What is embolization? Uterine artery embolization (UAE): essence, indications, how it is performed, results and rehabilitation. How is catheter embolization performed?

Embolization (embolotherapy) is a minimally invasive x-ray surgical endovascular procedure. The essence of this operation is the selective occlusion (blockage) of arteries with specially introduced emboli (special particles). This type of surgery is performed by an endovascular surgeon or an interventional radiologist (radiologist).

When is there a need for surgery?

The need for vascular occlusion may arise in the following situations:

If the patient has a benign tumor with increased blood flow.
When pathologically altered arteries are detected in the body.
With valvular incompetence of the spermatic vein (varicocele).
When areas of pathological blood flow (aneurysms) occur.
With kidney damage.
For bleeding of the gastrointestinal tract.
For bleeding in the early postpartum period.

Vessels may also require embolization in a number of other cases.

How exactly does embolization occur?

Embolization intervention is minimally invasive, which means there are no wide incisions or tissue trauma, the procedure is performed in an outpatient setting and there is minimal risk for the patient.

Embolization actions are as follows:

the patient receives local anesthesia or no anesthesia is used (however, embolization of an aneurysm in the vessels of the brain or portal vein most often takes place under general anesthesia);
through a puncture with the help of a guide, a catheter is inserted into the patient’s vessel;
Special substances (emboli) or devices are delivered into the artery in need of occlusion through a tube of minimal diameter.

At the end of the operation, a series of angiographic images are taken to monitor how successful the embolization was.

Products used

Specialists use a number of auxiliary structures and drugs to carry out embolization, thanks to which it is possible to achieve rapid and reliable blockage of blood vessels. The main embolization devices are:

Spirals. Injected into a vein or artery, they stop blood flow in the installation area.
Plastic (gelatin) particles. Mixed with liquid, they are introduced into the vessel and seal it. During the operation, it is possible to close a large number of even small arterial branches.
Sclerosants. Such fluids are injected into a vein or artery, where they cause blood to clot. Sclerosants are effective in areas with low blood flow.

The following types of artificial emboli are also in demand:

gelatin sponge (“gel foam”);
cylinders;
cylinders.

Sometimes all of the listed embolic agents and devices are used in combination. In this case, embolization is most effective.

Details of the embolotherapy procedure

Embolotherapy (artery blockage) has the following features:

On average, embolization takes about thirty to forty minutes; complex procedures can last up to several hours. The operation time depends on many factors, one of the main ones being the professionalism of the surgeon. Experienced doctors usually perform embolization fairly quickly.
Discomfort during embolization of any vessel is relieved with special medications, so the procedure is virtually painless.
Minimally invasive intervention does not leave scars on the patient’s body.
Embolization of any vessel is always carried out in a hospital setting. The patient will need to stay in the clinic for 1-2 days. In some cases (for example, to exclude possible or already occurring complications), the length of hospitalization is increased.

Patient care after vessel embolization is provided by clinic specialists in accordance with the type and degree of complexity of the minimally invasive intervention.

Within a week after embolization surgery, you will be able to return to normal life. Rapid recovery of patients who have undergone embolization is ensured by a combination of rest and compliance with several simple conditions. First of all, operated patients must adhere to the following rules:

Strengthen the drinking regime in the first 7 days after surgery.
Avoid water procedures - taking baths, swimming in the pool, visiting the bathhouse for 3-5 days. You can also take a shower.
Maintain complete physical rest for 2-3 weeks after surgery. During this time, you should not lift weights or play sports.

The main advantages of the embolization method

Endovascular embolization is a low-traumatic procedure. It differs radically from standard surgical interventions in the absence of large incisions. This reduces numerous risks associated with conventional operations, including the risk of infection. In addition, embolization rarely requires the patient to be placed under general anesthesia.

