adenomyosis, pcs and fallopian tube embolization€¦ · adenomyosis 511 women 15 studies/76%...
TRANSCRIPT
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Adenomyosis, PCS and Fallopian Tube Embolization
Mohammed ALMoaiqelHead of VIR
KAMC & KASCHRiyadh
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Disclosure
Speaker name:
.................................................................................
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
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Adenomyosis
• 40-55 yrs old
• 20-30%
• Focal
• Diffuse
• Mixed with fibroids 50%
• Endometriosis 10%
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Adenomyosis
• Menorrhagia
• Dysmenorrhea
• Metrorragia
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Adenomyosis
• IUD (Mirena)
• Hormonal Therapy
• GnRH agonist
• Hysterectomy
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Adenomyosis
511 women 15 studies/76% improvement F/U 26/12
29 women (15 with fibroids) 82% Hsterctomy avoided, 72% satisfied
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Adenomyosis
1037 women/30 studies, pure and mixed with fibroids, 83% improved up to 3 yrs F/U
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PCS
• 30 % in multipara with pelvic varices with no clear pelvic etiology
• 20% of lower limb VVs, its pelvic origin
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PCS
• Chronic pelvic pain and heaviness (>6/12)
• Dysmenorrhea
• Dysparunia
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PCS
• US
• +/- CT (Nutcracker and May Thurnner)
• Venography and embolization
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PCS
• Bilateral Ovarian vein embolization
• +/- Pelvic vein source of reflux embolization
• 1 to 2 sessions
• OP
• RT Brachial vein approach
• Coils and Foam
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> 75 % clinic succes
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Fallopian Tube Embolization
• hydrosalpinx occurs in 10%–30% of infertile couples (reducing the probability of implantation and by increasing the risk of early pregnancy loss)
• Salpingectomies, salpingostomies, proximal tubal ligation ultrasound-guided hydrosalpinx aspiration and interventional tubal occlusion
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Dose not affect pregnancy rate, decrease aboration rate
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Fallopian Tube Embolization
• 2 Hospitals
• 22 patients
• (18 women’s with secondary infertility)
• 38 yrs old
• 3 patients with endometriosis
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Fallopian Tube Embolization
• all in single session
• OP
• Detachable or pushable coils
• 3 patients misplaced coils corrected during the procedure
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Fallopian Tube Embolization
• 1 patient expel the coils
• IVF-ET with pregnancy rate seen in 2 patients (out of 21 patients) (2 attests)
• 2 yrs F/U
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Fallopian Tube Embolization
Conclusion
• alternative to surgical ligation
• minimally invasive
• need more patients to conclude on this technique
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Adenomyosis, PCS and Fallopian Tube Embolization
Mohammed ALMoaiqelHead of VIR
KAMC & KASCHRiyadh