The Experts below are selected from a list of 1917 Experts worldwide ranked by ideXlab platform
James B Spies - One of the best experts on this subject based on the ideXlab platform.
-
updates on Uterine Artery Embolization
Seminars in Interventional Radiology, 2018Co-Authors: Maureen P. Kohi, James B SpiesAbstract:Uterine fibroids (leiomyomas) are the most common benign neoplasm of the female pelvis and have a lifetime prevalence exceeding 80% among African American women and approaching 70% among Caucasian women. Approximately 50% of women with fibroids experience symptoms which may include menorrhagia that may result in anemia, bulk symptoms with bladder and bowel dysfunction and abdominal protrusion, dysmenorrhea, and infertility. Hysterectomy remains the most common treatment option for fibroids and concerns have been raised about the overuse of this procedure. Uterine Artery Embolization (UAE) is now a well-established Uterine preserving and minimally invasive therapy for symptomatic fibroids. Since its introduction, strong evidence for safety and efficacy of UAE has been generated with low rates of complications. This review will discuss UAE for the management of symptomatic Uterine fibroids with special focus on emerging technical approaches and novel periprocedural patient care.
-
Uterine Artery Embolization a review of current concepts
Best Practice & Research in Clinical Obstetrics & Gynaecology, 2017Co-Authors: Jonathan J Keung, James B Spies, T CaridiAbstract:Uterine Artery Embolization (UAE) has gained traction as a safe and effective treatment modality for symptomatic Uterine leiomyomata since its introduction nearly two decades ago. This review includes an overview of current concepts with regard to patient selection, technique, and outcomes following UAE. Specific topics also include the impact of this procedure on fertility and pregnancy, the emerging role of UAE in the treatment of adenomyosis, and how UAE compares with surgical intervention for the treatment of symptomatic leiomyomata.
-
the impact of Uterine Artery Embolization on ovarian function
Journal of Vascular and Interventional Radiology, 2013Co-Authors: Geoffrey R Kaump, James B SpiesAbstract:Soon after the introduction of Uterine Artery Embolization (UAE) as a treatment for fibroid tumors, questions arose regarding its potential impact on ovarian function. The onset of amenorrhea caused by ovarian failure after UAE was reported, and occlusion of ovarian arterial supply via Uterine-arterial communications was suspected as the mechanism. Despite that, premature induction of menopause after UAE remains very infrequent. Perhaps of greater concern is a subclinical diminution of ovarian functional reserve. Data from randomized trials and prospective case series suggest that degradation of ovarian function may occur after UAE, but is concentrated in women older than age 45 years, with little evidence of an impact in women younger than 40 years of age. This review is intended to summarize current knowledge regarding the impact of UAE on ovarian reserve and the induction of menopause.
-
Uterine Artery Embolization for treatment of leiomyomata long term outcomes from the fibroid registry
Obstetrics & Gynecology, 2008Co-Authors: Scott C Goodwin, James B Spies, R Worthingtonkirsch, Eric D Peterson, Gaylene Pron, Shuang Li, Evan R MyersAbstract:OBJECTIVE:To assess long-term clinical outcomes of Uterine Artery Embolization across a wide variety of practice settings in a large patient cohort.METHODS:The Fibroid Registry for Outcomes Data (FIBROID) for Uterine Embolization was a 3-year, single-arm, prospective, multi-center longitudinal study
-
imaging manifestations of complications associated with Uterine Artery Embolization
Radiographics, 2005Co-Authors: Yuri Kitamura, Reena C Jha, Susan M Ascher, C Cooper, Sandra J Allison, Pamela A Flick, James B SpiesAbstract:Uterine Artery Embolization (UAE) is an increasingly performed, minimally invasive alternative to hysterectomy or myomectomy for women with symptomatic Uterine fibroids. A growing body of literature documents symptomatic improvement in the majority of women who undergo UAE. Although UAE is usually safe and effective, there are a number of known complications associated with the procedure. Major complications include fibroid passage, infectious disease (endometritis, pelvic inflammatory disease-tubo-ovarian abscess, pyomyoma), deep venous thrombosis, pulmonary embolism, inadvertent Embolization of a malignant leiomyosarcoma, ovarian dysfunction, fibroid regrowth, Uterine necrosis, and even death. Minor complications include hematoma, urinary tract infection, retention of urine, transient pain, and vessel or nerve injury at the puncture site. As UAE takes its place in the treatment arsenal for women with symptomatic fibroids, radiologists need to be familiar with UAE-associated complications, which may require further treatment and may even be life threatening in some cases. Knowledge of these complications and their imaging features should lead to prompt diagnosis and appropriate treatment.
