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Hostmaster.britishfibroidtrust.org.ukManagement of Uterine Artery Embolization for
Fibroids as an Outpatient Procedure
João M. Pisco, MD, Tiago Bilhim, MD, Marisa Duarte, MD, and Daniela Santos, MD
PURPOSE: To evaluate whether it is safe to perform uterine artery embolization (UAE) as an outpatient procedure.
MATERIALS AND METHODS: This retrospective study was approved by the institutional review board and
included 234 patients (age range, 24 –58 years; mean age, 40.5 years) who underwent UAE as an outpatient
procedure with polyvinyl alcohol particles between January 2007 and March 2008. Patients were given acid-
suppressing drugs, nonsteroidal anti-inflammatory drugs, anti-histaminic drugs, and laxatives twice on the day
before UAE and once on the morning of UAE. Pain score, rated from 0 to 10, was evaluated by using a numeric
pain scale during UAE, after the procedure, at discharge, at the night of discharge, and on the following morning.
The outcome of UAE was evaluated at 6 months by means of pelvic magnetic resonance imaging and clinical
RESULTS: The mean pain score was 0.9 during embolization, 2.5 4 – 8 hours after embolization, 0.9 at discharge,
1.1 the first night after discharge, and 0.7 the next morning. All patients were discharged from the hospital 4 – 8
hours after the procedure, with no overnight hospital admissions. At 6 months, 146 of 158 patients (92.4%)
reported an improvement in menorrhagia, 39 of 44 (88.6%) reported an improvement in bulk symptoms, and 20
of 25 (80%) reported an improvement in pain. The volumes of the uterus and the dominant fibroid decreased
33.7% and 39.3%, respectively.
CONCLUSIONS: With acid-suppressing, anti-inflammatory, and anti-histaminic drugs started on the day before UAE,
the procedure can be performed safely as an outpatient procedure.
J Vasc Interv Radiol 2009; 20:730 –735
consists of nausea, vomiting, pelvic pain, low-grade fever, fatigue, and general mal- aise in the 1st hours after the procedure myometrium. It is expected that there will From the Department of Radiology, St Louis Hospi- tal, Rua Luz Soriano, no182, 1200-249, Lisbon, Por-tugal; and the University Department of Radiology, of tissue infarcted and the severity of this Faculty of Medical Sciences, New University of Lis- bon, Lisbon, Portugal (J.M.P., T.B.); the Department of Radiology, Pulido Valente Hospital, Lisbon, Por-tugal (M.D.); and the Department of Surgery, Cas- cais Hospital, Lisbon, Portugal (D.S.). Received Sep- tember 8, 2008; final revision received January 25, 2009; accepted January 26, 2009. Address correspon-
crease patient satisfaction and to reduce None of the authors have identified a conflict of patients for 1–2 days in the hospital after DOI: 10.1016/j.jvir.2009.01.029
Pisco et al • 731
Medication for UAE
den Pfizer]), and an antibiotic (cefazolin, MATERIALS AND METHODS
tion of each uterine artery (total amount, 1 mg) was administered if necessary.
the patient under local anesthesia by us- were no other exclusion criteria. The pa- ence in UAE—was present in all cases.
ume of the uterus and the largest fibroid tion of the flow in the uterine artery, or 732 • Outpatient Uterine Artery Embolization for Fibroids
the time of the embolization procedure.
Summary of Baseline Data
intravenously), analgesics (1-g paraceta- daily for a week and one to be filled out charged from the hospital 4–8 hours af- ter the procedure. Just before discharge, tients were questioned about their satis- Note.—Except where indicated, dataare given as number of patients.
faction with their time of discharge, the ity of life they had before and after UAE.
After being filled, the score sheets were pain, 67 reported a pain score of 1–2, 23 bleeding were considered for discharge.
thereafter up to discharge, at discharge, charge, 54 patients did not feel any pain, 42 reported a pain score of 1–2, 109 re- ported a pain score of 3–5, 23 reported a rate verbally their pain severity by using pain score of 8–10. The mean pain score pain). Pain was classified as follows: no pain (score, 0), light pain (score, 1–2), moderate pain (score, 3–5), severe pain (score, 6–7), and very severe pain (score line data. The technical success rate for tients). In three patients, only one uter- in a sheet by the patient or with the help of an accompanying person or a nurse.
the hospital 4–8 hours after the proce- Volume 20
Pisco et al • 733
Summary of Pain Scores
Summary of Postembolization Data
a decrease of 66.3%. The mean domi-nant fibroid volume was 67.1 cm3 after DISCUSSION
procedure, it is important to control the pain score of 2.5 (rated from 0–10) dur- ing the first 8 hours after embolization.
charge, 54 of the 234 patients (23.1%) did not feel any pain, proving the efficacy of ication started on the day before and the 6–7) during UAE (0.9%), and 29 patients score of 1–2, and 11 had a pain score of the hospital for pain control, but as the lergic reactions to the medication or con- was moderate pain (pain score of 3–5 in six patients), with no cases of vomiting.
7.3 days (range, 2–13 days); 233 of the tients). Two patients were treated as in- gia, five of 44 patients (11.4%) had per- 734 • Outpatient Uterine Artery Embolization for Fibroids
mation present in almost every fibroid.
Clinical Outcome of UAE at Six Months
crease the effects of the anti-inflamma-tory on gastric mucosa and the vomiting that may be associated with the anti-inflammatory when administered by Note.—Percentages of number of patients with persisting symptoms after UAE.
Siskin et al has potent analgesic andmoderate anti-inflammatory activity and may potentiate the action of the tra- Mean Uterus and Fibroid Volumes at Six Months
madol given previously. Due to the ad-ministration of anti-inflammatory drugs of each uterine artery, only two of ourpatients felt severe pain during emboli- Note.—Data are given as volumes. Numbers in parentheses are percentages.
zation. Siskin et al inject ketorolakafter the embolization of each uterineartery, but we do it before embolization 15% of their patients because of fever.
lak, cefazoline, meperidine, hydroxyzine, lization but also to the effect of analgesic or fever control. We think that, with the venously. Thus, the protection of gastric effectively. It is important, however, to with ondansetron after finishing UAE.
to tell them to contact the interventional unless it has been directly measured.
radiologist in case of need or any doubt.
Total availability to assist the patient is as outpatients, it is important that they ing. The patients receive the information first consultation, and the information is cular ketorolak before, during, and after during the procedure associated with nar- Volume 20
Pisco et al • 735
tomatic uterine fibroids: experience in 49 ine artery embolization. Am J ObstetGynecol 2002; 187:1401–1404.
efit with an overnight stay in the hospi- intense pain or vomiting persisting 4–6 References
J, Smith TP. Simplified pain-controlprotocol after uterine artery emboliza- tion. Radiology 2002; 224:610 – 611.
Complications after uterine artery em-bolization for leiomyomas. Obstet Gy- heart diseases, or other debilitating con- 10. Worthington-Kirsch RL, Koller NE.
Vasc Interv Radiol 2000; 11:1047–1052.
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Recovery after uterine artery emboliza-tion for leiomyomas: a detailed analy- sheim F, Magee ST, Ascher SA, Jha RC.
12. Huskisson EC. Measurement of pain.
ON IMAGES OF WEAK FANO MANIFOLDS II Abstract. We consider a smooth projective surjective morphismbetween smooth complex projective varieties. We give a Hodge the-oretic proof of the following well-known fact: If the anti-canonicaldivisor of the source space is nef, then so is the anti-canonicaldivisor of the target space. We do not use mod p reduction ar-guments. In addition, we make some sup