Anbumalar, S (2012) Three Dimensional Color Doppler Sonographic Assessment of changes in Volume and Vascularity of Fibroids - Before and After Uterine Artery Embolization. Masters thesis, Madras Medical College, Chennai.
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Abstract
Menorrhagia is defined as bleeding that originates from the uterus. In developing countries, the majority of cases are due to fibroid uterus. Massive menorrhagia is a major clinical and surgical problem with a mortality of 80%, which is most often related to hemodynamic instability. Uterine fibroids are the most frequent tumors of the female genital tract, occurring in 20 –50% of women who are older than 40 years. Uterine fibroid, the most common cause of nonacute abnormal uterine bleeding, is also the most common solid uterine neoplasm occurring in 20–40% of all women during their reproductive period. Uterine artery embolization (UAE) was introduced in the 1970s to treat postpartum hemorrhage. In the 1990s, this technique was successfully used preoperatively 3–10 days before myomectomy to reduce bleeding during the surgical phase. In 1995, Ravina et al. proposed embolization of uterine arteries as an alternative to surgical treatment of uterine leiomyoma. Menorrhagia is defined as heavy or prolonged uterine bleeding that occurs at regular intervals. Some sources define menorrhagia further as the loss of ≥ 80 mL blood per cycle or bleeding > 7 days. Conservative management of massive menorrhagia carries a mortality rate of 50%–100% and the mortality is up to 35% even in patients undergoing operation. Surgery remains the procedure of choice in the treatment of massive menorrhagia caused by specific conditions, such as dysfunctional uterine bleeding, hypertension, and endocrine etiology, that is resistant to other therapies. Embolization has become a first-line treatment for symptomatic uterine fibroid . Therapeutic uterine artery embolization is a good treatment adjunct to control uterine bleeding and reduces the need for high -risk hysterectomy.UAE may help to avoid surgery in patients who are not good surgical candidates. Should menorrhagia recur in these patients, repeat embolization can be performed safely. Even in surgical candidates, UAE is effective in preparing the patient for elective rather than high-risk surgery. The goal of uterine fibroid embolisation is to stop blood flow to the uterus through the uterine arteries, thus depriving myomas of their blood supply to produce ischemic infarction . AIM OF THE STUDY: The purpose of the present study is to prospectively evaluate the accuracy of three-dimensional color doppler sonography in depicting changes in fibroid volume and vascularity of pre and post uterine artery embolisation in patients undergoing treatment of fibroid. CONCLUSION: From this study we have found that Uterine Artery Embolisation for the patients having symptomatic uterine fibroid is an effective and safe alternate treatment with significant reduction in volume and vascularity of fibroid particularly in less than 7 cm fibroids. Three dimensional color Doppler sonography assists in assessing the vascularity within the fibroid before and after embolisation. Single trans femoral approach with bilateral uterine arteries embolisation technique was used successfully in most of our patients. Combined PVA - Gelfoam is one of the ideal embolic agents effective in causing volume and vascularity reduction along with relief of the symptoms in patients with fibroid. Hypervascular fibroid respond well to embolisation . It has less failure rates in long term follow up. This procedure has good patient’s tolerance, short recovery time, quick and sustained symptomatic improvement. This procedure may reduce the need for invasive surgery in many patients. From this study we conclude that Three Dimensional Color Doppler Imaging can be a tool for pre and post UAE evaluation in assessing reduction in fibroid vascularity and volume. It is less expensive, more extensively available and provides an estimate of completeness of embolisation.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Three Dimensional ; Color Doppler ; Sonographic Assessment ; Changes Volume ; Vascularity Fibroids ; Before and After Uterine Artery Embolization. |
| Subjects: | MEDICAL > Radio Diagnosis |
| Depositing User: | Subramani R |
| Date Deposited: | 04 Jul 2017 00:37 |
| Last Modified: | 04 Jul 2017 00:44 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/744 |
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