Opportunities for eliminating tumors located in hard-to-reach places. A catheter inserted into an artery can penetrate places that are difficult to reach with a scalpel.
Reducing the likelihood of relapse. The technique used to block the vessel allows blood flow to be quickly and reliably stopped.
No discomfort. During vessel embolization, the patient does not experience pain. All unpleasant sensations are eliminated with the help of special medications.
Short recovery period. For minor vascular interventions, the patient may be discharged on the day of the procedure. In this case, special care, complex treatment, and regular dressings are not required.
Minimal number of contraindications and complications. The success of the operation largely depends on the professionalism of the doctor. That is why it is important to choose a surgeon wisely.
Opportunities for organ preservation. For example, embolization on the vessels of the uterus allows a woman to become a mother and bear a healthy child, even if she has a history of a large tumor.

Embolization measures, that is, stopping blood flow through a vessel, in some cases are the only possible medical solution to the problem in the presence of general contraindications to standard surgery.

Embolization effectiveness

For example, when treating uterine fibroids, after 14 days the process of replacing the muscle tissue of the nodes with connective tissue begins. In this case, the nodes are significantly reduced and are unable to grow again and provoke the progression of the disease. Reduction of nodes takes approximately 6-8 months.

Note! The effectiveness of the method has been clinically proven. In addition, embolotherapy allows you to block a wide variety of vessels. Patients who have undergone the embolization procedure quickly forget about pain and discomfort, returning to their normal lives in the shortest possible time.

Advantages of visiting Professor Kapranov’s clinic

At the Center for Endovascular Surgery, Prof. Kapranov carries out vascular embolization using the most modern techniques and using the latest equipment. We invite patients to independently choose a clinic for embolization surgery. This will allow you to take into account all the wishes of the patient:

to the conditions of hospital stay;
on personnel qualifications;
other important treatment factors.

Today, Professor S. A. Kapranov and highly qualified staff of the endovascular surgery center offer their patients:

targeted staged and partial embolization, taking into account the individual characteristics of the body and the degree of development of the disease;
selection of drugs used depending on the size and shape of the arteries;
the use of only the most modern drugs, such as Contour (Boston Scientific), BeadBlock (Terumo, Japan) and Embosphere (Merit Medical, USA).

You can sign up for an operation to embolize uterine arteries, large fibroids, prostate vessels, and cerebral aneurysms. In our center, professional medical care is provided in full.

Minimally invasive manipulation - embolization is a surgical procedure to mechanically close the lumen of a blood vessel feeding a cancerous tumor. During the intervention, the surgeon inserts a special catheter into the femoral artery.

This treatment technique is widely used in many areas of medicine. It gained particular popularity in oncological practice in the 21st century due to its low-traumatic, painless nature and relative simplicity of the technique.

The essence and goals of embolization

The procedure for mechanically stopping blood flow in a malignant neoplasm has the following goals:

The development of ischemia (impaired blood supply) of mutated tissues, which leads to persistent remission or disintegration of the tumor. In some cases, this scenario can protect the patient from radical intervention.
Prevention of spontaneous bleeding during tumor excision surgery.
Reducing the size of tumor formation, which in the future makes it possible to more accurately remove oncology.
Palliative care for seriously ill patients by reducing the growth of pathology and, as a consequence,. The improvement in the well-being of the cancer patient is short-term.

The essence of the manipulation is as follows:

Preliminary treatment is carried out for the cancer patient. X-ray examination of the structure of the circulatory system using a contrast agent is necessary to clarify the method of bringing the embolus to the site of mutation.
For the patient, the puncture site is treated with an anesthetic solution.
Femoral artery puncture.
Inserting a catheter into an arterial vessel and moving it towards the previously selected cancer artery.
Transporting emboli through a catheter and cutting off the blood supply to the pathological area of the body.

Types of embolization

In oncological practice, it is customary to distinguish the following types of embolization:

Preoperative – it is also considered the initial stage of radical intervention.
An independent method of anti-cancer treatment - this type is most often used for liver and kidney tumors.
Palliative care, which is based on stopping bleeding, eliminating pain and stabilizing malignant growth.

