Fig. 2. LAO arteriogram of the left internal iliac artery revealing the tortuous and dilated left uterine artery prior to selective catheterization.

A 39-year-old white female, without significant past medical history, was referred for uterine artery embolization as primary treatment for symptomatic uterine fibroids. This patient presented with a history of menorrhagia, abdominal distension, and increased urinary frequency. A pre-procedure MRI of the pelvis revealed a dominant anterior, fundal leiomyoma measuring 12.0 cm by 11.5 cm by 12.5 cm for a volume of 902.7 cc (length X height X width X 0.5233).

Access was obtained via the right common femoral artery. The initial, nonselective pelvic arteriogram (Figure 1) revealed a dilated left uterine artery and a mildly dilated right uterine artery supplying a hypervascular fibroid uterus. It also revealed a markedly dilated right ovarian artery, arising from the infrarenal aorta which also supplied the fibroids. The left uterine artery (Figure 2) was catheterized with a glide cobra-2 catheter and was successfully embolized with PVA (350-500 microns). The right uterine artery (Figure 3) was also catheterized with the cobra-2 glidecatheter. However, this vessel was smaller than the left uterine artery and the Cobra-2 glidecatheter was occlusive to flow. Therefore, a Tracker-325 microcatheter was used for embolization.

Following bilateral uterine artery embolization, the right ovarian artery was catheterized with a Mikaelsson catheter. A selective right ovarian arteriogram revealed a significant contribution to the arterial blood supply to the fibroids (Figure 4). Therefore, this vessel was embolized with PVA (710-1000 microns) until flow stasis. The final, nonselective arteriogram revealed successful uterine embolization without contribution from any other branches (Figure 5).

This patient was discharged after 6 hours of observation in our outpatient recovery area. The patient experienced 1 day of nausea and 4 days of moderate pelvic cramping, both controlled with oral medications including Ketorolac, Hydrocodone, and Compazine. The patient resumed her menstrual period 2 months after the procedure with reduced cramping and flow. She has begun to notice a decrease in urinary frequency and abdominal distension as well. The patient will return for follow-up imaging in 3 months to determine the degree of volume reduction in this dominant fibroid.

Fig. 3. Selective RAO arteriogram of the mildly dilated right uterine artery.

Fig. 4. Selective arteriogram of the right ovarian artery revealing the dominant nature of its contribution to the blood supply of the uterine fibroid.

Fig. 5. Nonselective pelvic arteriogram s/p embolization of the right and left uterine arteries and the right ovarian artery.