Treatment of uterine myomas with transvaginal uterine artery occlusion: possibilities and limitations.
The objective of this pilot study was to evaluate the feasibility of a transvaginal clamp prototype used for temporary uterine artery occlusion as a treatment for myomas. In particular, we aimed to evaluate technical aspects of successful occlusion with angiography and magnetic resonance imaging (MRI) and to evaluate possible ureter occlusion with pyelography. Ten premenopausal women aged 34 to 37 years with menorrhagia and myomas were treated with a temporary uterine artery occlusion for 6 hours. Five patients did not complete the clamping procedure because of unsuccessful clamping. While the clamp was in position, angiographic examination of the uterine arteries and pyelography were performed in 8 of the patients. The clamps occluded both uterine arteries in 4 patients and 1 side in another 2. Two procedures occluded the ureter unilaterally. MRI with contrast was done before, the day after, and 3 months after the procedure. Three of 5 patients who completed the clamp treatment had reduced or no contrast enhancement at MRI afterward. Clinical effects were obtained in 3 patients. Difficulties with application of the vaginal clamp were related to initial learning and size of the myomas. Our initial experience shows that the treatment is feasible in some patients with symptomatic myomas. However, improvement of the technique and equipment is needed. Care with regard to the ureters is required during further studies aimed at evaluating this approach.
Hald
Kirsten
K
Department of Obstetrics and Gynecology, Ullevål University Hospital, University of Oslo, Oslo, Norway. Kirsten.hald@uus.no
Kløw
Nils-Einar
NE
Qvigstad
Erik
E
Istre
Olav
O
D000328:Adult; D000792:Angiography; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000098:blood supply / Q000628:therapy*; D017211:Treatment Failure; D014594:Uterine Neoplasms / Q000098:blood supply / Q000628:therapy*; D014599:Uterus / Q000098:blood supply* / Q000601:surgery