Armand Aymard

Arterial embolisation to treat uterine myomata

Haemorrhage, probably related to hypervascularisation, is the commonest complication of uterine myomata and is difficult to treat. 16 patients, aged 34-48 years, with symptomatic uterine myomata, for which a major surgical procedure was planned after failure of medical treatment, were treated by selective free-flow arterial embolisation of the myomata with Ivalon particles. With a mean follow-up of 20 months (range 11-48) in the responders, symptoms resolved in 11 patients; menstrual cycles returned to normal in ten of these. Three patients had partial improvement. Two failures required surgery. In 14 cases embolisation caused pelvic pain, which required analgesia in all.

Pregnancy after embolization of uterine myoma: report of 12 cases

OBJECTIVE To treat uterine myomas with embolization, to look for pregnancy-induced myoma recurrences, and to assess pregnancy course and outcome after embolization. DESIGN Observational clinical study. SETTING University of Paris VII hospital. PATIENT(S) Nine women had embolization for symptomatic myoma, with 12 pregnancies observed. INTERVENTION(S) Embolizations were highly selective and performed bilaterally through the uterine arteries with polyvinyl alcohol. MAIN OUTCOME MEASURE(S) Pregnant women were evaluated by physical and sonographic examinations. RESULT(S) Before embolization, the mean uterine volume was 450 cm(3), and in six patients polymyomas were present. The median age at embolization was 40 years; the median delay before pregnancy was 9 months; and the median age at first pregnancy outcome was 41 years. Five early miscarriages occurred. The seven other pregnancies were uneventful, although three premature births and one case of late toxemia occurred unrelated to previous embolization. Three women delivered vaginally and four by cesarean section. Neither myoma recurrence nor abnormality in uterine function was observed. CONCLUSION(S) The results of this first series of 12 pregnancies after myoma embolization are promising. If these preliminary results are confirmed, embolization could be a major breakthrough in the management of myoma and could replace conventional medical and surgical treatments.

Percutaneous Transvenous Catheterization and Embolization of Vein of Galen Aneurysms

Seven cases of vein of Galen aneurysms treated by percutaneous transvenous endovascular occlusion of the aneurysmal vein are presented. In one case, the approach was via the femoral vein, and in the other six cases, by the jugular vein. All of the malformations were multipedicular and, additionally, in six of the seven there was an intervening arterial-arterial network between the posterior thalamoperforating arteries and the wall of the venous aneurysm. This fistulous network was interpreted as purely arterial and not as an associated arteriovenous malformation. For this reason, the transvenous approach was considered justified, and was performed without risk of hemorrhage caused by retrograde venous hypertension. Measurement of intra-aneurysmal pressure during the course of treatment allowed better understanding of the hemodynamics of the lesions, guided the amount of occlusion to be accomplished during each treatment session, and thus may have prevented the phenomenon of normal perfusion pressure breakthrough. The percutaneous transvenous approach offers all the advantages of the transtorcular approach but avoids surgery. Because of our excellent angiographic and clinical results--five complete and two partial occlusions, with favorable outcomes and no major complications--we believe that this technique is better for the treatment of multipedicular vein of Galen aneurysms than transarterial embolization or surgery.

Ethanol embolization of arteriovenous fistulas: a primary mode of therapy.

Arteriovenous fistulas (AVFs) can be posttraumatic or congenital vascular malformations. In the initial arteriographic evaluation, chronic AVFs potentially can be confused with arteriovenous malformations (AVMs). The authors studied five patients with a single AVF and one patient with numerous AVFs. Three patients had undergone surgery for treatment of their AVFs, one patient had undergone isobutyl-2-cyanoacrylate (IBCA) embolization, and two patients had undergone no prior therapy. The AVFs recurred in the three patients who had undergone surgery and in the patient who had undergone IBCA embolization. All patients underwent ethanol embolization of their AVFs. Angiograms obtained immediately after embolization documented closure of all AVFs. At follow-up, none of the embolized lesions have recurred. The authors conclude that ethanol embolotherapy can cure these problematic lesions. Extreme caution, however, must be employed with the use of intravascular ethanol because nontarget embolization can potentially result in tissue devitalization. In this study, two patients developed a small focal area of skin necrosis that did not require skin grafting and healed with conservative management.

Uterine artery embolisation for fibroid disease: Results of a 6 year study

SummaryUterine myomata are very common Failed treatment frequently leads to major surgery Therefore, non-invasive techniques, such as uterine artery embolisation (UAE) are of great interest and were first reported by Ravina et a1 to treat symptomatic myomata initially scheduled for surgery The objectives of this 6 year study were to evaluate UAE as the only treatment of myomata.Between 1991 and 1997, 184 women with symptomatic myomata were prospectively enrolled in the study Bilateral, particular UAE was performed with polyvinyl alcohol (PVA, halon) under local anaesthesia and analgesia during a 24 h hospitalisation Womens ages ranged from 21 to 54 years (mean 41) Menorrhagia was present in 93% of cases, pain in 22%, enlarged uterus in 25% Myomata were interstitial (77%), subserous (16%) or submucous (7%) Multiple myomata were common (in 80%, ≥3 myomata) mean myomata diameter 58 mm 157 cases could be evaluated (19 were lost during follow-up and there were eight catheterisation failures) The mean duration...

