Fig. 1.Selective arteriogram of the right uterine artery shows a relatively small artery.

Fig. 2. Selective arteriogram of the left uterine artery shows a relatively small artery.

The patient is a 46-year-old woman with a histroy of menorrhagia from fibroids for more than 3 years. Her gynecologist has been recommending hysterectomy for the last 2 years. She currently has a hemoglobin of 6.

She heard about uterine artery embolization (UAE) from a member of her church, who was treated with UAE previously. Ultrasound showed a 12-13cm uterus with multiple fibroids, including one at the fundus measuring 5-6 cm. At arteriography, her uterine arteries were relatively small (Figures 1 and 2). Each was embolized with approximately 130mg of 300-500u PVA and a gelfoam pledget. At this point she felt no pain (she had elected conscious sedation for the UAE).

Injection of the right ovarian artery (Figure 3) showed a large collateral to the fundal fibroid. The proximal portion of the right ovarian artery was catheterized and embolized with 3 large gelfoam pledgets. Injection of the left ovarian artery (Figure 4) showed a small collateral to the same fundal fibroid. This artery was not embolized because of technical difficulties.

Her post-UAE course was uneventful. She had experienced mild to moderate cramping. The plan is to see how she does over the next few months. If she does not respond, she will be offered repeat angiography and embolization of the left ovarian artery.

Fig. 3.Selective arteriogram of the right ovarian artery shows a large collateral to the fundal fibroid.

Fig. 4. Injection of the left ovarian artery shows a small collateral to the same fundal fibroid.