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Daca esti femeie ai un risc de 60% de a avea un fibrom! Medicii iti vor spune cu o probabilitate de 70% ca trebuie sa te operezi, ca uterul tau trebuie scos! Este aceasta singura solutie? Sau cea mai buna? Sigur nu! 80% din operatii pot fi evitate! Cum? Afla in aceasta prezentare!
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EMBOLIZARE SAU CHIRURGIE?La ce riscuri ma expun?
Fibromul uterin
Dr. Rares Nechifor - ARES Clinics, Bucuresti [email protected]
–Helmuth Karl Bernhard von Moltke
“ Intai cantareste consideratiile, apoi asuma-ti riscuri ”
60% dintre femei au fibrom
70% primesc recomandare pentru Histerectomie doar 20%
au indicatie corectahisterectomia!
80% dintre femei nu primesc informatii
despre alternative!
30% Histerectomie cu scoaterea ovarelor 100%
infertilitate 60% depresie
50% menopauza
30% complicatii
minore 7% complicatii
majore
40% afectare
viata sexuala
Din fericire, 90% dintre fibroame
se se pot trata mai bine!
1 deces/zi
Situatia actuala
Consecinte
Histerectomie Embolizare Miomectomie
Alternative
scoaterea chirurgicala a uterului
scoatereachirurgicalaa fibromului
inchidereavaselor de sange
ce hranesc fibroamele
Afirmatii despre embolizare
Este o procedura foarte dureroasa!
Se pot produce infectii grave ajungand pana la deces!
Nu este eficenta, fibroamele recidiveaza!
Nu elimina riscul de cancer!
Nu mai poti avea copii!
Sunt aceste afirmatii adevarate ?
Sa vedem!
“ Este o procedura dureroasa ? ”
Intensitatea si durata durerii
1-2 saptamani
ChirurgieEmbolizare
1-2 zile
“ Este o procedura dureroasa ? ”
Pacientele ce fac embolizare au nevoie de jumatate din cantitatea
de medicamente pentru durereprimite de cele ce s-au operat!
“ Exista riscuri legate de anestezie ? ”
Riscul asociat anesteziei
2%ChirurgieEmbolizare
0%
“ Exista riscuri legate de anestezie ? ”
La embolizare nu se foloseste anestezia, deci nu exista astfel de riscuri!
Toate interventiile chirurgicale necesita anestezie!Cu riscurile asociate
“ Pot face o infectie grava ? ”
Riscul de infectie
2% 10%Embolizare
Chirurgie
“ Pot face o infectie grava ? ”
Riscul de infectie pentru chirurgieeste de 5 ori mai mare
decat cel asociat embolizarii!
5x
“ Fibroamele recidiveaza dupa tratament ? ”
Riscul de recidiva
2% 60%Embolizare
Miomectomie
“ Fibroamele recidiveaza dupa tratament ? ”
Riscul de recidiva pentru miomectomieeste de 30 ori mai mare
decat cel asociat embolizarii!
30x
“ Pot face cancer ? ”
ParkinsonAccident vascular
Riscul de cancerHisterectomie totala
0,1%Embolizare
InfarctFractura sold
Dementa
“ Pot face cancer ? ”
Riscul de deceseste de 5 ori mai mare
atunci cand uterul si ovarele sunt scoase chirurgical!
5x
“ Ce risc am sa devin infertila ? ”
Riscul de infertilitate
0,1% 100%
Histerectomie
2%
Embolizare / Miomectomie
“ Ce risc am sa devin infertila ? ”
Embolizarea si miomectomiaau acelasi risc, mic, de 2%Prin scoaterea uterului
toate femeile devin infertile!
1x
“ Pot intra la menopauza ? ”
Riscul de menopauza
2% 50%Embolizare / Miomectomie
Histerectomie
“ Pot intra la menopauza ? ”Embolizarea si miomectomia
au acelasi risc, mic, de 2%Prin scoaterea uterului
jumatate dintre femei intra la menopauza!
