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?
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)
What's so good about this procedure vs hysterectomy anyway?
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)
Does it allow the patient to bear children?
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).
As I understand it, you can perform a hysterctomy and still retain the ovaries, so the pt won't have to take hormones.
Yes. In a non-oncologic hysterectomy the ovaries are typically left in.
Also, what are some of the most common interventional radiology procedures? any particularly interesting ones?
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
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?
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.