Scott C Goodwin - One of the best experts on this subject based on the ideXlab platform.
-
Uterine Artery Embolization for treatment of leiomyomata long term outcomes from the fibroid registry
Obstetrics & Gynecology, 2008Co-Authors: Scott C Goodwin, James B Spies, R Worthingtonkirsch, Eric D Peterson, Gaylene Pron, Shuang Li, Evan R MyersAbstract:OBJECTIVE:To assess long-term clinical outcomes of Uterine Artery Embolization across a wide variety of practice settings in a large patient cohort.METHODS:The Fibroid Registry for Outcomes Data (FIBROID) for Uterine Embolization was a 3-year, single-arm, prospective, multi-center longitudinal study
-
comparison of long term outcomes of myomectomy and Uterine Artery Embolization
Obstetrics & Gynecology, 2002Co-Authors: Michael S Broder, Gary Chen, Scott C Goodwin, Linda J Tang, Mary M Costantino, Michael H Nguyen, Tugce N Yegul, Heike ErberichAbstract:OBJECTIVE: To compare long-term outcomes of Uterine Artery Embolization and abdominal myomectomy in patients with symptomatic Uterine myomas. METHODS: At a single institution in an 18-month time, 59 patients had bilateral Uterine Artery Embolization and 38 patients had abdominal myomectomy to treat symptomatic Uterine myomas. We reviewed medical records and surveyed patients 3 or more years after their procedures to assess how many needed further surgical procedures in the intervening years, to what extent symptoms remained improved, and how satisfied the patients were with the long term results of the index procedure. RESULTS: Follow-up was available on 51 Embolization and 30 myomectomy patients and ranged from 37 to 59 months. Patients who had Embolization were older (44 versus 38 years, P <.001) and more likely to have had previous surgical procedures (P <.001) than those who had myomectomy. Taking into account the variable follow-up period, Embolization patients were more likely to have had further invasive treatment for myomas (29% versus 3%) (P =.004). Among women not needing further surgery, overall symptoms improved in 92% (33/36) of Embolization and 90% (26/29) of myomectomy patients (P =.78). Ninety-four percent (34/36) of Embolization patients and 79% (23/29) of myomectomy patients were at least somewhat satisfied with their choice of procedure (P =.06). CONCLUSION: Women who had Embolization were more likely than those who had myomectomy to need further invasive treatment (surgery or repeat Embolization) in the 3-5 years after the index procedure. Among women who did not need such treatment, satisfaction and relief of symptoms were similar. Large, randomized trials are needed to more accurately compare these two procedures.
-
Uterine Artery Embolization for the treatment of Uterine leiomyomata midterm results
Journal of Vascular and Interventional Radiology, 1999Co-Authors: Scott C Goodwin, Gary Chen, Susie Muir, James Sayre, R R Perrella, Suresh Vedantham, Bruce Mclucas, Mabel DeleonAbstract:Introduction The authors review their midterm experience with Uterine Artery Embolization for the treatment of Uterine fibroids. Materials and methods Sixty patients were referred for permanent polyvinyl alcohol (PVA) foam particle Uterine Artery Embolization during an 18-month period. Detailed clinical follow-up and ultrasound follow-up were obtained. Results Bleeding was a presenting symptom in 56 patients and pain was a presenting symptom in 47 patients. All patients underwent a technically successful Embolization. One of the patients underwent unilateral Embolization. Fifty-nine patients underwent bilateral Embolization. Of all patients undergoing bilateral Embolization, at last follow-up (mean, 16.3 months), 81% had their uterus and had moderate or better improvement in their symptoms. Ninety-two percent of these patients also had reductions in Uterine and dominant fibroid volumes. Overall, the mean Uterine and dominant fibroid volume reduction were 42.8% and 48.8%, respectively (mean follow-up, 10.2 months). One infectious complication that necessitated hysterectomy occurred. Conclusion Uterine Artery Embolization for the treatment of Uterine fibroids is a minimally invasive technique with low complication rates and very good clinical efficacy.
-
Uterine Artery Embolization for the treatment of Uterine fibroids.
