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Women's Health Procedures


Fallopian Tube Recanalization

Some common causes of infertility in both women and men can now be treated without surgery by interventional radiologists. Often these treatments do not require hospitalization or general anesthesia. Patients usually may return to normal activity shortly after the procedure.

Blockage of the Fallopian Tube

The most common cause of female infertility is a blockage of the fallopian tube through which eggs pass from the ovary to the uterus. Occasionally, these tubes become plugged or narrowed, preventing successful pregnancy.

Interventional radiologists can diagnose and treat a blockage in the fallopian tubes with a non-surgical procedure known as selective salpingography. In the procedure, which does not require an incision, a thin tube (catheter) is placed into the uterus. A contrast agent, or dye, is injected through the catheter, and an X-ray image of the uterine cavity is obtained. When a blockage of the fallopian tube is identified, another catheter is threaded into the fallopian tube to open the blockage.

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Fallopian tube before treatment Right fallopian tube open after treatment

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Chronic Pelvic Pain
 
It is estimated that one-third of all women will experience chronic pelvic pain in their lifetime. Many of these women are told the problem is "all in their head" but recent advancements now show the pain may be due to hard-to-detect varicose veins in the pelvis, known as pelvic congestion syndrome.

The causes of chronic pelvic pain are varied, but are often associated with the presence of ovarian and pelvic varicose veins. Pelvic congestion syndrome is similar to varicose veins in the legs. In both cases, the valves in the veins that help return blood to the heart against gravity become weakened and don't close properly. This allows blood to flow backwards and pool in the vein, causing pressure and bulging veins. In the pelvis, varicose veins can cause pain and affect the uterus, ovaries and vulva. Up to 15 percent of women, generally between the ages of 20 and 50, have varicose veins in the pelvis, although not all experience symptoms.

The diagnosis is often missed because women lie down for a pelvic exam, relieving pressure from the ovarian veins so that the veins no longer bulge with blood as they do while a woman is standing.

Many women with pelvic congestion syndrome spend many years trying to get an answer to why they have this chronic pelvic pain. Living with chronic pelvic pain is difficult and affects not only the woman directly, but also her interactions with her family and friends and her general outlook on life. In these cases, because the cause of the pelvic pain is not diagnosed, no therapy is provided even though there is therapy available.


Prevalence

  • Women with pelvic congestion syndrome are typically less than 45 years old and in their child bearing years. 
  • Ovarian veins increase in size related to previous pregnancies. Pelvic congestion syndrome is unusual in women who have not been pregnant. 
  • Chronic pelvic pain accounts for 15% of outpatient gynecologic visits. 
  • Studies show 30% of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a sole cause of their pain, and an additional 15% have PCS along with another pelvic pathology. 


Risk Factors

  • Two or more pregnancies and hormonal increases 
  • Fullness of leg veins 
  • Polycystic ovaries 
  • Hormonal dysfunction 

Symptoms

The chronic pain that is associated with this disease is usually dull and aching. The pain is usually felt in the lower abdomen and lower back. The pain often increases during the following times:

  • Following intercourse 
  • Menstrual periods
  • When tired or when standing (worse at end of day) 
  • Pregnancy

     Other symptoms include:

  • Irritable bladder 
  • Abnormal menstrual bleeding 
  • Vaginal discharge 
  • Varicose veins on vulva, buttocks or thigh. 

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Black area represents engorged pelvic veins responsible for Pain. 

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Tubal Occlusion Treatment

Essure - A Breakthrough Technology 

The Essure procedure is performed by a trained gynecologist. A soft, flexible micro-insert is placed into each fallopian tube through your body's natural pathways.

In clinical testing, the total procedure took about 35 minutes, with only 15 minutes required to place the micro-inserts into the fallopian
tubes. Most women were able to leave the facility 45 minutes after the procedure. In the Pivotal Trial of Essure, 92% of working women resumed work in 24 hours or less after the day of the procedure. In fact, many women resumed normal physical activities the same day they had the procedure.

Essure Works With Your Body

Unlike tubal ligation (having your tubes tied) or vasectomy, the Essure procedure does not require incisions or punctures to the body and there is no cutting, clipping, suturing, or burning of tubes. During the three months after the procedure, your body and the micro-insert work together to form a tissue barrier that prevents sperm from reaching the egg. The micro-inserts do not contain or release hormones and are made with the same materials used in other medical products for many years. For example, these materials have been used in blood vessel grafts, heart valve replacements, and abdominal repair.


Safety and Effectiveness

The Essure procedure has undergone significant clinical testing in the United States, Europe, and Australia. Data from clinical testing show that Essure was 99.80% effective in preventing pregnancy after three years of follow-up. Additionally, 92% of women who relied on Essure rated their long-term satisfaction with Essure as "somewhat satisfied" to "very satisfied" at 3 years of follow-up.

