ASSISTANT:
ANESTHESIOLOGIST:
OPERATION:
1.
Pelvic angiogram x4.
2.
Abdominal aortogram.
3.
Bilateral uterine artery embolization.
PREOPERATIVE DIAGNOSIS:
Symptomatic uterine fibroids.
POSTOPERATIVE DIAGNOSIS: Symptomatic uterine fibroids.
ANESTHESIA: Conscious sedation was provided throughout the
procedure by interventional surgical suite nursing staff
under my direct supervision.
Local sedation with 1% lidocaine solution without
epinephrine in the subcutaneous and subcuticular tissues.
DURATION OF PROCEDURE:
One-and-a-half hours.
INDICATION FOR PROCEDURE: The patient is a _____-year-old
female presenting with symptomatic uterine fibroids.
Significant workup including MRI examination of pelvis with
and without contrast has been done. Discussion has been
made with the patient's referring gynecologist and
physician. This procedure is being done for further
evaluation of the patient's condition and possible
treatment.
CONSENT: Verbal and written consent were obtained after a
detailed discussion of the risks and benefits of the
procedure including small but real risk of ovarian failure
and menopause (could be up to 15% in patients over 45 years
of age), vascular damage, nephrotoxicity, infection,
nausea, procedure not being therapeutic and other
inadvertent events. Questions were answered in detail.
Consent was obtained.
TECHNIQUE: The patient was prepped and draped in the usual
sterile fashion over both groin areas. The right common
femoral artery area was anesthetized with 1% lidocaine
solution. A small skin incision was made with a #11 blade.
Tissue was separated with a hemostat. Access was gained to
the common femoral artery by use of a single-puncture
needle and over a Bentson wire a 5-French arterial sheath
was placed.
Conscious sedation was provided throughout the procedure
under my direct supervision by the nursing staff in the
department.
The sheath was connected to continuous heparinized saline
drip. An Omni Flush catheter was advanced through the
sheath over a Bentson wire and negotiated with its tip in
the contralateral common iliac artery over the wire, the
catheter was exchanged for an Anne Roberts catheter. The
catheter was used to grain access to the internal iliac
artery contralaterally and subsequently the tip of the
uterine artery. A microcatheter over a 0.018 microwire was
negotiated into the uterine artery gently. An angiogram
was performed to exclude the cervicovaginal branch and also
to evaluate for potential supply to the ovarian artery.
Embolization of this vessel was done __________ the
cervicovaginal branch with 500-700 cc of micron Embosphere
particles.
The microcatheter was flushed. Angiogram of the internal
iliac artery was repeated to evaluate and exclude the
proximal uterine artery vasospasm and progress. After
removal of the microcatheter, the Anne Roberts catheter was
positioned into the ipsilateral internal iliac artery. The
microcatheter was used after proper flushing over the wire
to gain access of the ipsilateral uterine artery. Uterine
artery angiography was then performed in the left anterior
oblique projection. Evaluation was done for presence of
cervicovaginal branch or ovarian arteries. Embolization
was done with 500-700 cc micron Embosphere particles.
Forward flow was slowed to 4 seconds of visualization of
contrast after a small amount of injection. The
microcatheter was flushed and removed. The internal iliac
artery angiogram was repeated. The Anne Roberts catheter
was removed after opening it in the abdominal aorta over a
Bentson wire. An Omni Flush catheter was again placed in
the proximal abdominal aorta. An abdominal aortogram was
performed in the AP projection.
SPECIMENS TO PATHOLOGY:
ESTIMATED BLOOD LOSS:
None.
15 cc.
INTERPRETATION OF FILMS:
Findings: Bilaterally dilated and enlarged uterine
arteries were seen. The uterine arteries were embolized
with 500-700 cc micron Embosphere particles successfully.
The patient tolerated the procedure well. The patient
received conscious sedation and antiemetics. She will be
started on a morphine pump.
IMPRESSION: Successful bilateral uterine artery
embolization. Pre and post angiograms of the uterine
arteries were demonstrating significantly diminished flow
to these vessels after embolization.