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uterine artery embolization doesnt make sense to me.

Discussion in 'Radiology' started by IheartCaffeine, Mar 5, 2007.

  1. IheartCaffeine

    IheartCaffeine I really do.
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    So I was watching an interventional radiology uterine artery embolization procedure on a website. I understand the theory: embolize the uterine artery to block blood flow to the uterine fibroid. But then the doc said that the embolization wouldn't affect the uterus because it has lots of collateral circulation. So if the uterus has collateral circulation, doesn't that mean the fibroid would get collateral circulation as well?

    What's so good about this procedure vs hysterectomy anyway? Does it allow the patient to bear children? As I understand it, you can perform a hysterctomy and still retain the ovaries, so the pt won't have to take hormones.

    Also, what are some of the most common interventional radiology procedures? any particularly interesting ones?

    A GS resident once told me that IR docs perforate during their procedures all the time and GS has to come in and clean up the mess. How true is that?

    Thanks!!
     
  2. hans19

    hans19 I'm back...
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    After a bowel surgery, GSs have a bleeder that they can't find. We angio and embolize it. During a central line, the surgery intern let go of the wire and now its sitting in the PA. The vascular surgeons put in a filter UPSIDE-
    DOWN. We bail the surgeons out too.
     
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  3. f_w

    f_w 1K Member
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    It is similar to radiation or chemo, you hit the normal uterus and the fibroids, but the regular uterine tissue is better equipped to deal with it. And the goal here is not to eradicate the fibroids but rather to shrink them and reduce their vascularity to alleviate/eliminate the symptoms that trouble the patients the most ('bulk' symptoms such as urinary frequency/urgency, pelvic pain, heavy periods, anemia)

    Lets see:
    - ambulatory procedure/overnight admission vs. 2-3 day inpatient stay
    - a week of cramps and malaise vs. 4-6 wks post-surgical recovery
    - 1/4 inch dermatotomy in the groin vs. abdominal scar
    - no risk of certain long-term complications such as adhesions and SBOs
    - I am not sure whether you are male of female, but women tend to be attached to the body parts that make them female (ask some old geezer whether he rather has a prostatectomy for an early stage prostate ca or some iodine seeds)

    Generally, this is a procedure for patients without a child wish. There are however good numbers of pregnancies documented after UAE. The rate of pregnancy loss or complications is not higher than expected in a comparable group of women of advanced maternal age.
    Generally, it is an alternative to hysterectomy. A patient with localized fibroid disease and a child-wish will typically benefit from a myomectomy (with >80% chance of fibroid re-growth, but typically a window of opportunity to have a pregnancy).

    Yes. In a non-oncologic hysterectomy the ovaries are typically left in.

    The more common ones are things like:
    - dialysis access management (AV-graft maintenance, tunneled catheters)
    - oncology acccess managent (ports tunneled caths like hickmans)
    - angiography and endovascular treatment of peripheral vascular disease
    - percutaneous image-guided placement of gastrostomy tubes
    - percutaneous nephrostomies, percutaneous ureteral stent placement
    - percutaneous biliary drainage and stent placement

    The more interesting ones are:
    - all types of tumor ablations (liver/kidney/lung)
    - chemo-embolization and radio-embolization of liver malignancies
    - pre-operative embolization of vascular tumors
    - endovascular abdominal aortic aneurysm repair
    - embolization therapy for various types of trauma (GSWs,pelvic fractures, iatrogenic)
    - treatment of DVT
    - percutaneous access for biliary tract brachytherapy

    Perforate what ?

    Just as often as GS has to come in and 'clean up the mess', IR has to come in and 'clean up the mess' for GS (except that those procedures are considered part of the regular routine and not an opportunity to brag). It seems like this GS resident sees himself threatened by IR and tries to feed crap into an impressionable medical student.
     
  4. OP
    OP
    IheartCaffeine

    IheartCaffeine I really do.
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    f_w

    thanks for your helpful input! :thumbup:
     
  5. Whisker Barrel Cortex

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    In my 3.6 years of radiology residency, I have not personally seen a complication of an IR procedure that had to have surgical intervention. Yes, they do happen, but very infrequently.

    In that same time period, I have performed numerous procedures to help out my surgical colleagues secondary to a surgical complication (which is a known risk of any surgical therapy) and innumberable procedures to stabilize a patient prior to surgery or to prevent the necessity for surgery.

    The rest of your questions were answered very well above.
     
  6. boston

    boston Junior Member
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    As a GS PGY-4 I want to say that radiology is a great ally of ours. In fact, I think IR is the only dept that actually reduces our workload rather than adding to it, unlike most other specialties. So I am very grateful.

    (Although in my 3.6 years, I have seen 2 IR gastrostomy tubes that eroded thru the stomach wall requiring emergent ex laps -- but not IR's fault. One was a high risk patient on chemo, malnourished. Also it makes sense that it's riskier if you can't do it under direct visualization like in the OR.)

    Again, I truly appreciate our radiology colleagues and wanted to take this opportunity to express thanks. Also for being patient with us relentlessly dogging you guys for reads, because you understand the acuity and the pressure that flows down onto us from above.

    - a tired gen surg resident
     
  7. f_w

    f_w 1K Member
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    Hey thanks, rare to hear this from a surgeon (rare to hear any type of appreciation in this line of work).
     
  8. boston

    boston Junior Member
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    hey we all deserve a pat on the back once in a while -- lord knows surgical culture could be a little more nurturing
     

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