Article

Uterine artery embolization for the treatment of fibroids.

Issues in emerging health technologies 09/2002; DOI: 10.1016/S0015-0282(02)04683-6
Source: PubMed

ABSTRACT Uterine artery embolization (UAE), or uterine fibroid embolization, is a non-surgical treatment for uterine fibroids that preserves the uterus and offers women an alternative to surgical procedures such as hysterectomy and myomectomy. Evidence from controlled trials comparing fibroid treatments is not yet available. Case series reports indicate that UAE is a relatively safe and effective treatment for symptomatic fibroids. The effect of UAE on fertility and pregnancy is not known, though pregnancies following UAE have been reported. UAE may reduce health care costs associated with treating fibroids through shorter hospital stays and faster recoveries.

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    • "irregular vaginal bleeding, pelvic pain and infertility) does not necessitate complete resolution of the fibroid but rather a modest decrease in their size (Vilos, 2000). Uterine artery embolization literature clearly documents this, where a modest decrease in the volume of the uterine leiomyoma was associated with marked improvement in clinical conditions and patient satisfaction (Ravina et al., 1995; Bradley et al., 1998; Goodwin and Walker, 1998; Hutchins et al., 1999). Unlike cancer gene therapy, gene delivery does not have to be achieved in every leiomyoma cell to attain clinical improvement. "
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    ABSTRACT: Leiomyomas (fibroids) are common estrogen-dependent uterine tumours that cause significant morbidity for women and a substantial economic impact on health delivery systems. Currently, there is no effective medical treatment option for this condition-hysterectomy is the mainstay of management. This is not an attractive choice for many women, especially patients desiring to preserve their fertility potential. Gene therapy is becoming a clinical reality, with more than 600 clinical trials worldwide. Researchers have recently attempted to develop a gene-therapy-based approach for the ablation of uterine fibroids. The localized nature of this condition and its accessibility using different imaging or endoscopic techniques make it an attractive target for direct delivery of gene-based vectors. Recent work from our laboratory suggests the potential use of a dominant-negative form of estrogen receptor (ER) to inactivate estrogen signalling in leiomyoma cells and induce apoptosis. Our in vivo data in a mouse model demonstrate the ability of an adenovirus-expressing dominant-negative ER to arrest leiomyoma growth. We and others also have described the utility of the herpes simplex virus-thymidine kinase (HSV-TK) plus ganciclovir (GCV) suicide gene-therapy system to effectively eradicate leiomyoma cells by utilizing the bystandard effect phenomena and the high expression of gap-junction protein in these tumours. Further work on rat models will pave the way for future leiomyoma gene-therapy clinical trials and allow the realization of gene therapy as a viable non-surgical option for this common problem in women's health.
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    ABSTRACT: Objective. To evaluate ovarian function in 29 patients who underwent uterine artery embolisation (UAE). Methods. Twenty-nine patients with myomas of the uterus underwent UAE using polyvinyl alcohol (PVA) particles with a diameter of 150 - 550 µm. Follicle-stimulating hormone (FSH) levels were measured before and after UAE. Results. The median age of the patients was 39 years (range 19 - 51 years). Two patients (7%) were menopausal before UAE was attempted. In 3 patients (10.3%), normal pre-procedural FSH values rose to menopausal levels afterwards (95% confidence interval (CI) 3.6 - 26.4%). Only 1 of these patients was younger than 40 years of age (39 years). Of 15 patients less than 40 years of age, 6.7% (95% CI 1.2 - 29.8%) therefore developed a significant rise in FSH levels. One patient, aged 35 years, developed temporary amenorrhoea and endometrial atrophy, which returned to normal within a year. Conclusions. UAE resulted in ovarian failure in 7% of patients younger than 40 years of age and 10% of patients overall.
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    ABSTRACT: Uterine artery embolization is a minimally invasive technique that is gaining popularity as a safe and effective alternative to myomectomy and hysterectomy. This first part of a two-part series on the management of uterine fibroids discusses uterine artery embolization: when it is applicable, how to perform it, and what to expect from the procedure.
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