Current opinion in obstetrics & gynecology, 1998Co-Authors: Scott C Goodwin, Woodruff J. WalkerAbstract:The first reported cases of Uterine Artery Embolization in obstetric and gynaecological practice were carried out in the late 1970s. Recently, bilateral Uterine Artery Embolization was used as a primary treatment for fibroids. Meticulous preoperative assessment is essential. The technique of Uterine Artery Embolization involves the catheterization of both Uterine arteries and the installation of tiny micro particles of polyvinyl alcohol. Following the procedure, post-procedural pain occurs within the first 24 h and most patients are advised to rest for 1 week. In the UCLA and RSCH series, three infective complications occurred leading to hysterectomy and some patients developed amenorrhoea. Average shrinkage of fibroids in the UCLA, RSCH and French series were 40%, 64% and 70%, respectively, with most patients losing their symptoms and being satisfied with the procedure. Meticulous pre-operative assessment is essential. At UCLA, 140 patients, and at RSCH, 96 patients have been embolized. To date in the UK, US and French series, fibroid growth has been arrested and new fibroids have not formed. However, long-term follow-up on a larger number of cases will be required before the role of Uterine Artery Embolization in the gynaecologic therapeutic armamentarium can be fully defined.
-
preliminary experience with Uterine Artery Embolization for Uterine fibroids
Journal of Vascular and Interventional Radiology, 1997Co-Authors: Scott C Goodwin, Suresh Vedantham, Bruce Mclucas, Alice E Forno, Rita PerrellaAbstract:Purpose To evaluate the potential usefulness of transcatheter Uterine Artery Embolization as a treatment for fibroid-related vaginal bleeding and pelvic pain refractory to hormonal therapy and myomectomy. Materials and Methods Eleven patients (aged 27–55 years; mean, 44.2 years; none desiring future pregnancy) with refractory vaginal bleeding and/or chronic pelvic pain related to Uterine leio-myomata underwent Uterine Artery Embolization with use of polyvinyl alcohol (PVA) particles. Clinical improvement was assessed by detailed questionnaire at 2–9 months (mean, 5.8 months) after the procedure. Sonographic measurements of the uterus and dominant masses were obtained before and at 2 months after the procedure. Results All 11 patients underwent technically successful Embolization. Eight of nine women who completed the follow-up questionnaire reported noticeable symptomatic improvement, including three women with complete resolution of symptoms. One woman (the only patient undergoing unilateral Embolization) exhibited no clinical response. Another patient developed endometritis and pyometra 3 weeks after the procedure, necessitating hysterectomy. Large reductions in Uterine volume (average, 40%) and dominant fibroid size (average, 60%–65%) were sonographically demonstrated. Conclusion Uterine Artery Embolization represents a promising new method of treating fibroid-related menorrhagia and pelvic pain. Further investigation will be required to assess clinical response and durability, identify appropriate candidates, and define the optimal angiographic technique and PVA particle size.
Wouter J K Hehenkamp - One of the best experts on this subject based on the ideXlab platform.
-
Uterine Artery Embolization for the treatment of adenomyosis a systematic review and meta analysis
Journal of Vascular and Interventional Radiology, 2017Co-Authors: Annefleur M De Bruijn, Marieke Smink, Paul N M Lohle, Judith A F Huirne, Jos W R Twisk, Caroline Wong, Linda J Schoonmade, Wouter J K HehenkampAbstract:The effect of Uterine Artery Embolization (UAE) on symptomatic adenomyosis was evaluated in a systematic review and meta-analysis. Four groups were evaluated: short-term ( 12 months) pure adenomyosis, and long-term combined adenomyosis. Improvement of symptoms occurred in 83.1% (872/1,049) of patients. Reported symptom reduction was 4.8% greater in the short-term combined group (P = .169) and 11.4% greater in the long-term combined group (P = .003). Uterine volume was reduced in all patients at 3 months. The effects of UAE on symptom improvement and Uterine volume reduction in patients with adenomyosis are encouraging.
