Presence of fibroids can reduce the possibility of pregnancy in women attempting
conception (6). Symptoms are often of sufficient severity to necessitate surgical
intervention; fibroids are the most common indication for hysterectomy. In the United
States about 300,000 hysterectomies are performed to remove fibroids each year. In
The Netherlands, this figure is estimated to be 5000-8000 hysterectomies per year.

Treatment

Since uterine fibroids are benign, treatment is only indicated if symptoms are severe.
Medical treatment may consist of analgesics or hormonal therapy. Nonsteroidal anti-
inflammatory drugs (NSAIDs) are often effective for the relief of pain and diminish
uetrine bleeding. Hormonal therapy may include oral contraceptive pills, levonorgestrel
containing IUD’s and gonadotropin-releasing hormone analoques. However, long-term
benefits of hormonal therapy are questionable (7,8). In addition, many patients have an
aversion against hormonal therapy or do not tolerate it well. For patients requiring
interventional treatment options include hysterectomy, myomectomy and uterine artery
embolization. Selection of treatment modality depends on many factors such as
patient’s age, severity of symptoms, comorbidity, wish to future conceive and number,
size and location of the fibroids (7,8). Choice of treatment should be tailored to the
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