In Reply to: Case 1199_03 -- Anatomical Variations in Uterine Artery posted by Editor on November 02, 1999 at 10:45:33:
I have not seen any variations of uterine anatomy
except a few cases with a tiny accessory uterine
branch.
I think that a comment on the need to block all
feeding branches to the uterus is apropros here.
We do not know if if is necessary to block both
uterine arteries in all cases,although there have
been failures reported in cases where unilateral
embolization was done. As Scott Goodwin
mentioned, there are rich collaterals across the
midline in the uterus. But it is also known that
fibroids usually derive their blood supply from a
relatively small number of vessels, usually less
than three. This was shown in an anatomic study
from 1912 ( I apologize that I don't have the
reference here). The goal of embolization is to
occlude those few vessels. This leads to the
infarction of the fibroid. If those vessels are
occluded, then cross uterine collaterals should be
irrelevant. What we don't know is if our
embolization is distal enough to block those
vessels. If we have our embolic material occlude
more proximally, then there is the opportunity for
collaterals to supply them. This is an area that
needs considerable research. We need to determine
the optimal size of embolic material, the best way
of delivering it and the effect of the
embolization on the rest of