Benefits of tumor embolization for cancer patients

The procedure does not cause mechanical damage to tissues adjacent to the tumor.
Rapid rehabilitation and recovery of a cancer patient.
Ease of manipulation.
Minimal number of postoperative complications.
Point effect on malignant neoplasm.
No seams or soft tissue incisions.

How is embolization done in oncology?

Doctors do not recommend eating food or carbonated drinks 4-5 hours before surgery. Also, the patient uses sedatives.

After examining the contrast X-ray data, the surgeon inserts a catheter into the femoral artery. The embolus gradually penetrates into a large cancer vessel, completely blocking its lumen.

Contraindications

The presence of a chronic or acute infectious process.
An allergic reaction of an immediate type in the form of anaphylactic shock or Quincke's edema.
Respiratory and renal failure.
Patient intolerance to contrast agent or other components of this technology.

Disadvantages of embolization in the treatment of cancer patients

The positive outcome of therapy largely depends on the experience and qualifications of the oncologist.
There is a high probability of emboli implanting into nearby physiologically healthy tissues.
Often the clinical picture of cancer excludes tumor embolization.
After successful treatment, symptoms may often occur.
Presence of postoperative pain in the tumor growth area.

Is embolization safe for cancer patients?

This technique is aimed at stopping the blood flow to the malignant growth site. In this case, neighboring healthy tissues, as a rule, remain undamaged and retain their function. Modern medical technologies use ultra-precise catheters that deliver the embolus directly to the problem area of the body.

To ensure safe manipulation, before radical intervention, the cancer patient undergoes additional diagnostics using contrast radiography, ultrasound, computed tomography and magnetic resonance imaging. These examinations are aimed at clarifying the location of the tumor, the structure of the vascular network and the point of overlap of the artery lumen.

The specialist pays special attention to the patient’s existing contraindications to this measure. Despite this, most prohibition factors are relative. For example, pathology of the renal system causes a chronic increase in blood pressure. In such conditions embolization is an extremely dangerous procedure. To carry out this manipulation, it is enough to normalize hypertension. In most clinical cases, an individual selection of research method and treatment tactics is carried out for each patient.

Reproductive medicine is an extremely delicate area. It affects the most precious thing in a woman’s life – the opportunity to bear and give birth to a healthy child. And the methods that are used in this branch of medicine are also famous for their delicacy, since their main goal is the emergence of a new life, as well as preparing the woman’s body for this event and bringing it to normal functioning. Unfortunately, it should be noted that in the modern world the number of women suffering from diseases of the reproductive organs, such as inflammatory processes, the occurrence of neoplasms of various etiologies, and infertility, is steadily increasing every year. And the most common tumor in women is uterine fibroids. It is this disease that is designed to combat such a treatment method as uterine artery embolization (UAE), which will be discussed further.

What are uterine fibroids?

Myoma is a benign neoplasm that occurs on the muscular layer of the uterus. Usually it looks like an irregularly shaped knot, woven from smooth muscle fibers, ranging in size from a few millimeters to several centimeters. Most often, the main symptom of this disease is a feeling of pressure in the lower abdomen, turning into a nagging pain. Less commonly, symptoms of fibroids can include infertility and bladder dysfunction. It should be noted that the prevalence of this type of neoplasm is very high - according to experts, fibroids occur in every 2-4 women of reproductive age (from 16 to 45 years).

Interesting fact: The largest fibroid recorded in the world weighed 63 kilograms.

Uterine artery embolization method: what is it and when is it used?

In general, uterine vascular embolization is used in the following cases:

Uterine fibroids are in the growth stage, if there are no pathologies of the cervix, ovaries, and also among patients who have been diagnosed with infertility due to fibroids.
Uterine bleeding that puts a woman's life at risk.