-
Uterine Artery Embolization versus surgery in the treatment of symptomatic fibroids a systematic review and metaanalysis
American Journal of Obstetrics and Gynecology, 2011Co-Authors: Sanne M Van Der Kooij, Wouter J K Hehenkamp, Willem M Ankum, Shandra Bipat, Jim A ReekersAbstract:Objective To summarize the evidence on short-, mid-, and long-term results up to 5 years of Uterine Artery Embolization in comparison to surgery. Study Design We searched the CENTRAL, MEDLINE and EMBASE databases for randomized clinical trials comparing Uterine Artery Embolization with hysterectomy/myomectomy in premenopausal women with heavy menstrual bleeding caused by symptomatic Uterine fibroids, written from September 1995 to November 2010. Two reviewers independently assessed methodologic quality and extracted data from included trials. Results Four randomized controlled trials with a total of 515 patients were included. On the short-term, Uterine Artery Embolization showed fewer blood loss, shorter hospital stay, and quicker resumption of work. Mid- and long-term results showed comparable health-related quality of life results and a higher reintervention rate in the Uterine Artery Embolization group, whereas both groups were equally satisfied. Conclusion Uterine Artery Embolization has short-term advantages over surgery. On the mid- and long-term the benefits were similar, except for a higher reintervention rate after Uterine Artery Embolization.
-
Uterine Artery Embolization vs hysterectomy in the treatment of symptomatic Uterine fibroids 10 year outcomes from the randomized emmy trial
American Journal of Obstetrics and Gynecology, 2007Co-Authors: Annefleur M De Bruijn, Nicole A Volkers, Jim A Reekers, Willem M Ankum, Erwin Birnie, Sanne M Van Der Kooij, Wouter J K HehenkampAbstract:BACKGROUND: Since 1995 Uterine Artery Embolization has been described as an alternative for hysterectomy in patients with symptomatic fibroids. Many studies including several randomized controlled trials established Uterine Artery Embolization as a valuable treatment. These randomized controlled trials reported outcomes in terms of health-related quality of life, clinical outcomes, efficacy, and cost-effectiveness after 1, 2, and 5 years of follow-up. OBJECTIVE: The purpose of this study was to compare clinical outcome and health-related quality of life 10 years after Uterine Artery Embolization or hysterectomy in the treatment of heavy menstrual bleeding caused by Uterine fibroids in a randomized controlled trial. STUDY DESIGN: In all, 28 Dutch hospitals recruited patients with symptomatic Uterine fibroids who were eligible for hysterectomy. Patients were 1:1 randomly assigned to Uterine Artery Embolization or hysterectomy. The outcomes assessed at 10 years postintervention were reintervention rates, health-related quality of life, and patient satisfaction, which were obtained through validated questionnaires. Study outcomes were analyzed according to original treatment assignment (intention to treat). RESULTS: A total of 177 patients were randomized from 2002 through 2004. Eventually 81 Uterine Artery Embolization and 75 hysterectomy patients underwent the allocated treatment shortly after randomization. The remaining patients withdrew from the trial. The 10-year questionnaire was mailed when the last included patient had been treated 10 years earlier. The mean duration of follow-up was 133 months (SD 8.58) accompanied by a mean age of 57 years (SD 4.53). Questionnaires were received from 131 of 156 patients (84%). Ten years after treatment, 5 patients underwent secondary hysterectomy resulting in a total of 28 of 81 (35%) (24/77 [31%] after successful Uterine Artery Embolization). Secondary hysterectomies were performed for persisting symptoms in all cases but 1 (for prolapse). After the initial treatment health-related quality of life improved significantly. After 10 years, generic health-related quality of life remained stable, without differences between both groups. The urogenital distress inventory and the defecation distress inventory showed a decrease in both groups, probably related to increasing age, without significant differences between study arms. Satisfaction in both groups remained comparable. The majority of patients declared being (very) satisfied about the received treatment: 78% of the Uterine Artery Embolization group vs 87% in the hysterectomy group. CONCLUSION: In about two thirds of Uterine Artery Embolization-treated patients with symptomatic Uterine fibroids a hysterectomy can be avoided. Health-related quality of life 10 years after Uterine Artery Embolization or hysterectomy remained comparably stable. Uterine Artery Embolization is a well-documented and less invasive alternative to hysterectomy for symptomatic Uterine fibroids on which eligible patients should be counseled.
-
myoma expulsion after Uterine Artery Embolization complication or cure
American Journal of Obstetrics and Gynecology, 2004Co-Authors: Wouter J K Hehenkamp, Nicole A Volkers, Alexander Montauban D Van Swijndregt, Sjoerd De Blok, Jim A Reekers, Willem M AnkumAbstract:A 54-year-old woman had an expulsed myoma 10 weeks after Uterine Artery Embolization. After treatment with antibiotics and a small surgical intervention, she recovered completely without any sign of myomatous disease afterwards. Patients should be informed about the possibility of expulsion. Expulsion of myomas after Uterine Artery Embolization occurs relatively frequently and may be just one of the ways to attain cure.