1x
“ Pot surveni complicatii ? ”
Riscul de complicatii majore
7%
Chirurgie
Embolizare
1%
“ Pot surveni complicatii ? ”
Interventiile chirurgicale producde 7 ori mai multe complicatii majore
decat embolizarea!
7x
“ Imi pot pierde uterul ? ”
Riscul de scoatere a uterului
10%
Miomectomie
0,1%Embolizare
Riscul de scoatere a uterului
100%
Histerectomie
“ Imi pot pierde uterul ? ”
Persoanele ce fac miomectomie are un risc de 100 de ori mai mare
de a-si pierde uterulfata de cele ce au facut embolizare
100x
“ Alte organe pot fi afectate ? ”
Riscul de afectare a altor organe
Chirurgie
Embolizare
0,01% Vezica Intestine
UreterPlaman 5%
“ Alte organe pot fi afectate ? ”
Persoanele ce sunt tratate chirurgicalare un risc de 500 de ori mai mare
de afectare a altor organefata de persoanele ce au facut embolizare
500x
“ Sunt cazuri de deces ? ”
Riscul de deces
Embolizare
1deces la 3 ani 1deces in fiecare ziin lume in USA
(1/50.000 cazuri) (1/1.500 cazuri)
Chirurgie
“ Sunt cazuri de deces ? ”
50x
Persoanele ce sunt tratate chirurgicalare un risc de deces
de 50 de ori mai mare fata de persoanele ce au facut embolizare
Histerectomie
Recomandarea initiala a
medicului
70%
Alegerea pacientei
10%cea mai veche metodacea mai folosita metoda
cea mai agresivacele mai multe complicatii
descurajata de ghidurile terapeutice
prinInformare corecta si completa
Alegerea pacientului
Miomectomie
Recomandarea initiala a
medicului
30%Alegerea pacientei
15%
prinInformare corecta si completa
Alegerea pacientului
mai dificila ca tehnicaputini medici pregatiti
mai putin agresivamai putine complicatii
inrficienta pentru polifibromatozarata mare de recidiva
incurajata de ghidurile terapeutice
cea mai putin agresivacele mai putine complicatiiposibila in 90% din cazuri
rezultate similare miomectomieiincurajata de ghidurile terapeutice
Embolizare
Recomandarea initiala a
medicului
30%
Alegerea pacientei
60%
prinInformare corecta si completa
Alegerea pacientului
6000 cazuri
FIBROID | CENTER
Cea mai mare experienta din Europa
Centru de Training International
Prin Embolizare nu au mai fost necesare
24000 zile de spitalizare
1000 de ani de concediu medical
FIBROID | CENTER
Prin Embolizare am evitat
3000cazuri de
menopauza precoce
500 infectii
300 complicatii majore
6 decese
FIBROID | CENTER
VA MULTUMESC!Dr. Rares Nechifor - ARES Clinics, Bucuresti
Bibiliografie (http://www.fibroidcenter.ro/#!dovezi-stiintifice/c1gly)
Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged WomenABSTRACT: Initial evaluation of the patient with acute abnormal uterine bleeding should include a prompt assessment for signs of hypovolemia and potential hemodynamic instability. After initial assessment and stabi-lization, the etiologies of acute abnormal uterine bleeding should be classified using the PALM–COEIN system. Medical management should be the initial treatment for most patients, if clinically appropriate. Options include intravenous conjugated equine estrogen, multi-dose regimens of combined oral contraceptives or oral progestins, and tranexamic acid. Decisions should be based on the patient’s medical history and contraindications to therapies. Surgical management should be considered for patients who are not clinically stable, are not suitable for medical management, or have failed to respond appropriately to medical management. The choice of surgical manage-ment should be based on the patient’s underlying medical conditions, underlying pathology, and desire for future fertility. Once the acute bleeding episode has been controlled, transitioning the patient to long-term maintenance therapy is recommended.
