Uterine artery embolization

Uterine artery embolization is a modern minimally invasive method of X-ray endovascular treatment, which consists in selective artificial occlusion (blockage) of the vascular channel of uterine myoma.

Etiology and pathophysiology

The procedure is performed by an interventional surgeon under local anesthesia through femoral artery puncture. Under X-ray control, a microcatheter is inserted into the uterine arteries, where calibrated polymer microspheres (emboli) are injected. They get stuck in the perifibroid vascular plexus, which is terminal (has no collaterals). This causes irreversible ischemia and aseptic necrosis (infarction) of myomatous nodes. Over time, the tissue of the node is replaced by fibrosis with subsequent hyalinosis, and it decreases in volume. Healthy myometrium is not affected due to the developed network of bypass vessels.

Clinical significance

EMA is an effective alternative to hysterectomy and myomectomy, especially in case of multiple nodes and high surgical risk. It allows to relieve symptoms of myoma and adenomyosis in 90-95% of cases. The main advantages: preservation of the uterus, no general anesthesia and incisions, short recovery period. Post-embolization syndrome (pain, fever) in the first day is characteristic, requiring anesthesia.