The main factor for prescribing this technique as the main therapy is the patient’s desire to have children in the future, maintain the integrity of the uterus, as well as the occurrence of phobia before surgery. It is not uncommon for uterine artery embolization to be performed immediately before surgery to remove fibroids to reduce the risk of bleeding.

In our country, such a procedure is considered a radically new method of combating fibroids. However, it has been successfully used all over the world since the 70s, initially to eliminate uterine bleeding during surgery, and subsequently as an independent treatment method. Since 1996, this procedure has received permission to perform in the United States, and since 1998, it has been included in the list of approved endovascular interventions of the Ministry of Health of the Russian Federation.

What is the essence of endovascular embolization of the uterine arteries? This method owes its effectiveness to the cessation of blood supply to the tumor, as a result of which the fibroid nodes are reduced, and then their complete disappearance is possible. Moreover, after embolization, a woman does not lose her ability to bear children, restores her normal menstrual cycle and is able to have a full sex life. The technique is considered innovative compared to the previously used only method of combating uterine fibroids by removing them during surgery. During embolization of the uterine arteries, no foreign body enters the body, and general anesthesia is not used. This method is considered low-invasive and gentle on the female body. Until 1998, in our country, fibroids were considered curable only by surgery. Often, this operation involved the removal of the tumor along with the uterus and ovaries, as a result of which there could be no talk of any continuation of the family.

How is uterine fibroid embolization performed?

At the preparation stage, patients are prescribed to undergo an ultrasound examination of the pelvic organs. Cervical mucus is also collected. This is necessary to exclude the possibility of oncological tumors and inflammatory processes in the pelvic organs, for which this method is not recommended. Next, through a puncture in the inguinal fold, as with any procedure, a catheter tube is inserted into the femoral artery. This procedure is not too painful, and therefore is performed under local anesthesia. After this, the doctor, monitoring the insertion process using x-rays, inserts a catheter into the uterine artery where it begins to branch, supplying blood to the fibroid nodes.

To confirm the correct location of the catheter, as well as to confirm fibroids, an arteriogram is performed - a contrast agent is injected into the catheter, visible under x-ray. If everything is done correctly, the surgeon begins injecting small particles of gelatin sponge or plastic preparations such as polyvinyl alcohol or polyurethane foam through the catheter into the artery. When these particles enter narrow vessels, they clog them, as a result of which blood does not enter the tumor tissue. To completely block the fibroids, a similar procedure is performed in both femoral arteries. Then another control arteriogram is performed to completely exclude the possibility of blood supply to the neoplasm. A sterile bandage is applied to the puncture sites for 12 hours, after which the embolization of uterine fibroids is considered complete.

Video: 3D animation of the embolization process

Recovery after the procedure

Full recovery after this procedure takes about two weeks. However, hospital stay during this period is not required - many women leave the clinic right on the day of surgery. Among the features of patient care during the rehabilitation period, it is necessary to adhere to bed rest for 6-7 days, take painkillers to avoid pain and control body temperature to monitor a possible inflammatory process. In this case, the doctor may also prescribe anti-inflammatory drugs. For successful rehabilitation after endovascular embolization, experts recommend that patients adhere to the following rules:

Increase fluid intake in the first week after the blockage;
Avoid taking aspirin and other blood thinning drugs;
Avoid taking a bath and visiting a bathhouse or sauna for several days after the procedure;
Patients are given complete physical and sexual rest for several weeks;
You should stop using hygienic tampons in the first 3 months after embolization.

Video: report from the operating room of the perinatal center

Advantages of using embolization

The effectiveness of this method reaches 95%.
As a result of embolization, no visible traces are left: no cuts or scars.
After administration of the drug, the recurrence of fibroids is extremely unlikely, in contrast to the surgical method of treatment.
General anesthesia is not used, and as a result, there is no need for a long and painful recovery after the anesthesia wears off.
The hospital stay for uterine artery embolization is short - usually no more than two days.
This procedure is indicated for many categories of people who are prohibited from surgical intervention.
After embolization, the ability to bear children is completely preserved.

