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5INNOVATION: THE JOURNAL OF SOCIAL SCIENCES AND RESEARCHES
ISSN: 2181-3868 SJIF-2023: 3.812 | ISI: 0.539 | VOLUME 1, ISSUE 6, 2023
INTERNATIONAL SCIENTIFIC JOURNAL
SPECIFIC FEATURES OF CORONARY ANGIOGRAPHY IN UTERINE ARTERY
EMBOLIZATION
Mirzaeva Dilnoza Abdiolimovna
Internal diseases, Rehabilitation and Traditional Medicine Rakhimov Azamat Urgench branch of Tashkent Medical Academy, 4th year student
Abstract: This activity reviews the minimally invasive medical therapy known as uterine artery embolization (UAE). It discusses which patients may or may not benefit from this therapy. It reviews how an interprofessional team works together for these patients.
Keywords: uterine artery embolization, transradial approach, transradial embolization, radial approach, myoma.
https://doi.ors/10.5281/zenodo.7693573
Introduction. Uterine artery embolization (UAE) represents a feasible therapeutic option introduced in clinical practice for females with symptomatic uterine leiomyoma who want to avoid the surgical intervention. One of the first attempts of uterine artery embolization, as described in the literature, was performed in 1976 on two patients who were suffering from intractable metrorrhagia and were poor candidates for surgery, but two decades later, in 1995, Ravina et al. reported successful outcomes of UAE in 16 cases of uterine myoma. Since then, several large studies have proved both the effectiveness and the safety of UAE and current guidelines on this topic, established the impact of UAE for fertile patients who desire a pregnancy, the clinical failure risk or re-intervention risk of this procedure, but also the success of the intervention based on clinical symptomatology. Hence, women with symptomatic fibroids, with contraindications for surgery due to an associate medical condition, or who does not accept blood transfusion or who had a previous failed surgery for multiple fibroids are fine candidates for UAE procedure. In addition, although uterine myoma is still the main indication for UAE, other conditions such as obstetrical hemorrhage, adenomyosis, and cervical ectopic pregnancy can benefit from it.
The classic and the most utilized approach for UAE is by transfemoral catheterization. The advantages of this access site are its easy location and approach for puncture and hemostasis. When TFA is difficult, the access through other vessels, including the brachial, radial, and ulnar arteries, is especially used in cardiologic interventions. The transradial approach (TRA) has been gaining popularity over the last three decades, and nowadays represents a valuable technique for cardiovascular interventions compared to TFA, due to its lower risk of complications such as hemorrhage and vascular complications (3.7% TFA vs. 1.4% TRA, p < 0.0001). Several studies proved the same efficacy as for the TFA in peripheral arterial procedures, showing great benefits for patient contentment, rapid hospital discharge due to short recovery time. Nevertheless, the use of the radial artery access for non-coronary
INNOVATION: THE JOURNAL OF SOCIAL SCIENCES AND RESEARCHES
INTERNATIONAL SCIENTIFIC JOURNAL
ISSN: 2181-3868 SJIF-2023: 3.812 | ISI: 0.539 | VOLUME 1, ISSUE 6, 2023
interventions, especially for UAE has received less attention and very few studies have been published on this topic. This paper represents a systematic review of the literature data in order to describe the use of TRA for UAE.
The primary goal of this systematic review was to appreciate the procedure's effectiveness and safety. It was considered successful when the entire embolization procedure was performed as intended, with no need to change the access route. Moreover, it was evaluated the complications that followed the local access of the catheter and their incidence rates.
In all the studies except one, the Allen test or Barbeau test was performed before the procedures in order to verify the ulnar artery's ability to counterbalance for transitory occlusion of the radial artery. Subjects with abnormal Allen or Barbeau test results were excluded from the study. Pre-procedural sonography assessment was reported in seven studies to measure the radial artery caliber, anatomical varieties, and for guided puncture.
The success rate of UAE using TRA was very good among the selected studies, ranging from 95% to 100%, with an average of 98.86% .. This is similar to TRA for cardiologic interventions, where the failure of the technique is limited (5% to 7% of cases) and is usually associated with elderly patients, women, and patients with a decreased body mass index. This increased success rate of the procedures using TRA might be because patients with uterine myoma are usually younger with no comorbidities. There was no permanent occlusion of the radial vessel reported among patients; instead, some cases of transitory radial occlusion were reported.
Campeau firstly described transradial access for angiographic diagnosis in 1989 in a series of 100 patients. He concluded that TRA is as effective and safe as the transbrachial approach, which was the alternative to the TFA at that time. The embolization method has been used in various hemorrhagic conditions such as rectus sheath hematoma or postpartum hemorrhage. Nowadays, in many centers, TRA is the main access for both coronary angiography procedures and patients who go for cardiac interventions.
Several advantages have been attributed to TRA technique. The radial artery, compared to femoral artery or even ulnar artery, is shallow and easy to compress and bleeding is rapidly controlled. Because there are no major vessels or nerves on the radial artery topography, the risk for vascular and peripheral nerve injury is reduced and complications like compartment syndrome of the arm or arteriovenous fistulas have a low incidence. The estimated incidence of vascular complications varies from 1.5% to 30.5% among transradial coronary procedures.
Conclusion. Uterine fibroid embolization using the TRA is as safe and as effective as the TFA. Its advantages include rapid mobilization and shorter hospital stay. However, it has a longer learning curve. This conclusion relies on a few studies and subsequent reports are required.
1. Worthinghton-Kirsch R., Spies J.B., Myers E.R., Mulgund J., Mauro M., Pron G., Peterson E.D., Goodwin S., FIBROID Inverstigators The fibroid registry for outcomes data (FIBROID) for uterine embolization: Short-term outcomes. Obstet. Gynecol. 2005;106:52-59. doi: 10.1097/01.AOG.0000165828.68787.
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INNOVATION: THE JOURNAL OF SOCIAL SCIENCES AND RESEARCHES
ISSN: 2181-3868 SJIF-2023: 3.812 | ISI: 0.539 | VOLUME 1, ISSUE 6, 2023
INTERNATIONAL SCIENTIFIC JOURNAL
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