Abnormal uterine bleeding (AUB) may be acute or chronic and is defined as bleeding from the uterine cor-pus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy (1, 2). Acute AUB refers to an episode of heavy bleeding that, in the opinion of the clinician, is of sufficient quantity to require immediate intervention to prevent further blood loss (1). Acute AUB may occur spontaneously or within the context of chronic AUB (abnormal uterine bleeding present for most of the previous 6 months). The general process for evaluating patients who present with acute AUB can be approached in three stages: 1) assessing rap-idly the clinical picture to determine patient acuity, 2) determining most likely etiology of the bleeding, and 3) choosing the most appropriate treatment for the patient.
Assessment of the Patient With Acute Abnormal Uterine BleedingInitial evaluation of the patient with acute AUB should include a prompt assessment for signs of hypovolemia and potential hemodynamic instability. If the patient is hemodynamically unstable or has signs of hypovolemia, intravenous access with a single or two large bore intra-
venous lines should be initiated rapidly as should the preparation for blood transfusion and clotting factor replacements. After the initial assessment and stabili-zation, the next step is to evaluate for the most likely etiology of acute AUB so that the most appropriate and effective treatment strategy to control the bleeding can be chosen.
Etiologies of Acute Abnormal Uterine BleedingThe etiologies of acute AUB, which can be multifacto-rial, are the same as the etiologies of chronic AUB. The Menstrual Disorders Working Group of the International Federation of Gynecology and Obstetrics proposed a classification system and standardized terminology for the etiologies of the symptoms of AUB, which has been approved by the International Federation of Gynecology and Obstetrics’ executive board and supported by the American College of Obstetricians and Gynecologists (1, 2). With this system, the etiologies of AUB are class- ified as “related to uterine structural abnormalities” and “unrelated to uterine structural abnormalities” and cat-egorized following the acronym PALM–COEIN: Polyp,
COMMITTEE OPINIONCommittee on Gynecologic PracticeThis document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.
The American College of Obstetricians and GynecologistsWOMEN’S HEALTH CARE PHYSICIANS
Close window
Scope
Methodology
Guideline Title
Alternatives to hysterectomy in the management of leiomyomas.
Bibliographic Source(s)
American College of Obstetricians and Gynecologists (ACOG). Alternatives to hysterectomy in the management of leiomyomas.Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2008 Aug. 14 p. (ACOG practice bulletin; no. 96). [117references]
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version: American College of Obstetricians and Gynecologists (ACOG). Surgical alternatives tohysterectomy in the management of leiomyomas. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2000May. 10 p. (ACOG practice bulletin; no. 16). [64 references]
The American College of Obstetricians and Gynecologists (ACOG) reaffirmed the currency of this guideline in 2012.
Disease/Condition(s)
Uterine leiomyomas (fibroids)
Guideline Category
EvaluationManagementTreatment
Clinical Specialty
Obstetrics and GynecologySurgery
Intended Users
Physicians
Guideline Objective(s)
To aid practitioners in making decisions about appropriate obstetric and gynecologic careTo review the literature about medical and surgical alternatives to hysterectomy and to offer treatment recommendations
Target Population
Women with uterine leiomyomas
Interventions and Practices Considered
Treatment/Management
Surgical Alternatives to Hysterectomy
1. Abdominal myomectomy2. Laparoscopic myomectomy3. Hysteroscopic myomectomy4. Uterine artery embolization5. Magnetic resonance imaging-guided focused ultrasound surgery (considered, but not specifically recommended)
Adjunctive Medical Treatment
1. Preoperative adjuvant therapy: gonadotropin-releasing hormone agonists (GnRH)2. Intraoperative adjuvant therapy: vasopressin infiltration into the myometrium3. Medications considered but not specifically recommended:
Contraceptive steroids and nonsteroidal anti-inflammatory drugsAromatase inhibitorsProgesterone modulators
Major Outcomes Considered
Morbidity and mortalityRecurrence of leiomyomasRisk of follow-up treatment, including unplanned hysterectomy
Methods Used to Collect/Select the Evidence
What are uterine fibroids?Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas. The size, shape, and location of fibroids can vary greatly. They may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure. A woman may have only one fibroid or many of varying sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years.
