Department of Radiology, Keck School of Medicine, University of Southern California, LAC+USC Medical Center, 1200 N State St, D&T Tower 3D321, Los Angeles, CA 90033, USA.
Radiographics. 2012 Oct;32(6):1713-31. doi: 10.1148/rg.326125524.
Percutaneous vascular embolization is a useful therapeutic option for a wide range of gynecologic and obstetric abnormalities. Transcatheter embolization procedures performed with the use of radiologic imaging for guidance are minimally invasive and may obviate surgery, thereby decreasing morbidity and mortality and safeguarding the patient's future fertility potential. To integrate this treatment method optimally into patient care, knowledge is needed about the clinical indications for therapeutic embolization, the relevant vascular anatomy, technical considerations of the procedure, and the potential risks and benefits of embolization. The most well-known and well-studied transcatheter embolization technique for treating a gynecologic-obstetric condition is uterine fibroid embolization. However, the clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as adenomyosis and arteriovenous malformations, as well as intractable bleeding due to inoperable advanced-stage malignancies. Uterine artery embolization may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage, placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury, and ovarian vein embolization has been shown to be effective for the management of pelvic congestion syndrome. The article discusses these and other gynecologic and obstetric indications for transcatheter embolization, provides detailed descriptions of imaging findings before and after embolization, and reviews procedural techniques and outcomes.
经皮血管栓塞术是治疗广泛的妇科和产科异常的一种有效治疗选择。在放射影像学引导下进行的经导管栓塞术是一种微创方法，可以避免手术，从而降低发病率和死亡率，并保护患者未来的生育潜力。为了将这种治疗方法最佳地融入患者的护理中，需要了解治疗性栓塞的临床适应证、相关的血管解剖结构、手术的技术注意事项以及栓塞的潜在风险和益处。治疗妇科-产科疾病最著名和研究最多的经导管栓塞技术是子宫肌瘤栓塞术。然而，经导管栓塞的临床适应证要广泛得多，包括许多良性妇科疾病，如腺肌病和动静脉畸形，以及无法手术的晚期恶性肿瘤引起的难治性出血。子宫动脉栓塞术可用于预防或治疗与各种产科疾病相关的出血，包括产后出血、胎盘植入异常和异位妊娠。也可以进行子宫动脉或髂内动脉栓塞以控制因凝血障碍或医源性损伤引起的骨盆出血，卵巢静脉栓塞已被证明对治疗盆腔淤血综合征有效。本文讨论了这些和其他妇科和产科的经导管栓塞适应证，提供了栓塞前后的详细影像学表现描述，并回顾了手术技术和结果。
