Uterine artery embolization as an alternative option for adenomyosis treatment
M.I. MAZITOVA1, 4, E.YU. ANTROPOVA1, 4, B.M. SHARAFUTDINOV2–4, K.V. FAUSTOVA4
1Kazan State Medical Academy — Branch Campus of the FSBEI FPE RMACPE MOH Russia, Kazan
2Russian Medical Academy for Continuous Professional Education, Moscow
3Republic Clinical Oncology Dispensary named after Prof. M.Z. Sigal, Kazan
4Medical Clinic «Institute for Health and Longevity», Kazan
Contact details:
Antropova E.Yu. — PhD (medicine), Associate Professor of the Department of Obstetrics and Gynecology
Address: 36 Butlerov St., 420012 Kazan, Russian Federation, tel.: +7-903-344-01-32, е-mail: antropoval@mail.ru
Adenomyosis is a complex clinical condition that is often diagnosed in women of reproductive age. Unfortunately, only a hysterectomy can lead to a complete cure today. At the same time, the current trend is the desire of women to preserve the organ even after the reproductive program is completed. Insufficient knowledge of the pathogenetic aspects of this disease hinders definitively resolving the treatment issues. As a result, various alternative minimally invasive techniques are developed in order to preserve the uterus and potential fertility, while avoiding extensive surgery.
Currently, several organ-preserving treatment options are available, including pharmacotherapy, conservative surgical techniques, and minimally invasive techniques, each with its own risks and benefits. Uterine artery embolization (UAE) is a modern minimally invasive treatment option for uterine fibroids and has recently gained popularity as a safe and cost-effective treatment for adenomyosis with promising results. This review discusses the place of uterine artery embolization in the treatment of adenomyosis as a possible organ-preserving alternative to hysterectomy.
Key words: adenomyosis, uterine artery embolization, hysterectomy.
REFERENCES
- Medzhidova A.M., Esedova A.E. Current issues of diagnostics and treatment of infertility in women with internal genital endometriosis. Issledovanie i praktika v meditsine, 2017, vol. 4, no. 4, pp. 89–98 (in Russ.). DOI: 10.17709/2409-2231-2017-4-4-10
- Adamyan L.V., Andreeva E.N. The role of modern hormone-modulating therapy in the complex treatment of genital endometriosis. Problemy reproduktsii, 2011, vol. 17, no. 6, pp. 66–77 (in Russ.).
- Orazov M.R., Radzinskiy V.E., Khamoshina M.B., Kavteladze E.V., Shustova V.B. Tsoraeva Yu.R., Novginov D.S. Infertility associated with endometriosis: from legend to harsh reality. Trudnyy patsient, 2019, vol. 17, no. 1–2, pp. 6–12 (in Russ.). DOI: 10.24411/2074-1995-2019-10001
- Yarmolinskaya M.I., Rusina E.I., Khachaturyan A.R., Florova M.S. Clinic and diagnostics of genital endometriosis. Zhurnal akusherstva i zhenskikh bolezney, 2016, vol. 65, no. 5, pp. 4–21 (in Russ.). DOI: 10.17816/JOWD6554-21
- Gorpenko A.A., Chuprynin V.D., Smol’nova T.Yu., Buralkina N.A. Clinical and anamnestic features and quality of life of patients with nodular and diffuse adenomyosis. Meditsinskiy sovet, 2021, no. 13, pp. 68–76 (in Russ.). DOI: 10.21518/2079-701X-2021-13-68-76
- Dzhamalutdinova K.M., Kozachenko I.F., Gus A.I., Adamyan L.V. Modern aspects of the pathogenesis and diagnosis of adenomyosis. Akusherstvo i ginekologiya, 2018, no. 1, pp. 29–34 (in Russ.). DOI: 10.18565/aig.2018.1.29-34
- Shchegolev A.I., Bykov A.G., Tumanova U.N., Pavlovich S.V. Endometriosis and tumor development. Akusherstvo i ginekologiya, 2016, no. 11, pp. 49–56 (in Russ.). DOI: 10.18565/aig.2016.11.49-56
- Exacoustos C., Brienza L., Giovanni A., Szabolcs B., Romanini M.E., Zupi E., Arduini D. Adenomiyosis three-dimensional sonographic findings of the junctional zone and correlaion with histology. Ultrasound Obstet. Gynecol, 2011, vol. 37 (4), pp. 471–479. DOI: 10.1002/uog.8900
- Salim R., Riris S., Saab W., Abramov B., Khadum I., Serhal P. Adenomyosis reduces pregnancy rates in infertile women undergoing IVF. Reprod. Biomed. Online, 2012, vol. 25 (3), pp. 273–277. DOI: 10.1016/j.rbmo.2012.05.003
- Saremi A., Bahrami H., Salehian P., Hakak N., Pooladi A. Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique. Reprod. Biomed. Online, 2014, vol. 28 (6), pp. 753–760. DOI: 10.1016 /j.rbmo.2014.02.008
- Unanyan A.L., Sidorova I.S., Kogan E.A., Demura T.A., Demura S.A. Active and inactive adenomyosis: issues of pathogenesis and pathogenetic therapy. Akusherstvo i ginekologiya, 2013, no. 4, pp. 10–13 (in Russ.).
