Minimally Invasive Image Guided Interventions in Gynaecology and Women's Health

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Minimally Invasive Image Guided Interventions in Gynaecology and Women's Health

Journal Title: Interventions in Gynaecology and Women’s Healthcare - Year 2018, Vol 1, Issue 5

Abstract

Image guided interventions are increasingly being used in different fields of medicine. A large number of such minimally invasive interventions are routinely done for surgical, medical and oncological patients, besides the endovascular interventions performed for a variety of vascula r conditions and diseases. Minimally invasive image guided interventions in gynaecology are primarily embolisation procedures where supplying arteries or draining veins are occluded using different embolisation materials. The major image guided interventions are described below. Uterine and pelvic arterial embolisation is a life saving tool for post partum haemorrhage (PPH) [1,2], post-operative bleeding including after caesarian section and hysterectomy, and for bleeding (or risk of bleeding) in abnormal placentation, post-abortion/ectopic pregnancy, trophoblastic disorders and gynaecological malignancies [3]. The embolisation techniques are minimally invasive, quick and easy to perform saves a lot of blood transfusion and patients recover early with shorter hospital stay. Most embolisations are performed through a puncture in the right and/or left common femoral artery and use 4F-5F selective catheters, co-axial micro catheters (2.4F-3F) and corresponding guide wires. Typical embolisation materials used to occlude the bleeding vessels are coils (steel, platinum, fibred or hydro gel coils), particles (uncalibrated gel foam, calibrated particles from 500-900 micron) and liquid embolic materials (Glue & Onyx). Coils and Gel foam are the most frequently used embolic agents (Figures 1-3). Leiomyomas occur in 50-60% of women, rising to 70% by the age of 50 [4]. It causes pressure symptoms such urinary symptoms, heaviness, pelvic pain, infertility and obstetric complications, and in 30% of cases, cause heavy menstrual bleeding leading to anemia [5]. Effectiveness of uterine artery embolisation (UAE) in treating selected patients with uterine fibroids has been established by multiple studies. Royal College of Obstetrics & Gynaecologists (RCOG) recommends that UAE should always be considered along with surgical options [6]. UAE has similar outcome as surgery in up to a five-year follow up with no greater major complication rate [7]. On the other hand UAE is minimally invasive, can be performed on a day-care basis and thus has very short hospital stay compared to surgery, though with a higher re-intervention rate in the long term. Pre-treatment and follow up MR scanning is mandatory to diagnose, plan intervention and evaluate treatment success and rule out complications. UAE is always performed bilaterally as leiomyomas tend to have bilateral uterine arterial supply. 500-900 micron particles are used for embolisation until complete stasis of the uterine arteries. Smaller particles are usually not recommended to avoid complications such as necrosis of fibroid/ uterus. Cervical branches should also be avoided during UAE (Figures 4-9).

Authors and Affiliations

Arindam Bharadwaz

Keywords

Evaluation of Gasometric Behavior of Transfused Fetuses in Alloimmunized Pregnant Women According to the Concentration of Circulating Adult Hemoglobin

Introduction: Perinatal hemolytic disease occurs due to the passage of antibodies from maternal to fetal circulation through the placenta; this leads to fetal erythrocytes hemolysis and death (in extreme cases). Regardin...

EP ID EP571493
DOI 10.32474/IGWHC.2018.01.000121
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