Who is most likely to have fibroids?Fibroids are most common in women aged 30–40 years, but they can occur at any age. Fibroids occur more often in African American women than in white women. They also seem to occur at a younger age and grow more quickly in African American women.
What are symptoms of fibroids?Fibroids may have the following symptoms:
• Changes in menstruation
FREQUENTLY ASKED QUESTIONS
FAQ074
GYNECOLOGIC PROBLEMS
The American College of Obstetricians and Gynecologists
fAQ
• What are uterine fibroids?
• Who is most likely to have fibroids?
• What are symptoms of fibroids?
• What complications can occur with fibroids?
• How are fibroids diagnosed?
• When is treatment necessary for fibroids?
• Can medication be used to treat fibroids?
• What types of surgery may be done to treat fibroids?
• Are there other treatments besides medication and surgery?
• Glossary
Uterine Fibroids
Fibroids may be attached to the outside of the uterus or be located inside the uterus or uterine wall.
Fibroid outside the uterus attached by a stem
Fibroid within the inside layer of the uterine wall
Fibroid within uterine wall
Fibroid within the outside layer of the uterine wall
Human Reproduction Vol.16, No.7 pp. 1473–1478, 2001
Morbidity of 10 110 hysterectomies by type of approach
Juha Makinen1,8, Jari Johansson2, Candido Tomas2, Eija Tomas3, Pentti K.Heinonen3,Timo Laatikainen4, Minna Kauko5, Anna-Mari Heikkinen6 and Jari Sjoberg7
1Department of Obstetrics and Gynecology, Turku University Hospital, FIN-20520 Turku, 2Department of Obstetrics andGynecology, Oulu University Hospital, P.O.Box 22, FIN-90221 Oulu, 3Department of Obstetrics and Gynecology, TampereUniversity Hospital, P.O.Box 2000, Fin-33521 Tampere, 4Department of Obstetrics and Gynecology, Helsinki City MaternityHospital, Sofialehdonkatu 5 A, 00610 Helsinki, 5Department of Obstetrics and Gynecology, North Carelia Central Hospital,Tikkamaentie 16, 80210 Joensuu, 6Department of Obstetrics and Gynecology, Kuopio University Hospital, P.O.Box 1777, FIN-70211Kuopio, 7Department of Obstetrics and Gynecology, Helsinki University Hospital, Haartmaninkatu 2, FIN-00290 Helsinki, Finland
8To whom correspondence should be addressed. E-mail: [email protected]
BACKGROUND: Since the late 1980s, the option of laparoscopic hysterectomy has raised questions about the mostsuitable approach to hysterectomy. METHODS: To evaluate the influence of the type of approach, in causing oravoiding certain complaints in hysterectomies a prospective nationwide study was conducted comprising allhysterectomies for benign disease performed in Finland during 1996. The primary outcomes of interest were theoperation-related morbidity, common surgical details and post-operative complications. RESULTS: A total of 10 110hysterectomies, including 5875 abdominal, 1801 vaginal and 2434 laparoscopic operations showed a low rate ofoverall complications, 17.2, 23.3 and 19.0% respectively. Infections were the most common complications withincidences of 10.5, 13.0 and 9.0% in the abdominal, vaginal and laparoscopic group respectively. The most severetype of haemorrhagic events occurred in 2.1, 3.1 and 2.7% in the abdominal, vaginal and laparoscopic grouprespectively. Ureter injuries were predominant in laparoscopic group [relative risk (RR) 7.2 compared withabdominal] whereas bowel injuries were most common in vaginal group (RR 2.5 compared with abdominal).Surgeons who had performed >30 laparoscopic hysterectomies had a significantly lower incidence of ureter andbladder injuries (0.5 and 0.8% respectively) than those who had performed ≤30 operations (2.2 and 2.0%respectively). A decreasing trend of bowel complications was also seen with increasing experience in vaginalhysterectomies. CONCLUSIONS: This large-scale observational study on hysterectomies provides novel informationon operation-related morbidity of abdominal, vaginal or laparoscopic approach. The results support the importanceof the experience of the surgeon in reducing severe complications, especially in laparoscopic and vaginalhysterectomies.