- Shklyar A.A., Adamyan L.V., Kogan E.A., Paramonova N.B., Kozachenko I.F., Gavrilova T.Yu. Clinical and morphological features of diffuse and nodular forms of adenomyosis. Problemy reproduktsii, 2015, vol. 21, no. 1, pp. 74–79 (in Russ.). DOI: 10.17116/repro20152174-79/
- Campo S., Campo V., Benagiano G. Adenomyosis and infertility. Reprod. Biomed. Online, 2012, vol. 24 (1), pp. 35–46. DOI: 10.1016/j.rbmo.2011.10.003
- Zhigalenko A.R., Karakhalis L.Yu., Papova N.S. Clinical and diagnostic parallels in adenomyosis-associated infertility. Kubanskiy nauchnyy meditsinskiy vestnik, 2017, no. 24, pp. 65–73 (in Russ.). DOI: 10.25207/1608-6228-2017-24-4-65-73
- Endometrioz: Diagnostika, lechenie i reabilitatsiya, klinicheskie rekomendatsii po vedeniyu bol’nykh, pod red. L.V. Adamyan [Endometriosis: Diagnostics, Treatment and Rehabilitation, Clinical Guidelines for the Management of Patients, edited by L.V. Adamyan]. Moscow, 2013. Pp. 9–37.
- Radzinsky V.E., Khamoshina M.B., Nosenko E.N. et al. Treatment strategies for pelvic pain associated with adenomyosis. Gynecol. Endocrinol, 2016, vol. 32, pp. 19–22. DOI: 10.1080/09513590.2016.1232673
- Taran F.A., Stewart E.A., Brucker S. Adenomyosis: epidemiology, risk factors, clinical phenotype and surgical and interventional alternatives to hysterectomy. Geburtshilfe Frauenheilkd, 2013, vol. 73, pp. 924–931. DOI: 10.1055/s-0033-1350840
- Ravina J.H., Herbreteau D., Ciraru-Vigneron N. et al. Arterial embolisation to treat uterine myomata. Lancet, 1995, vol. 346, pp. 671–672.
- de Bruijn A.M., Ankum W.M., Reekers J.A. et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am. J. Obstet. Gynecol, 2016, vol. 215, pp. 741–745.