Mitsukuni Tokuhiro - One of the best experts on this subject based on the ideXlab platform.
-
Uterine Artery Embolization using gelatin sponge particles alone for symptomatic Uterine fibroids midterm results
American Journal of Roentgenology, 2002Co-Authors: Tetsuya Katsumori, Kazuhiro Nakajima, Tadashi Mihara, Mitsukuni TokuhiroAbstract:OBJECTIVE. The purpose of this study was to assess the safety and effectiveness of Uterine Artery Embolization using gelatin sponge particles alone for women with symptomatic Uterine fibroids.SUBJECTS AND METHODS. During 38 months, 60 patients (age range, 32-52 years; mean age, 42.5 years) with symptomatic Uterine fibroids underwent Uterine Artery Embolization. Only gelatin sponge particles, approximately 500-1000 μm in diameter, were used in all patients. The improvement of clinical symptoms was assessed by questionnaire. Reduction of the largest tumor and Uterine volume reductions were assessed using MR imaging. The follow-up period ranged from 1 to 38 months (mean, 10.6 months).RESULTS. Menorrhagia improved markedly or moderately in 41 (98%) of 42 of patients 4 months after Embolization and in 20 (100%) of 20 patients 1 year after Embolization. Bulk-related symptoms improved markedly or moderately in 31 (97%) of 32 of patients 4 months after Embolization and in 19 (100%) of 19 of patients 1 year after ...
-
gadolinium enhanced mr imaging in the evaluation of Uterine fibroids treated with Uterine Artery Embolization
American Journal of Roentgenology, 2001Co-Authors: Tetsuya Katsumori, Kazuhiro Nakajima, Mitsukuni TokuhiroAbstract:OBJECTIVE. The purpose of this study was to determine whether tumor volume reduction can be predicted by the infarction rate of Uterine fibroids as seen on gadolinium-enhanced MR images obtained immediately after Uterine Artery Embolization.MATERIALS AND METHODS. In our study, 36 women with symptomatic Uterine fibroids successfully underwent Uterine Artery Embolization. Unenhanced and enhanced MR imaging was performed before the procedure and repeated at 1 week, 4 months, and 1 year after the procedure. We retrospectively reviewed enhanced MR images of Uterine fibroids after Uterine Artery Embolization. At 4 months after Uterine Artery Embolization, we compared the rate of tumor volume reduction in patients with completely infarcted dominant fibroids with the rate of tumor volume reduction in patients with partially infarcted fibroids.RESULTS. Enhanced MR images obtained 1 week after Uterine Artery Embolization revealed that 100% infarction rates of the dominant Uterine fibroids were achieved in 33 women ...
Paul B. Marshburn - One of the best experts on this subject based on the ideXlab platform.
-
the impact of Uterine Artery Embolization on fertility and pregnancy outcome
Current Opinion in Obstetrics & Gynecology, 2007Co-Authors: Rebecca S Usadi, Paul B. MarshburnAbstract:Purpose of reviewUterine Artery Embolization for management of symptomatic fibroids is an effective and increasingly popular treatment option. There are several studies evaluating the effects of Uterine Artery Embolization on later pregnancies; however, the effects on fertility are still largely unc
-
Uterine Artery Embolization for symptomatic Uterine myomas.
Fertility and sterility, 2000Co-Authors: Bradley S. Hurst, Daniel J. Stackhouse, Michelle L. Matthews, Paul B. MarshburnAbstract:Abstract Objective: To evaluate the role of Uterine Artery Embolization as treatment for symptomatic Uterine myomas. Design: Medline literature review, cross-reference of published data, and review of selected meeting abstracts. Result(s): Results from clinical series have shown a consistent short-term reduction in Uterine size, subjective improvement in Uterine bleeding, and reduced pain following treatment. Posttreatment hospitalization and recovery tend to be shorter after Uterine Artery Embolization compared with hysterectomy. Randomized controlled trials have not been conducted, and long-term efficacy has not been studied. A limited number of deliveries have been reported following Uterine Artery Embolization for Uterine myomas. Conclusion(s): Uterine Artery Embolization is a unique new treatment for symptomatic Uterine myomas. Even without controlled studies, demand for this procedure has increased rapidly. Uterine Artery Embolization may be considered an alternative to hysterectomy, or perhaps myomectomy, in well-selected cases. At the present time, however, Uterine Artery Embolization should not be routinely recommended for women who desire future fertility.
