In Reply to: Re: Case 1199_01 -- Embolization of Dominant Ovarian Arterial Supply to a Uterine Fibroid posted by Pasteur Rasuli on November 09, 1999 at 01:43:07:
Before the embolization procedure in this patient, as in all of our patients, we had an extensive discussion on two occasions (consultation and immediately prior to the procedure) concering the potential risks of this procedure. One of the issues covered in all discussions with patients is that of premature menopause after embolization. At the time of consultation, I do get a sense of how these women feel about this possibility. I'm sure that most of us performing a lot of these procedures have experienced the common sentiment among these patients that the premature onset of menopause would not be the worst thing in the world. In fact, many of them laugh when I present this as a risk and many others say "Bring it on". Our consent form does include the risks of the procedure and one of the listed risks is premature menopause. In addition, the procedure is entitled Uterine Fibroid Embolization and not just Uterine Artery Embolization. In this case, the right ovarian artery clearly represented the dominant source of arterial supply to her fibroid and without addressing this particular vessel, the procedure would have almost been guaranteed to fail in my opinion.
The consent issue was raised among my partners immediately prior to catheterizing and embolizing this vessel. However, she acknowledged the risk of premature menopause by signing the consent form, she expressed limited concern about the possibility of this "complication", and she wanted this procedure to work. I believe that this supported our decision to proceed with the embolization. It does not, I believe, support the decision to embolize vessels which are less obviously providing significant supply to the fibroids. That decision can only be justified after a formal study of pre- and post-embolization films in patients in whom embolization has failed.