- Edwards R.D., Moss J.G., Lumsden M.A. et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N. Engl. J. Med, 2007, vol. 356, pp. 360–370. DOI: 10.1056/NEJMoa062003
- de Bruijn A.M., Smink M., Hehenkamp W.J.K. et al. Uterine artery embolization for symptomatic adenomyosis: 7-year clinical follow-up using UFS-Qol questionnaire. Cardiovasc. Intervent. Radiol, 2017, vol. 40, pp. 1344–1350. DOI: 10.1007/s00270-017-1686-1
- de Bruijn A.M., Lohle P.N., Huirne J.A. et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic adenomyosis: protocol for the randomized questa trial. JMIR Res. Protoc, 2018, vol. 20, p. e47. DOI: 10.2196/resprot.8512
- Resnick N.J., Kim E., Patel R.S., Lookstein R.A., Nowakowski F.S., Fischman A.M. Uterine artery embolization using a transradial approach: initial experience and technique. J. Vasc. Interv. Radiol, 2014, vol. 25, pp. 443–447. DOI: 10.1016/j.jvir.2013.11.010
- Bilhim T., Pisco J.M., Duarte M., Oliveira A.G. Polyvinyl alcohol particle size for uterine artery embolization: a prospective randomized study of initial use of 350–500μm particles versus initial use of 500–700μm particles. J. Vasc. Interv. Radiol, 2011, vol. 22, pp. 21–27. DOI: 10.1016/j.jvir.2010.09.018
- Popovic M., Puchner S., Berzaczy D., Lammer J., Bucek R.A. Uterine artery embolization for the treatment of adenomyosis: a review. J. Vasc. Interv. Radiol, 2011, vol. 22, pp. 901–909. DOI: 10.1016/j.jvir.2011.03.013
- Dueholm M. Minimally invasive treatment of adenomyosis. Best Pract. Res. Clin. Obstet. Gynaecol, 2018. DOI: 10.1016/j.bpobgyn.2018.01.016
- Pelage J.-P., Jacob D., Fazel A., Namur J., Laurent A., Rymer R. et al. Midterm results of uterine artery embolization for symptomatic adenomyosis: initial experience. Radiology, 2005, vol. 234, pp. 948–953. DOI: 10.1148/radiol.2343031697
- Keung J.J., Spies J.B., Caridi T.M. Uterine artery embolization: a review of current concepts. Best Pract. Res. Clin. Obstet. Gynaecol, 2017, vol. 46, pp. 66–73. DOI: 10.1016/j.bpobgyn.2017.09.003
- Popovic M., Puchner S., Berzaczy D., Lammer J., Bucek R.A. Uterine artery embolization for the treatment of adenomyosis: a review. J. Vasc. Interv. Radiol, 2011, vol. 22, pp. 901–909. DOI: 10.1016/j.jvir.2011.03.013
- Zhou J., He L., Liu P. et al. Outcomes in adenomyosis treated with uterine artery embolization are associated with lesion vascularity: a longterm follow-up study of 252 cases. PLoS One, 2016, vol. 11, e0165610, DOI: 10.1371/journal.pone.0165610
- de Bruijn A.M., Smink M., Lohle P.N.M. et al. Uterine artery embolization for the treatment of adenomyosis: a systematic review and meta-analysis. J. Vasc. Interv. Radiol, 2017, vol. 28, pp. 1629–1642.e1. DOI: 10.1016/j.jvir.2017.07.034
- Yuan K., Zhang J.L., Yan J.Y., Yuan B., Fu J.X., Wang Y. et al. Uterine artery embolization with small-sized particles for the treatment of symptomatic adenomyosis: a 42-month clinical follow-up. Int. J. Gen. Med, 2021, vol. 14, pp. 3575–3581. DOI: 10.2147/IJGM.S312618
- Caridi T.M., Spies J.B. Management of adenomyosis. A review of characteristic imaging findings and treatment options, with an emphasis on the use of uterine artery embolization. Endovasc. Today, 2018, vol. 17, pp. 57–61.
- Hehenkamp W.J.K., Volkers N.A., Birnie E., Reekers J.A., Ankum W.M. Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy—results from the randomized clinical embolisation versus hysterectomy (EMMY) trial. Radiology, 2008, vol. 246, pp. 823–832. DOI: 10.1148/radiol.2463070260
- Osada H., Silber S., Kakinuma T., Nagaishi M., Kato K., Kato O. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod. Biomed. Online, 2011, vol. 22 (1), pp. 94–99.
- Mohan P.P., Hamblin M.H., Vogelzang R.L. Uterine artery embolization and its effect on fertility. J. Vasc. Interv. Radiol, 2013, vol. 24, pp. 925–930. DOI: 10.1016/j.jvir.2013.03.014
- Sharafutdinov B.M., Antropova E.Yu., Ryzhkin S.A., Mazitova M.I., Abdul’yanov I.V., Klyucharov I.V. Effect of radiation exposure on the ovarian reserve of the ovaries after uterine artery embolization. Voprosy ginekologii, akusherstva i perinatologii, 2020, vol. 19, no. 3, pp. 22–29 (in Russ.). DOI: 10.20953/1726-1678-2020-3-22-29