자궁 근종 및 자궁 선근증의 치료로 양측 자궁 동맥 색전술 시행 후 임상 경과

류기영,박영준,송순영 관동대학교 의과학연구소 2001 關東醫大學術誌 Vol.5 No.1

Objective : This study was performed to evaluate the potential effectiveness of uterine artery embolization in patients with symptomatic uterine myomas and adenomyosis. Materials and methods : Uterine artery embolization was performed in 16 patients (age range, 36-53 years) with menorrhagia, dysmenorrhea, mass related symptoms, or both, due to leiomyomas and adenomyosis during a 18-month period. The usefulness of the treatment was evaluated in the view of symptomatic relief, uterine and myoma size checked with ultrasonography. Imaging was performed before the procedure, at 1 month, 3 months and 6 months after the procedure. Results : All 16 patients underwent technically successful embolization. Fourteen of fifteen women who completed the follow-up check reported noticeable symptomatic improvement. One woman exhibited no clinical response. Imaging at 6 months after the procedure showed reduction with a median uterine volume reduction of 22% (p=0.0072) and median dominant fibroid volume decrease of 55% (p=0.0014). Conclusion : In the authors' initial clinical experience, uterine artery embolization appears effective in controlling symptoms and substantially reducing uterine and fibroid volume with few complications. However, long term follow-up will be necessary to establish the efficacy of this procedure.

분만 후 출혈 환자에서 선택적 색전술 후 자궁동맥의 부분적 폐쇄에도 불구하고 발생한 자궁괴사

이지연 ( Yeon Lee ),황종윤 ( Jong Yun Hwang ),이향아 ( Hyang Ah Lee ),이동헌 ( Dong Hun Lee ),이승구 ( Seung Koo Lee ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.5

Selective uterine arterial embolization is widely used in the management of obstetric hemorrhage. Owing to the physiological changes associated with pregnancy and selection of uterine arteries, ischemic injury after uterine arterial embolization in postpartum bleeding is rare. In previous reports, the known causes of ischemic injury after embolization are using the too small particle and complete occlusion of fine branch of uterine artery with absence of collateral ovarian artery. We experienced uterine necrosis despite partial obstruction of uterine arteries following the selective embolization. We report this case with brief review of literature.

자궁선종을 동반한 자궁근종에서 자궁동맥 색전술을 이용한 치료의 효과

장진범,배상욱,임재학,이도연,김정연,정경아,김세광,박기현,Jang, Jin-Beum,Bai, Sang-Wook,Lim, Jae-Hak,Lee, Do-Yeon,Kim, Jung-Yeon,Jeong, Kyung-Ah,Kim, Sei-Kwang,Park, Ki-Hyun 대한생식의학회 2001 Clinical and Experimental Reproductive Medicine Vol.28 No.3

Objective: The purpose of this study was to make a guideline of uterine artery embolization for the treatment of uterine leiomyomas accompanying with adenomyosis in Korea. Materials and Methods : We performed the retrospective study for 37 women who had uterine leiomyomas accompanying with adenomyosis. Bilateral uterine artery embolization was performed in 37 patients (age range 25-65) during 17 months with pain, hypermenorrhea, urinary frequency etc due to leiomyomas. Ultrasound imaging was performed before the procedure and at mean 6.9 months after the procedure. Results: All procedures were technically successful. Mean clinical follow-up was 12.8 months. Minor complication occurred in 82% patients after the procedure. After imaging follow-up (mean, 6.9 months postprocedure), median uterine volume decreased 34.4%, and dominant myoma volume decreased 86%. There was no statistical difference in uterine volume reduction and dominant myoma size reduction whether occluding agents was polyvinyl alcohol, polyvinyl alcohol plus gelfoam, and gelfoam, and whether ultrasound measured Resistance Index value before the procedure was low or high. Conclusion: Primary candidates for uterine artery embolization include those with symptomatic uterine leiomyomas who no longer des ire fertility but wish to avoid surgery or are poor surgical risks. To our study, uterine volume reduction and dominant myoma size reduction in patients who had adenomyosis were similar to previous other studies in patients who had not adenomyosis. Therefore adenomyosis should not be considered as a contraindication for uterine artery embolization. Because there is little data about subsequent reproductive potential after this procedure, it should not be routinely advocated for infertile women. Further investigation is warranted for occluding agents and Resistance Index.