Embolisation des fibromes utérins : résultats sur 454 cas

OBJECTIVE: To determine the effectiveness of uterine arterial embolization (UAE) as primary treatment in the management of symptomatic leiomyomas. PATIENTS AND METHOD: UAE was performed on 454 patients (age range: 21-68) with menorrhagia, bulk-related symptoms or both, due to leiomyomas. The effectiveness of this therapy in the control of symptoms and reduction of uterine and leiomyoma volume was measured by clinical and imaging controls at 3, 6 and 9 months after the procedure. RESULTS: Four hundred and thirty-three patients were evaluated, and 42 failures were observed (9.6%). Six months after the procedure, 391 patients were symptom-free. Follow-up ultrasonic examination showed an average reduction of 55% in dominant myoma volume at 6 months, 70% at 1 year. Twenty-seven women became pregnant (30 pregnancies). Complications related to procedure, and requiring surgery, occurred in three cases. Principal complications are amenorrhoea and fibroid sloughs. Severe complications are rarely found. DISCUSSION AND CONCLUSION: UAE is an efficient therapy in the management of symptomatic myomas and proves to be a valid alternative to surgical procedure. The future of this mini-invasive and conservative technique appears to be a very promising one.

Balloon-assisted coil embolization for large-necked renal artery aneurysms

An aneurysm of the right renal artery was discovered in a patient suffering from cerebral arterial angiodysplasia and arterial hypertension. The aneurysm was large necked, which made selective endovascular treatment very difficult. To perform the embolization of the aneurysm, a balloon remodelling technique was used. This prevented migration of coils within the arterial lumen.

Aneurysm of the Gastroduodenal Artery Associated With Stenosis of the Superior Mesenteric Artery

A 68-year-old patient was hospitalized after the incidental discovery of an aneurysm of the gastroduodenal artery associated with stenosis of the superior mesenteric artery. This patient had severe heart failure, which led to acute pulmonary edema and inoperable triple-vessel coronary disease. In the first of two procedures the superior mesenteric artery was dilated; 48 hours later the gastroduodenal artery aneurysm was embolized with minicoils and acryl glue. Immediate and follow-up arteriograms at 10 months showed that results were satisfactory. Transluminal treatment of both lesions is an alternative to surgical treatment, especially in high-risk patients.

Endovascular Treatment of Arteriovenous Fistulas Arising from Branches of the Subclavian Artery

PURPOSE The goal of this study was to evaluate the role of endovascular techniques in the treatment of arteriovenous fistulas (AVFs) in the subclavian region. PATIENTS AND METHODS Since 1984 six patients with AVFs arising from branches of the subclavian artery have been treated. All AVFs were of iatrogenic origin (five venous punctures and one pacemaker insertion). Two patients had cardiac insufficiency, three had a bruit, and one had upper extremity venous hypertension. Angiographically, four of the AVFs were located on the thyrocervical trunk and two were on the internal mammary artery. RESULTS All fistulas were treated by means of endovascular occlusion with a detachable balloon, with full resolution of symptoms. One AVF recurred after a balloon deflated prematurely. The patient was treated again and was subsequently cured. No other complications were associated with treatment. CONCLUSION Endovascular balloon occlusion of AVFs in the subclavian region is a simple, effective, and safe method that eliminates the need for surgery. It should be the method of choice for treatment of these lesions.

Pregnancy after embolisation of uterine myomata

SummarySince our first report on uterine artery embolisation (UAE) of 184 women over a 6 year period, eight pregnancies were observed in seven treated women Our objectives were to evaluate the type of uterus before UAE, to assess eventual pregnancy-induced myomata recurrence, evaluate pregnancy delay after UAE, as well as pregnancy course and outcome Women were prospectively evaluated during pregnancy, at the time of delivery and post-partum Prior to UAE the uterus was enlarged (mean 455 cm3) with polymyomata in four cases Patient age at pregnancy ranged from 23 to 42 (mean 36, median 40) The time interval between UAE and pregnancy was short (4–27 months) Two early miscarriages were observed in one woman >40 years old There were two deliveries at term and two births were premature (one woman with AIDS, one twin pregnancy) Two women still have normal, ongoing pregnancies The mode of delivery could be assessed in four cases three vaginal, one Caesarian section No foetal growth retardation was present Neithe...