On June 05, 2017 in Yerevan, in Double Tree Hilton Hotel with great success was held a seminar on “Uterine arteries embolization, as a modern method of treatment of uterine fibroids”. It was organized by the management and doctors of MC Erebouni.
Welcoming remarks were made by the Director of Cardiology & Cardiovascular Surgery Services of MC Erebouni, the Chief Cardiologist of the Ministry of Health of RA Hamlet G. Hayrapetyan, MD, PhD, as well as a special guest of seminar Chief Gynecologist of RA R.Abrahamyan. A presentation was made by obstetrician-gynecologist G. Gezalyan, MD (Erebouni MC), obstetrician-gynecologist D. Abovyan Erebouni MC), as well as endovascular surgeon Arsen Tsaturyan (Erebouni MC).
Important aspects of revealing such a pathology as uterine fibroids, as well as modern methods of its treatment were discussed. In recent years, this pathology is increasingly detected in women of active reproductive age. In addition, introduction of new reproductive technologies, extending the age limits of fertile period, enables the childbearing even at pre-menopausal period. In this regard, the number of women with uterine fibroids wishing to preserve the uterine has increased, especially among the patients of older age groups.
Throughout the world until the end of the XX century the gold standard in the treatment of uterine leiomyoma remained hysterectomy, which, although a reliable and relatively safe method for treating the symptoms of this pathology, but inevitably leads to loss of reproductive function, causes a physical and psychological trauma to a woman, aggravates already existing disturbances of homeostasis.
A modern approach to the treatment of the uterine fibroids should be considered the organ preserving methods development and introduction into practice. One of a new promising minimally invasive method for the uterine fibroids treatment is X-ray surgical endovascular bilateral uterine artery embolization (UAE).
UAE is not a new method, and actively has been used for more than 15 years. Embolization method is recognized all over the world, and annually hundreds thousands procedures are carried out. Long-term results have been traced for almost 20 years. There is a class I evidence about the effectiveness and safety of UAE (prospective multi-centered randomized studies).
Uterine arteries – is a main source of the uterine blood supply. The structure of arterial network of uterine fibroids is that it can`t form collaterals and receive blood supply from other sources. Uterine arteries embolization is a self – sufficient method. After performing UAE no additional treatment is required, except situations, when UAE itself used in complex treatment as one of the stages.
In his report endovascular surgeon A. Tsaturyan focused mainly on advantages of UAE.
The advantages of this method are:
• The absence of anesthesia and associated risk of anesthesia complications
• Minimal blood loss • Minimal risk of thromboembolic complications
• Absence of any wound surface and the process of scaring of uterine tissue
• Reducing the risk of histopathologic rupture of the uterus during pregnancy compared with conservative myomectomy
• A shorter duration of hospitalization and temporary incapacity for work
• The absence of psychotraumatic fact of surgery, as well as relapses in the future.
Embolization allows to achieve a total replacement of myomatous nodes with connective tissue (after UAE the nodes is no longer fibroids), irreversible reduction of the nodes in size, disappearance of heavy menstrual bleeding and compression symptoms (the pressure of enlarged uterus on bladder and rectum). In the process of uterine arteries embolization through a thin (no more than 1,5mm) catheter, a special balls-emboli are introduced into the uterine arteries. Emboli are made from a special medical polymer and have a strict defined size. They selectively close the lumen of arteries, feeding all myomatous nodes in the uterus.
In the process of embolization endovascular surgeon doesn`t have to approach by the catheter to each specific node and embolize it. Oppositely, due to the peculiarities of blood flow in myomatous nodes, by introducing suspension of emboli from distal part of the uterine artery trunk, it is possible to achieve their selective entry exactly into arteries of fibroids, but passing the arteries of the healthy part of the uterus. Within 5 minutes after UAE all vessels of the fibroids are completely obstructed by emboli, fibrin and thrombotic masses. Emboli can`t “move”, ”fly away” or “ get” anywhere else (it should be reminded, that this are vessels with a diameter of not more than 1 mm).
With questions to the speakers addressed one of the leading specialists in gynecology - Prof. K. Tokhunts, PhD (Department of Obstetrics and Gynecology of Faculty of Postgraduate Education of YSMU). She noted the importance of modern approaches for the treatment of the uterine fibroids, development and introduction into practice of organ preserving methods, to which, of course, can be attributed UAE.
Chief Gynecologist of RA R. Abrahamyan noted, that all modern methods that take place in the world medicine, in most cases, always is introduced and used with great success in Erebouni MC, including – uterine arteries embolization.
Director of Cardiology & Cardiovascular Surgery Services of MC Erebouni, the Chief Cardiologist of the Ministry of Health of RA Hamlet G. Hayrapetyan, MD, PhD noted, that intervention technique, which used in cardiology, has become a launching board for its usage in treatment in a number of areas of medicine, including gynecology.
Executive director of MC Erebouni M. V. Manukyan noted in his speech the importance of the seminar, which made it possible to acquaint the general public with the world`s achievements in gynecology and endovascular surgery. Another main objective of the seminar is the popularization of UAE as less traumatic and more effective method of treatment of uterine fibroids.
Taking into consideration, that the intervention itself is implemented by X-ray endovascular surgeons, who master perfectly the methods of intravascular surgeries, and determination of indications and contraindications, preoperative examination, the safety of intervention in terms of oncological risk, preparing the patients and further dynamic examination are under the competence of gynecologist, it is possible to conclude that the key of success of UAE for the treatment of uterine leiomyoma is a close cooperation among the specialists of these profiles.