자궁동맥 색전술 후 자궁 경부로 배출된 점막하 자궁 근종

이재동(Jae Dong Lee),김사진(Sa Jin Kim),이해규(Hae Kyu Lee),김진아(Jean A Kim),강병채(Byung Chae Kang),허수영(Soo Young Hur),이귀세라(Gui Se Ra Lee),신종철(Jong Chul Shin),김수평(Soo Pyung Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.2

Uterine artery embolization was introduced to arrest post-partum hemorrhage 20 years ago. It has also been used to control severe hemorrhage from uterine gestational trophoblast tumors, carcinoma of the uterus, uterine arteriovenous malformations, and cases of pelvic trauma. More recently, transcatheter uterine artery embolization is a new treatment for uterine leiomyoma. A 33-year old married woman with 2 children had a history of heavy pelvic pain and pressure. Ultrasound and MRI investigation showed a bulky 12 x 10cm submucosal myoma in right lower uterine segment. The both uterine artery embolization was performed via a bilateral femoral artery. We present a case in which successful embolization of the uterine arteries in a woman with submucosal myoma resulted in a subsequent transcervical expulsion of large pieces of the dominant fibroid after 3 month of treatment with a brief review.

Uterine Artery Embolization as an Effective Management and Diagnostic Tool for Puerperal Uterine Inversion with Severe Postpartum Bleeding: A Case Report

Kim Seong Ju,Cho Youngjong,Park Sung-Joon,Lee Sangjoon,Lee Hyoung Nam,Ju Da Hye 대한영상의학회 2022 대한영상의학회지 Vol.83 No.3

Acute puerperal uterine inversion is a rare postpartum obstetric complication; however, without rapid diagnosis and appropriate management, it is life-threatening. Substantial bleeding hinders the verification of a partially inverted uterus, possibly delaying the treatment. Herein, we present the report of a 32-year-old female presenting with massive postpartum bleeding managed by uterine artery embolization. The peculiar course of the uterine artery bowing inferiorly along the inverted fundus during embolization could uncover the uterine inversion, which was not diagnosed by physical examination and CT. In conclusion, uterine artery embolization is not only an effective therapeutic strategy for postpartum hemorrhage but also a valuable tool for diagnosing uterine inversion.

자궁근종 치료를 위해 양측 자궁동맥색전술을

차성순(SS Cha),김영태(YT Kim),조재성(JS Cho),박용원(YW Park),김재욱(JU Kim),이도연(DY Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.7

Uterine myoma is the most common benign pelvic tumor in women. Especially, hemorrhage, probably related to hypervasculization, is the most complication of uterine myoma and is difficult to treat. We investigated whether arterial embolization of myoma might reduce or eliminate symptoms. She underwent uterine artery embolization with Gelform and polyvinyl alcohol. And then resolution of symptom observed in this case. It was probably due to obstruction of the blood supply by using arterial embolization. Arterial embolization to treat uterine myoma represents a promising method, resulting in resolution of menorrhagia and related another symptoms. We experienced a case of improvement of menorrhagia, with reductions in uterine size after the successful uterine arterial embolization. However, longterm follow-up will be necessary to establish the efficacy of this procedure.

Aberrant Ovarian Artery Originating from the Iliolumbar Artery: A Case Report

이지은,이재명 대한영상의학회 2016 대한영상의학회지 Vol.74 No.5

Here, we report a case of a 30-year-old woman who presented with primary postpartum hemorrhage due to uterine atony. She received uterine artery embolization (UAE). During left internal iliac arteriography, an aberrant left ovarian artery originating from the left iliolumbar artery was visualized. The aberrant left ovarian artery was connected to the left uterine artery via prominent collateral vessels. It supplied a significant amount of blood to the fundus of the uterus. Bilateral hypertrophied uterine arteries were embolized very carefully so that the embolic material did not reflux into the aberrant left ovarian artery. After the procedure, her vaginal bleeding was successfully controlled. Accurate understanding of anatomical variations of the ovarian artery is essential to avoid failure in controlling postpartum hemorrhage with UAE.

Case Report : Pseudoaneurysm of uterine artery causing intra-abdominal and vaginal bleeding after cervical conization

( Ga Eul Moon ),( Se Ob Jeon ),( Kye-hyun Nam ),( Seung Do Choi ),( Jae Geun Sun Woo ),( Ae Li Ryu ) 대한산부인과학회 2015 Obstetrics & Gynecology Science Vol.58 No.3

Uterine arterial pseudoaneurysm is a very rare condition usually associated with postpartum hemorrhage. It almost never occurs after cervical conization; however, since ruptured pseudoaneurysm could be life threatening, we should consider the possibility of vascular injury such as pseudoaneurysm when we find a patient with vaginal bleeding after the process of surgical operation. Emergency arterial embolization is a well established therapeutic option to control the ruptured pseudoaneurysm. This is a case report of uterine arterial pseudoaneurysm causing intra-abdominal bleeding followed by cervical conization, which was successfully treated by uterine artery embolization.

