Pieri Stefano, Di Felice Maurizio, Moreschi Emilo, Damiani Patrizio, Marasca Edvige, Agresti Paolo, Sessa Barbara, Trinci Margherita, Menichini Guendalina, Di Giampietro Ilenia, Miele Vittorio
, c/o MAZZONE, V.F.Algarotti, n° 8, 00137, Rome, Italy,
Radiol Med. 2015 Aug;120(8):759-66. doi: 10.1007/s11547-015-0498-0. Epub 2015 Feb 6.
Uterine leiomyomas are benign tumours; recently they have been managed with embolization of the uterine arteries. We analysed the technical feasibility, safety and efficacy of this treatment performed via an innovative transbrachial approach, rather than the traditional transfemoral approach.
Between 2009 and 2013, 115 patients were treated with embolization of the uterine arteries for one or more symptomatic leiomyomas. In 20 of these 115 patients, a transbrachial approach was used. Under ultrasound guidance, the left brachial artery was punctured. After having placed the tip of the angiography catheter at the level of L4 to check the aortic bifurcation, the uterine arteries were catheterised and embolized with calibrated particles. Data concerning exposure to radiation and the duration of the intervention were recorded for comparison between the two groups of subjects. Clinical controls and magnetic resonance imaging were complemented with echo-colour Doppler of the brachial artery to confirm the integrity and function of the vessel.
The uterine arteries were catheterised easily in a mean time of 25″, compared to 72″ using the femoral approach. As far as exposure to radiation was concerned, the mean fluoroscopy time for the femoral approach was 21.7' [range 14.4-42.7'] compared to 17.6' [range 7.7-25.5'] for the transbrachial approach. The time of occupation of the angiography suite was 118' (range 95-155') with the femoral approach, compared to 92' (range 65-123') with the transbrachial approach. No immediate complications involving the brachial artery were recorded.
In the treatment of symptomatic uterine fibromas, embolization of the uterine arteries performed via a transbrachial approach was shown to be safe and technically valid with regard to reducing the overall time of the intervention, ease of selective catheterisation, and shorter times spent in hospital, as well as being better accepted by patients.
子宫平滑肌瘤是良性肿瘤；最近一直采用子宫动脉栓塞术进行治疗。我们分析了通过创新的经肱动脉途径而非传统的经股动脉途径进行这种治疗的技术可行性、安全性和有效性。
2009年至2013年期间，115例因一个或多个有症状的平滑肌瘤接受子宫动脉栓塞术治疗的患者。在这115例患者中的20例采用了经肱动脉途径。在超声引导下，穿刺左肱动脉。将血管造影导管尖端置于L4水平以检查主动脉分叉后，对子宫动脉进行插管并用校准颗粒栓塞。记录有关辐射暴露和干预持续时间的数据，以便两组受试者之间进行比较。临床对照和磁共振成像辅以肱动脉的彩色多普勒超声检查，以确认血管的完整性和功能。
子宫动脉插管平均用时25秒，而经股动脉途径用时72秒。就辐射暴露而言，经股动脉途径的平均透视时间为21.7分钟[范围14.4 - 42.7分钟]，经肱动脉途径为17.6分钟[范围7.7 - 25.5分钟]。经股动脉途径占用血管造影室的时间为118分钟（范围95 - 155分钟），经肱动脉途径为92分钟（范围65 - 123分钟）。未记录到涉及肱动脉的即刻并发症。
在有症状的子宫纤维瘤治疗中，经肱动脉途径进行子宫动脉栓塞术在减少干预总时间、选择性插管的 ease、缩短住院时间方面被证明是安全且技术上有效的，并且患者更容易接受。 （注：此处“ease”疑有误，原文可能是“ease of access”之类表述，但按要求未修改）