Contraindications to the procedure

Still, even this method has its limitations. Contraindications to embolization are as follows:

Submucosal fibroid,
Inflammatory process in the pelvic organs;
Pregnancy;
The presence of allergic reactions to medications used for anesthesia.

Complications after endovascular embolization

In general, the risk of complications of any kind after this therapy is very low. On average it is no more than 1%. Complications resulting from embolization of uterine vessels may be the following:

Disruption of the menstrual cycle for six months after the procedure;
The occurrence of an inflammatory process during the first few days after administration of the drug;
With the submucous type of fibroids, new nodes may appear;
An extremely rare type of complication may be perforation of the uterine arteries.

If complications occur, it is likely that the patient may require surgery to remove the fibroids to complete treatment, but the likelihood is low, amounting to 1 in 1000 procedures.

Where and by whom is the embolization procedure performed?

After describing such a miraculous method, many women may wonder: where is embolization performed? Since this method requires quite expensive equipment, including angiography machines, the cost of which is about 1 million US dollars, not all clinics can perform uterine artery embolization. It also requires a special X-ray operating room, which is also not available everywhere. A limitation on such an intervention is also imposed by the small number of qualified specialists who can carry out this procedure. They are called endovascular surgeons and are specialists in directly performing operations on blood vessels through subcutaneous punctures. Since the field of endovascular surgery is relatively new in medicine, the number of those who have practice in performing such operations is very small.
If uterine artery embolization is required, the patient should first consult with her gynecologist and then go to a specialized clinic where this procedure is performed. In Russia, most often these are private medical reproductive centers.

Price issue and people's opinion

You should be prepared to be unpleasantly surprised by the price of uterine artery embolization. Often it exceeds the mark of 100,000 rubles for a complete procedure. This is primarily due to the expensive equipment already mentioned above, as well as the relative novelty of the procedure and the high cost of injected drugs and epidural anesthesia. In addition, according to reviews from patients of such clinics, embolization does not always lead to the complete destruction of fibroids. Often this procedure simply stops its growth and contributes to some reduction in the nodes. Also, almost all patients who left reviews about the method complained of severe pain during the rehabilitation period.
As it becomes clear from the above, such a new method of treating uterine fibroids as uterine artery embolization has both its supporters and opponents in the ranks of both doctors and patients. The advantages of this technique over the surgical method of solving the problem are its low trauma to the body, speed of implementation and a relatively short recovery period. A significant disadvantage is the very high price of such an intervention, as well as the small number of qualified endovascular surgeons who can perform embolization without complications and negative consequences for the patient’s health. Therefore, in solving the dilemma of which method to use to eliminate fibroids, you should carefully weigh the pros and cons of each method before deciding to resort to arterial embolization or surgery to remove fibroids. However, it should be remembered that after endovascular embolization, surgical intervention is not only possible, but will also be less likely to cause bleeding, so if possible, it is definitely worth trying this technique, because previously it was often used all over the world as preoperative preparation patients.

Video: Myths about EMA

Embolization of uterine fibroids is a minimally invasive procedure, the essence of which is to stop the movement of blood through the arteries supplying the fibroids. During and after this procedure, the blood supply to the healthy part of the organ is not disrupted. This operation is possible due to the fact that blood flows to the fibroid through vessels located on the periphery of the organ. The vessels that supply fibroids are much larger than those that supply healthy myometrium; their diameter can reach 0.5 mm. Embolization agents are injected into these vessels and the blood supply to the tumor is stopped. The neoplasm cells are replaced by connective tissue, which leads to a decrease in tumor size or even to its complete disappearance.

