Research Areas

Embolisation of Uterine Myoma

Optimization of Libroid Embolization

Leiomyoma

Leiomyomas are the most common tumors of the Uterus and occurs in about 40-50 % women in 3rd decade of life. Histologically the seem to arise from muscles of the myometrium.
They occur as single (Myoma uteri) or multiple (Uterus myomatosus).
The common location is the body of uterus, rarely in the cervix, occasionally myoma is found in ligamentum latum and in fallopian tube.
Myomas can grow up to sizes of 10 cm in diameter or more, leading to enlarged and deformed uterus.

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Preparation of a Uterus (4070g) with multiple myomas. The size of the mass corresponds to a gestational age of 28 weeks.

 

The myomas are divided into three types depending on location: subserosal (1*) and intramural (2*) which can be removed laparoscopically and submucosal (3*) which is removed with hysterectomy.

Histologically leiomyoma contains bundles of muscle fibres with uniform long core. They are very cellular or rich in connective tissue with fibrosis (Leiomyo-fibroma).
A malignant transformation of myoma is very rare (0,1-0,5 %).

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Leiomyoma of Uterus. Fibrous make-up with bundle of spindle shaped muscle cells with interstitial connective tissue.

 

Therapy

An indication for treatment of uterus myomatosus is rapid increase in size of the myoma or complaints such as bleeding, pain etc. Previously myomas were enucleated before pregnancy. Nowadays patients are in many cases allowed to go ahead with pregnancy after a complete medical diagnosis.
When there was no wish for conception anymore hysterectomy was the treatment of choice for myoma. Medical therapy has not brought much success and likewise the treatment with GnRH analogues is time-limited due to osteoporosis (maximal 6 months). With the recently introduced method of embolisation a new form of treatment has been developed. Because no sufficient experiences has been reported with this method of treatment in patients with pregnancy, it is presently only performed in patients who have no wish for conception.

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Illustration of a catheter which extends up to the distal artery supplying the myoma.

 

Intervention

After application of local anaesthesia in inguinal region, the femoral artery is punctured in Seldinger technique using a small 4F femoral sheath.
In our institute we use sidewinder or cobra catheter for superselective catheterisation and for application of embolising material.

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Schematic illustration of the procedure.

After documentation of the vascular anatomy embolisation of the uterus is done. Polyvinyl alcohon particles (PVA) are used as emobilsation material. For better visualisation magnevist (contrast) is injected additionally.
After completion of transarterial embolisation, a compression bandage is placed in the punctured inguinal region. The complete treatment consists of angiography guided embolisation followed by 6 hours observation period with regular check of blood pressure and pulse rate.

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