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Clinical history/indication *
Xy year old patient with uterine fibroids causing bleeding/bulk symptoms
presents for bilateral uterine artery embolization for symptom relief;
Medications**: [] mg of versed and [] micrograms of Fentanyl were
administered
for conscious sedation. Cefazolin, 1
gram/Cefotetan/cefoxitin/ampicillin-sulbactam/ penicillin allergy:
vancomycin/clindamycin gentamicin was administered for antibiotic
prophylaxis. Vital signs were continuously monitored by nursing staff
throughout the procedure.
Contrast used: ***: [] cc of
Iopamidol/Iohexol/IoversolIopromide/Oxilan/Iodixanol/Iotrelan/Gadolinium/
Co2
were used for intraarterial injection.
Procedure (includes findings and summary) ****
Both uterine arteries were catheterized from a (left/right/bilateral)
transfemoral approach. Contrast injection showed abnormal vascularity at
(anatomic location(s)) consistent with uterine fibroids. Embolization was
then
performed from the transverse portion of each uterine artery. At the
conclusion the fibroids were completely devascularized.
Summary: Successful bilateral uterine artery embolization resulting in
complete fibroid devascularization/Patient refused to undergo the
procedure.
Variant anatomy/unexpected findings/additional procedure*****
1. Ovarian artery supply: Significant right/left ovarian arterial supply
was
identified which was treated with distal ovarian artery
embolization/could not
be treated and will be evaluated carefully with subsequent clinical/MRI
follow-up and re-intervention will be considered;
2. Utero-ovarian anastomosis was noted which was treated with coil
embolization/could not be treated and requires careful follow-up with
monitoring of ovarian function;
3. Round ligament artery (arising from inferior epigastric artery) was
recognized as a variant feeding the right/left-sided fibroid(s) and was
treated with embolization.
4. Common genitourinary artery trunk was present and precluded uterine
artery
embolization/but still allowed for successful uterine artery
embolization.
5. Multiple small uterine arteries were present and precluded uterine
artery
embolization/were each catheterized and embolized.
6. Uterine artery replaced to ovarian artery precluded transcatheter
treatment/ necessitated distal ovarian artery catheterization and
embolization
7. Lumbar artery fibroid supply necessitated distal lumbar artery
catheterization and embolization;
8.
Other: specify
Complications ******
1. None immediate
2. Minor :
A.
Angiography: specify (such as hematoma, arterial dissection, contrast
nephrotoxicity/reaction)
B. Pelvic infection: specify
C. Contrast reaction: specify
D. Pulmonary embolism
E. Adverse drug reaction
F. Ischemia
Major
A. Angiography: specify (such as hematoma, arterial dissection, contrast
nephrotoxicity/reaction)
B. Pelvic infection: specify
C. Contrast reaction: specify
D. Pulmonary embolism
E. Adverse drug reaction
F. Ischemia
Other