자궁동맥 색전술: 여성 생식기 질환의 인터벤션 치료

이웅희,양승부,구동억,김용재,이재명,강채훈,엄준영,김영준 대한영상의학회 2017 대한영상의학회지 Vol.76 No.1

The uterus is the major female sex organ and is essential for pregnancy. The organ is located in the pelvic cavity. It is usually fist-sized with its volume changing from 75 to 200 cc depending on the menstrual cycle. There are various diseases associated with the uterus, including malignancy, uterine myoma, postpartum hemorrhage, and vascular malformation. The conventional surgical treatment for these diseases is hysterectomy. However, hysterectomy has some risk, and there may be complications associated with the surgery and anesthesia. In addition, hysterectomy results in loss of fertility and loss of female characteristics, both of which may lead to emotional problems. After uterine artery embolization (UAE) was performed for post-partum bleeding in 1979 and for uterine myoma in 1995, interventional treatment of UAE replaced the existing surgical treatment of hysterectomy. UAE is performed widely as a minimally invasive treatment modality that can preserve the uterus, make pregnancy and childbirth possible and resolve emotional problems. The interventional treatment has become increasingly popular to treat various female genital diseases. 여성 생식기인 자궁은 출산에 필수적일 뿐 아니라 여성의 성을 상징하는 대표적인 장기이다. 자궁은 보통 주먹만한 크기로 생리주기에 따라 75~200 cc로 체적이 변하며 골반강 내에 위치한다. 자궁과 관련되어서 많은 질환이 발생할 수 있으며 악성종양뿐 아니라 자궁근종(uterine myoma), 산후출혈(postpartum hemorrhage), 혈관기형(vascular malformation), 자궁외 임신(ectopic pregnancy) 등의 질환이 발생한다. 이러한 질환의 치료로 이전에는 대부분 자궁적출술 등의 고식적인 치료를 하였다, 그러나 외과적 수술은 마취 및 수술 과정에 따른 위험과 부작용을 가지고 있을 뿐 아니라 출산능력 상실과 여성의 성 상실이라는 정서적 문제를 가지고 있다. 1979년 산후출혈 치료에 그리고 1995년 자궁근종 치료에 자궁동맥 색전술(uterine artery embolization)이 시행된 이후 자궁동맥 색전술과 같은 중재적 치료방법(interventional treatment)이 자궁질환과 관련된 수술을 대체하여 자궁을 보존하여 임신 및 출산을 가능하게 하고 정서적 문제를 해결할 수 있는 최소 침습적인 치료로 널리 시행되고 있다. 이러한 중재적 시술은 현재 여러 여성 생식기 질환에 유용하게 사용되고 점차 증가하는 추세이다.

Uterine Artery Embolization in Patients with Postpartum Hemorrhage: Clinical Efficacy and Safety of Treatment with N-Butyl-2-Cyanoacrylate

권요한,소영호,김병재,김선민,최영호,문민환 대한영상의학회 2019 대한영상의학회지 Vol.80 No.1

Purpose To evaluate the clinical efficacy and safety of uterine artery embolization (UAE) using N-butyl-2-cyanoacrylate (NBCA) in patients with postpartum hemorrhage (PPH). Materials and Methods From February 2010 to May 2018, 14 patients (age: 28?39 years; mean: 33 years) underwent UAE using NBCA among 82 patients with PPH. Medical records were retrospectively reviewed to evaluate the patients characteristics, cause of PPH, embolization procedure, and outcomes. Results Angiograms revealed extravasation (n = 10) or pseudoaneurysm (n = 4) in all patients. The causes of PPH were hysterotomy or hysterectomy related arterial injury (n = 11), cervical laceration (n = 2), and abnormal placentation (n = 1). UAE was performed with NBCA in all patients. Additional UAE with gelatin sponge particles was performed in two patients. Additional non-uterine artery embolization was performed in three patients. Coagulopathy was found in five (35.7%) patients. The technical and clinical success rates were 92.9% and 85.7%, respectively. One patient died from multi-organ failure eight days after UAE. One patient with abnormal placentation had pelvic organ ischemia due to multiple pelvic artery embolization. Conclusion UAE using NBCA is safe and effective for the patients with PPH showing extravasation or pseudoaneurysm.