Key words: complication/epidemiology/gynaecology/hysterectomy/laparoscopy
Introduction et al., 1992; Liu, 1992; Kovac, 1995; Weber and Lee, 1996).There are, however, some concerns related to the costs and theHysterectomy is the most common major gynaecologicalmorbidity of the approach (Summitt et al., 1992; Kovac, 1995;operation in the world. For benign indications many countriesWeber and Lee, 1996). In general, the results of these studieshave favoured either the abdominal (Nathorst-Boos et al.,have a limited value because they are retrospective and include1992; Hall et al., 1998; Harkki-Siren et al., 1998) or theonly a small number of patients. Furthermore, they have beenvaginal approach (Querleu et al., 1993; Kovac, 1995). Theseperformed mainly by expert surgeons or done during the learningtraditions have prevailed unaltered throughout decades. How-curve of the new procedure (Garry, 1998). In order to increaseever, since the late 1980s, the new option of laparoscopicthe power of the observational studies on morbidity in largehysterectomy (Reich et al., 1989) has raised questions aboutnumbers of patients, a prospective evaluation was conducted ofthe most suitable type of approach (Stovall and Summitt, 1996;all hysterectomies performed for benign indications during 1996Kadar et al., 1997; Osborne, 1997; Porges, 1997)in the whole of Finland.The new laparoscopic technique has been assessed against the
other techniques by observational patient series, case-controlledMaterials and methodstrials and also by randomized controlled trials. The advantage
of the laparoscopic approach has been mainly associated with a From January 1 to December 31, 1996, the information on allhysterectomies performed for benign disease in Finland was registeredshort hospital stay and a quick convalescence (Garcia Padial
© European Society of Human Reproduction and Embryology 1473
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permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php
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http://dx.doi.org/10.2147/IJWH.S43591
Embolization of uterine fibroids from the point of view of the gynecologist: pros and cons
Michal MaraKristyna Kubinova
Department of Obstetrics and Gynecology, General Faculty Hospital and First Medical Faculty of Charles University, Prague, Czech Republic
Correspondence: Michal Mara Department of Obstetrics and Gynecology, General Faculty Hospital, Apolinarska 18, Prague 2, Czech Republic Tel 42 07 2396 8944 Fax 42 02 2496 7474 Email [email protected]
Abstract: Uterine artery embolization (UAE) is a minimally invasive procedure with large symptomatic potential in treatment of women with uterine leiomyomas. Due to specificities of this method and possible complications the appropriate indication is crucial. Patient’ symptoms, age, plans for pregnancy, and surgical and reproductive history play a major role in decision-making regarding appropriate subjects for UAE. Close cooperation between the gynecologist and the interventional radiologist is necessary. UAE is usually offered as an alternative to surgical treatment. In patients with no fertility plans, it is a less invasive option than abdominal hysterectomy, with a comparable effect on fibroid-related symptoms and quality of life. The need for reintervention is markedly greater in patients after UAE (up to 35% within 5 years) than after hysterectomy. Women with large symptomatic fibroids wishing to retain the uterus and ineligible for minimally invasive (laparoscopic or vaginal) hysterectomy are good candidates for UAE. However, studies comparing UAE with minimally invasive hysterectomy are lacking. Use of UAE in younger women desiring pregnancy is more controversial, mainly because of the significant risk of miscarriage (as high as 64% in some studies) as well as the increased risk of other complications of pregnancy, such as preterm delivery, abnormal placentation, and post-partum hemorrhage. The risk of infertility or subfertility following UAE is unknown. Even poor candidates for myomectomy should be carefully selected for UAE after counseling about all possible adverse effects on fertility. Good prospective studies focused on fertility comparing UAE with no treatment or with myomectomy are needed but would be ethically questionable. This review summarizes the current knowledge regarding the benefits and potential risks of UAE from the point of view of the gynecologist, who should be responsible for proper indica-tion of this treatment.Keywords: benefits, hysterectomy, myomectomy, risks, uterine artery embolization, uterine fibroid