Uterine fibroid embolization procedure

To carry out embolization of fibroids, it is necessary to puncture the artery in the thigh under local anesthesia. Then a catheter is inserted into the artery and, under the control of X-ray television, it is guided to the fibroid. The movement of the catheter through the arteries does not cause any sensation and does not pose any health hazard. When the catheter has reached the vessel through which blood flow must be stopped, embolization agents are injected into it. Embolization particles have a diameter of 0.5 mm and are made of polyvinyl alcohol (an inert polymer used in medicine). During embolization of uterine fibroids, the vessels through which the tumor is fed are blocked. This procedure is performed on all myomatous nodes. The operation lasts from 20 to 90 minutes, depending on the number of tumors. Also, the structure of the uterine arteries affects the time of the operation; sometimes additional time is required to correctly install the catheter.

When the operation is completed, the doctor presses on the puncture site for 10-20 minutes, this is done to prevent a bruise from forming. Then a pressure bandage is applied to the patient’s right thigh, which will be removed after a day. At the end of all manipulations, the patient is taken to the ward; she must remain in bed for 12 hours.

One or two hours after fibroid embolization, most patients begin to feel pain in the lower abdomen. Each woman has her own intensity of pain: some report unbearable pain, others note that the pain is similar to menstruation, but can be tolerated. All patients, regardless of pain intensity, receive painkillers. The pain usually goes away the next day.

Pain relief after embolization

For 8 to 12 hours after fibroid embolization surgery, patients will experience pain of varying degrees of intensity. These are the consequences of stopping blood flow through the arteries leading to tumors. To relieve pain, patients are prescribed painkillers. At their request, women can choose one of the proposed methods:

Taking painkillers (diclofenac, paracetamol) orally, administering suppositories or injections.
Epidural anesthesia, which leads to numbness of the lower half of the body and, as a result, the absence of pain.
Patient-controlled anesthesia: the woman herself, by pressing a button, administers intravenous painkillers.

If a woman has chosen anesthesia using method 2 or 3, then they are introduced before embolization.

Advantages of treating fibroids with tumor artery embolization

Compared to other surgical methods, embolization has the following advantages:

the quality of life does not change after surgery;
there is no blood loss and, as a result, there is no need for blood transfusion;
after embolization, the uterus returns to its previous size;
after the tumor size decreases, the pressure on nearby organs (bladder and intestines) stops;
the amount of menstrual bleeding decreases;
the operation is performed under local anesthesia;
short recovery period;
no scar after surgery;
low percentage of fibroid recurrence;
low-invasiveness of the method;
the reproductive organ is preserved;
the possibility of embolization of fibroids in case of multiple lesions of the uterus by nodes.

Contraindications for uterine artery embolization

Although treatment of fibroids with arterial embolization is a minimally invasive method and has many advantages, there are contraindications even for its use:

Inability to conduct radiopaque studies during surgery. This may be due to the following reasons: tortuosity of the iliac vessels, the presence of renal failure, intolerance to the contrast agent.
Cervical location of fibroids.
Subserous myomatous node on a thin stalk (due to the high risk of expulsion of the necrotic fibroid node into the abdominal cavity).
Active infectious process in the pelvis.
Malignant neoplasms.
Pregnancy.
Endometritis.

Complications after uterine artery embolization

Embolization of uterine fibroids is a minimally invasive operation, therefore there are much fewer complications after it than after abdominal operations, but they still occur, although rarely. The most common complications are separation of tissue from decaying fibroids and amenorrhea.

About 5% of patients observe the discharge of fibroid tissue through the vagina within several months after fibroid embolization. This does not pose a health threat if the cervical canal is freely passable and the woman is warned about this possibility. In a small proportion of patients, myomatous tumor tissue, for some reason, may linger in the cervical canal, which leads to infection. In this case, the woman needs to undergo curettage and hysteroscopy.

About 2% of patients report permanent or temporary (several cycles) amenorrhea. Permanent amenorrhea is observed in women over 45 years of age.

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