Clinical History
Use of microcatheters in uterine fibroid embolisation.
Imaging Findings
Transarterial embolisation of uterine fibroids was developed in France about 12 years ago and has become used more and more frequently in most European countries. It is a straightforward technique in most cases and the technical requirements for its performance are basic. The more complex aspects include patient selection, pain management and good collaboration with gynaecologists.
Normally, a 4–5F cobra-shaped catheter is introduced into the horizontal part of the uterine artery and particles are embolised into the uterine circulation. It is strictly required that no reflux occurs into the adjacent arteries to the bladder, vagina or the outer genitals. Since most patients are between 35 and 50 years old, the arteries are pretty healthy but have a tendency to spasm during treatment. If spasm occurs, flow into the uterine artery is compromised, which makes embolisation more risky, prolongs intervention and possibly fluoroscopy time and makes it difficult to determine when the endpoint of the embolisation process has been achieved. Spasmolytic drugs may be administered intraarterially.
Discussion
Under special conditions in order to avoid the occurrence of spasm or to continue a procedure once spasm has occurred, use of microcatheters is recommended. These should have a relatively large inner lumen (around 0.6mm) to allow passage of the preferential size of embolising particles of 350-900 micrometres. As a guiding catheter, a diagnostic catheter with an inner lumen of 4F can be used. Once the microcatheter is in place, the guiding catheter should be retrieved from the uterine artery to allow maximum flow into the uterine artery.
Figure 1 shows different examples of situations where use of a microcatheter is recommended including spasm (Fig. 1a), sharply angulated orifice of a uterine artery (Fig. 1b) and small lumen of a uterine artery (Fig. 1c).
Differential Diagnosis List
Uterine fibroid embolisation
Final Diagnosis
Uterine fibroid embolisation