Introduction
Uterine artery embolization (UAE) is a radiologic catheterization procedure traditionally used for intractable oncogynecologic or obstetric uterine bleeding, and was first described as a potential treatment for uterine fibroids in 1995.1–3 Since then, and in spite of skepticism and resistance on the part of many gynecologists, UAE has become more or less established in the spectrum of uterus-sparing treatments for uterine leiomyoma throughout the world, especially in developed countries.4–7
Premenopausal women aged 35–50 years with symptomatic uterine fibroids are the most likely candidates for UAE.8 However, there are still unanswered questions and controversies regarding UAE and these problems do not arise only from the different viewing angle and rivalry between gynecologists and interventional radiologists.
The Appropriateness of Recommendations forHysterectomy
MICHAEL S. BRODER, MD, DAVID E. KANOUSE, PhD, BRIAN S. MITTMAN, PhD,AND STEVEN J. BERNSTEIN, MD, MPH
Objective: To evaluate the appropriateness of recommenda-tions for hysterectomies done for nonemergency and non-oncologic indications.
Methods: We assessed the appropriateness of recommen-dations for hysterectomy for 497 women who had the oper-ation between August 1993 and July 1995 in one of ninecapitated medical groups in Southern California. Appropri-ateness was assessed using two sets of criteria, the firstdeveloped by a multispecialty expert physician panel usingthe RAND/University of California–Los Angeles appropri-ateness method, and the second consisting of the ACOGcriteria sets for hysterectomies. The main outcome measurewas the appropriateness of recommendation for hysterec-tomy, based on expert panel ratings and ACOG criteria sets.
Results: The most common indications for hysterectomywere leiomyomata (60% of hysterectomies), pelvic relaxation(11%), pain (9%), and bleeding (8%). Three hundred sixty-seven (70%) of the hysterectomies did not meet the level ofcare recommended by the expert panel and were judged tobe recommended inappropriately. ACOG criteria sets wereapplicable to 71 women, and 54 (76%) did not meet ACOGcriteria for hysterectomy. The most common reasons recom-mendations for hysterectomies considered inappropriatewere lack of adequate diagnostic evaluation and failure totry alternative treatments before hysterectomy.
Conclusion: Hysterectomy is often recommended for indi-cations judged inappropriate. Patients and physiciansshould work together to ensure that proper diagnostic eval-
uation has been done and appropriate treatments consideredbefore hysterectomy is recommended. (Obstet Gynecol 2000;95:199–205. © 2000 by The American College of Obstetri-cians and Gynecologists.)
Several studies suggested that physicians might usesurgical procedures inappropriately, with some pa-tients not receiving necessary care and others exposedto unwarranted risk.1,2 To improve the quality of pa-tient care, there has been a concerted effort to developguidelines and other criteria for physician practice. Anequivalent effort to implement and disseminate thoseguidelines has been lacking.
The Agency for Health Care Policy and Research, abranch of the US Department of Health and HumanServices, sponsored a series of studies to improve theprocess. One of those studies, the Women’s Health andHysterectomy Project, is designed to develop and dis-seminate recommendations for hysterectomy. We choseto focus this project on hysterectomy because it is thesecond most common major operation women haveand there are significant concerns among researchersand the public that it might be overused.3–5 In thisstudy, we report the appropriateness of recommenda-tions for hysterectomies in a cohort of women at nineSouthern California managed-care organizations beforethe dissemination of clinical recommendations on useof hysterectomy.