The Essure Procedure: Key Risks and Considerations

As with all medical procedures, Essure may not be suitable for all women and there are risks associated with Essure. The following are the
key risks associated with Essure:

  • The procedure should be considered irreversible 
  • Like all methods of birth control, the Essure procedure should not be considered 100% effective 
  • Not all women who undergo the Essure procedure will achieve successful placement of both micro-inserts
  • You must use another method of birth control for at least three months after the procedure
  • The Essure procedure is newer than other procedures
  • Removal of the Essure micro-inserts would require surgery

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Uterine Fibroid Embolization using Minimally Invasive Surgical Solutions and Procedures
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Uterine Fibroid Embolization (UFE) is a new way of treating fibroid tumors of the uterus. Fibroid tumors, also known as myomas, are masses of fibrous and muscle tissue in the uterine wall which are benign, but which may cause heavy menstrual bleeding, pain in the pelvic region, or pressure on the bladder or bowel. Uterine Fibroid Embolization, done under local anesthesia, is much less invasive than open surgery done to remove uterine fibroids. The procedure is performed by an experienced interventional radiologist, a physician specially trained to perform uterine fibroid embolization and similar procedures.

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Angiographic methods are similar to those used in heart catheterization. A catheter is placed in each of the two uterine arteries and small particles are injected to block the arterial branches that supply blood to the fibroids. The fibroid tissue dies, the masses shrink, and in most cases symptoms are relieved. The women who will benefit most from UFE are those who have symptomatic fibroids and are not pregnant, have no desire for future fertility, want to retain their uterus, and prefer to avoid transfusions because of health or religious reasons.



Appropriate treatment depends on the size and location of the fibroids, as well as the severity of symptoms. If a woman is not experiencing symptoms, her doctor will most likely suggest "watchful waiting" — checking the fibroid at annual gynecologic examinations and monitoring for symptoms.


 


If symptoms develop, there are a number of treatment options:

  • Drug Therapy including non-steroidal anti-inflammatory drugs (NSAIDs), birth-control pills and hormone therapy
  • Uterine Fibroid Embolization (UFE) a non-surgical treatment that causes the fibroid to shrink 
  • Surgery including myomectomy (surgical removal of the visible fibroids from the wall of the uterus) and hysterectomy (surgical removal of the uterus).

Treatment Option: Uterine Fibroid Embolization

Known medically as uterine artery embolization, this approach to the treatment of fibroids blocks the arteries that supply blood to the fibroids, causing them to shrink. It is a minimally invasive procedure, which means it requires only a tiny nick in the skin, and it is performed while the patient is conscious but sedated.

In the procedure, the interventional radiologist makes a small incision in the skin (less than one-quarter of an inch) in the groin to access the femoral artery and inserts a tiny catheter (tube) into the artery. Local anesthesia is used so the needle puncture is not painful. The catheter is guided through the artery to the uterus, while the radiologist guides the procedure using a moving X-ray (fluoroscopy). The radiologist injects tiny plastic particles the size of grains of sand into the artery supplying blood to the fibroid tumor. This cuts off the blood flow and causes the tumor (or tumors) to shrink. The artery on the other side of the uterus is then treated. The skin puncture where the catheter was inserted is cleaned and covered with a bandage.

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Fibroid embolization usually requires a hospital stay of one night. Pain-killing medications and drugs that control swelling are typically prescribed following the procedure to treat cramping and pain. Fever sometimes occurs after embolization and is usually treated with acetaminophen. Many women resume light activities in a few days, and the majority o women are able to return to normal activities within one week. While embolization to treat uterine fibroids has been performed since 1995, embolization of the arteries in the uterus is not new. It has been used successfully by interventional radiologists for more than 20 years to treat heavy bleeding after childbirth.

Expected Results

Studies show that 78 to 94 percent of women who undergo the procedure experience significant or total relief from heavy bleeding, pain, and other symptoms. The procedure is also effective for multiple fibroids. recurrence of treated fibroids is very rare. In one study in which patients were followed for six years, not one fibroid that had been embolized grew back.

Possible Side Effects and Complications

Fibroid embolization is considered to be a very safe procedure. However, there are some associated risks, as there are with almost any medical procedure. Most women experience moderate to severe pain and cramping in the first several hours following the procedure. Some experience nausea and fever. These symptoms can be controlled with appropriate medications. A small number of patients have experienced infection, which usually can be controlled with antibiotics. It has also been reported that there is a 1 percent chance of injury to the uterus, potentially leading to hysterectomy. These complication rates are lower than those of hysterectomy and myomectomy.
 

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