title: Interest of uterine artery embolization with gelatin sponge particles prior to myomectomy for large and/or multiple fibroids.
abstract: OBJECTIVE
  To evaluate the efficacy of pre-myomectomy uterine artery embolization with gelatin sponge particles to reduce operative blood loss and facilitate removal of fibroids.
  
  
  METHODS
  This retrospective study included 33 women (mean age, 36 years; range, 24-45 years), of whom at least 18 wished to preserve fertility. They presented with at least one large myoma (mean diameter, 90 mm; range, 50-150 mm) and had undergone preoperative uterine artery embolization with resorbable gelatin sponge by unilateral femoral approach between December 2001 and November 2008. Clinical, radiological and surgical data were available for all patients. Mean haemoglobin levels before and after surgery were compared with Student's t-test.
  
  
  RESULTS
  No complication or technical failure of embolization occurred. The myomectomies were performed during laparotomy (25 cases) or laparoscopy (8 cases). Dissection of fibroids was easier (mean, 3 per patient; range, 1-11), with a mean operating time of 108±50 min (range, 30-260 min). Bloodless surgery was the rule with a mean estimated peroperative blood loss of 147±249 mL (range, 0-800 mL). Mean pre-(12.9±1.3g/dL) and post-therapeutic (11.4±1.2g/dL) haemoglobin levels were not statistically different (p>0.05). There was no need for blood transfusion. None of the patients required hysterectomy. The mean duration of hospital stay was 7.5±1.3 days (range, 3-12 days).
  
  
  CONCLUSIONS
  Preoperative uterine artery embolization is effective in reducing intraoperative blood loss and improves the chances of performing conservative surgery. It should be considered a useful adjunct to myomectomy in women at high hemorrhagic risk or who refuse blood transfusion.
authors.affiliation: Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Maréchal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex, France.
authors.forename: Noémie
authors.initials: N
authors.lastname: Butori
authors.forename: Hervé
authors.initials: H
authors.lastname: Tixier
authors.forename: Laurence
authors.initials: L
authors.lastname: Filipuzzi
authors.forename: William
authors.initials: W
authors.lastname: Mutamba
authors.forename: Boris
authors.initials: B
authors.lastname: Guiu
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cercueil
authors.forename: Serge
authors.initials: S
authors.lastname: Douvier
authors.forename: Paul
authors.initials: P
authors.lastname: Sagot
authors.forename: Denis
authors.initials: D
authors.lastname: Krausé
authors.forename: Romaric
authors.initials: R
authors.lastname: Loffroy
mesh_terms: D000328:Adult; D003287:Contrast Media; D003952:Diagnostic Imaging; D005260:Female; D005471:Fluoroscopy; D005781:Gelatin Sponge, Absorbable; D006801:Humans; D007889:Leiomyoma / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome; D055357:Uterine Artery Embolization; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*
chemical_list: D003287:Contrast Media