MethodsWe measured appropriateness of recommendations forhysterectomy using two sets of criteria: 1) a set devel-oped for the Women’s Health and Hysterectomy Projectby an expert panel using the RAND/University ofSouthern California–Los Angeles appropriatenessmethod, and 2) three recent ACOG criteria sets de-
From the Department of Obstetrics and Gynecology, University ofCalifornia, Los Angeles, RAND, Santa Monica, and Veterans Admin-istration Medical Affairs, Sepulveda, California; the Veterans AffairsMedical Center, and the Departments of Medicine and Health Manage-ment and Policy, University of Michigan, Ann Arbor, Michigan.
Funded in part by grant no. R18HS07095 from the Agency for HealthCare Policy and Research, and in part by the Robert Wood JohnsonClinical Scholars Program.
The views expressed herein are those of the authors and do notnecessarily reflect those of the Agency for Health Care Policy andResearch or the Robert Wood Johnson Foundation.
The authors thank the members of the expert panel (Bruce Bagley,Constance Bohon, Vivian Dickerson, Karen Freund, Joseph Gambone,Frank Ling, Anne Moulton, Herbert Peterson, and Marian Swinker) fortheir assistance in developing the ratings, and Stanley Zinberg of ACOGfor assistance with revising the criteria.
199VOL. 95, NO. 2, FEBRUARY 2000 0029-7844/00/$20.00PII S0029-7844(99)00519-0
1
YouUr First ChoicE Patient Information and Choice – UFE Patient Survey
YouUr First ChoicE: An On-Line Survey of Women with Fibroids, the Information, Choice and Access They Had to Uterine Artery/Fibroid Embolisation and Alternatives to Hysterectomy for the Treatment of Fibroids
Title of Report: YouUr First ChoicE: Patient Information and Choice A UFE Patient Survey - An On-Line Survey of Women with Fibroids, the Information, Choice and Access They Had to Uterine Artery/Fibroid Embolisation and Alternatives to Hysterectomy for the Treatment of Fibroids
Key words: UFE, UAE, embolisation, uterine artery embolisation, uterine fibroid embolisation, embolization, uterine fibroids, patients, choice, information; NICE Guidance.
1. BACKGROUND
Fibroids are a major public health issue affecting up to 80% of women, with 20% requiring treatment for symptoms such as heavy and painful periods, bulk symptoms and infertility. Sixty percent of all hysterectomies (approximately 39,000 p.a. in total) carried out in the NHS in England are for fibroids. More are carried out in the private sector.
Uterine Fibroid/Artery Embolisation [UFE or UAE] is a newer medical technology, started in the 1980s in France. It is an interventional radiology treatment for symptomatic fibroids, which is much less invasive than the standard treatment - abdominal hysterectomy, allows women to maintain their fertility (and to become pregnant) and return to work/normal life much quicker. It has been shown to be safe and effective by two NICE Interventional Procedures Reviews and it is recommended in NICE Clinical Guidelines on Heavy Menstrual Bleeding ‘07 as a first line treatment for women with symptomatic fibroids over 3cm, wishing to retain their uterus. NICE Guidelines also state that women should be offered this treatment, as well as hysterectomy and myomectomy. UFE is also much less expensive to both women and the NHS.
Despite NICE Guidelines many women are still contacting FEmISA asking how to access UFE and/or alternatives to hysterectomy and are still not being told about or offered UFE or other alternatives to hysterectomy.
FEmISA and the Medical Technology Group (FEmISA is a member) has therefore asked women to complete this on-line survey on what treatments they were offered and told about for their symptomatic fibroids. The survey ran from March to September 2011 and FEmISA is grateful to Woman’s Hour for highlighting these issues and all the women for taking the time to complete the survey.
ABHI• AdvaMed • AMO •AntiCoagulation Europe • ARMA • Arrhythmia Alliance • Arthritis Care • Atrial Fibrillation Association • BD • Bladder and Bowel Foundation • Boston Scientific • British Cardiac Patients Association • C R Bard • Cardiomyopathy Association • Convatec • Eucomed • FABLE• FEmISA • Heart Research UK • ICD Group • INPUT • International Alliance of Patients' Organizations • IST Information and Support • JDRF• Johnson & Johnson • Lindsay Leg Club • Medtronic • National Rheumatoid Arthritis Society • Pelvic Pain Support Network • Roche Diagnostics • SADS UK • St Jude Medical • STARS • Stryker • The Circulation Foundation •The Patients Association • Transplant Support Network • Zimmer
Complications of Uterine FibroidEmbolizationBrian E. Schirf, M.D.,1 Robert L. Vogelzang, M.D.,1
and Howard B. Chrisman, M.D., M.B.A.1
ABSTRACT
Uterine fibroid embolization (UFE) is an increasingly popular, minimally invasivetreatment option for women with symptomatic fibroid disease. UFE therapy in qualifiedhands is an effective, well-tolerated procedure that offers relief of fibroid symptoms with alow risk of complications. In the acute postprocedural period, immediate complicationsmay relate to vascular access, thromboembolic events, infection, and pain management.Reported major complications include but are not limited to pulmonary embolus, uterineischemia, necrosis, sepsis, and death. Non-life-threatening complications include alteredovarian and sexual function, subcutaneous tissue necrosis, expulsion of fibroid tissue, andtreatment failure. Awareness of the known complications of UFE may allow more rapiddiagnosis and effective therapeutic responses to complications when they occur.
KEYWORDS: Fibroids, complications, embolization
Objectives: Upon completion of this article, the reader should be able to discuss the avoidance, detection, and management of bothprocedural and delayed complications associated with uterine fibroid embolization.Accreditation: Tufts University School of Medicine (TUSM) is accredited by the Accreditation Council for ContinuingMedical Educationto provide continuing medical education for physicians.Credit: TUSMdesignates this educational activity for a maximumof 1 Category 1 credit toward the AMAPhysicians Recognition Award.Each physician should claim only those credits that he/she actually spent in the activity.
Uterine fibroid embolization (UFE) is an in-creasingly popular minimally invasive treatment optionfor women with symptomatic fibroid disease. UFEtherapy in qualified hands is an effective, well-toleratedprocedure that offers relief of fibroid symptoms with alow risk of complications. The Society of InterventionalRadiology Reporting Standards for Uterine ArteryEmbolization for the Treatment of Uterine Leiomyo-mata recommends that complications be categorized asrelated to: ‘‘angiography, pelvic infection, ischemia,
post-embolization syndrome (prolonged admission, re-admission, or escalation of care), ovarian failure, sexualdysfunction, fibroid tissue passage requiring interven-tion, non-gynecologic embolization (bowel, buttock,nerves, etc.), radiation injury, adverse drug reaction,pulmonary embolism, and other.’’1 Complications arefurther defined as minor or major events within eachcategory1 with major events resulting in an unplannedincreased level of care or prolonged hospitalization.Overall, major complications typically occur in fewer
1Department of Radiology, Northwestern University, Chicago,Illinois.
Address for correspondence and reprint requests: Howard B.Chrisman, M.D., M.B.A., Vice Chairman, Clinical Operations,Department of Radiology, NUMS, 676 N. St. Claire Avenue, Suite800, Chicago, IL 60611.
Complications in Interventional Radiology; Guest Editor, JonathanLorenz, M.D.
Semin Intervent Radiol 2006;23:143–149. Copyright # 2006 byThieme Medical Publishers, Inc., 333 Seventh Avenue, New York,NY 10001, USA. Tel: +1(212) 584-4662.DOI 10.1055/s-2006-941444. ISSN 0739-9529.
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