How about good afternoon. Look, right now we are going to talk a little about uterine embolization in myomatosis because we had a patient who just came from Ensenada when she was 40 years old. Remember: Knowledge is Success.

Look, we must remember, embolization is an invasive but minimally invasive technique, because they insert a catheter through the femoral artery very similar to cardiac catheterizations, they go up the femoral artery and then down through the uterine artery or through the hypogastric branch and reach the uterine, there they inject a contrast medium that has like microspheres and what it does is act as a plugging of the arteries that mainly supply the uterus, which are the uterine arteries, it mainly began to be used ago… 1990 had a lot of boom, without However, today it has some contraindications or some medical prescriptions.

The main or first thing about embolization is that it is a slightly more expensive procedure than surgery and obviously one of its contraindications is the size of the tumors. Why do I explain this? Because we are already seeing patients with fibroids larger than 14, 15 centimeters and with uteruses above the umbilical scar, let’s say that the umbilical scar is one of the limits for whether to perform an embolization or not. It also has a lot to do with whether they are one fibroid or multiple fibroids, whether it is subserous, intramural or submucosal. Generally the submucosal ones, since it is better to use stereoscopic means, the subserosal ones are not highly recommended, especially when you have a slightly large pedicle, two centimeters in diameter, and the intramural ones in single fibroids may work, but when they are multiple fibroids, no, sometimes they don’t. They are doing so well. What could be the contraindications for embolization?

Mainly if they are multiple fibroids and they range from medium to large elements.
2: Women who want fertility, that is, assisted reproduction, which is our forte here at Creafam.
3 obviously the patient believes that by doing the embolization that fibroid is going to disappear or disintegrate, no, the fibroid if you have an 8 centimeter fibroid to do the embolization the irrigation is reduced by perhaps 80% and momentarily there will be an improvement in both bleeding and discomfort, but as time passes, if 5, 6, 7 years pass, that fibroid continues to be nourished, a little, but it continues to be nourished by accessory vessels to the uterus or by collateral branches. and then it will start to grow again and cause problems

As in the case of this patient who underwent embolization, the first year she improved a lot but then she began to have an increase in the volume of her uterus again and also intermenstrual bleeding and hemorrhages, and then her main problem was also that she began with a little anemia. What is the main indication for embolization? Well, in women, preferably young women with a single intramural fibroid, smaller than 10-12 centimeters and/or who no longer desire assisted reproduction.

But in patients who do not have pregnancies (Nuligestas) and with a desire for fertility under 40 years of age, the ideal from my point of view is an open myomectomy and obviously orienting it later to the reproductive issue. So look, this little patient came here ago… In February, I did the ultrasound and you can see how clearly the fibroid looks because it is well delimited on the periphery by a dense, slightly hypoechoic area, which we call calcified. She already measured the tumor 78 mm by 75 mm and in the cross section it was a small tumor of 87 millimeters, but she already had metrorrhagias and bleeding, so it was really bothering her. There is a second very small fibroid that we also removed and you will see it, see this little one also looks slightly calcified. At the time of performing the surgery, that fibroid on the outside was like an eggshell as it was, that is, it was completely petrified, calcified, solid, and on the inside it had some areas of necrosis or degeneration, but that fibroid was still bleeding and obviously well. irrigated.

Let’s talk to you, this is a 40-year-old patient who came to see me about 4 months ago, I think, she comes from Baja California, she has a large intramural fibroid but the peculiarity of this patient is that she already had an embolization done six years ago. , four years ago, for large element myoma. It partially worked for her because after a year she felt very well but then she continued to grow, she continued to have discomfort and so now we are going to remove the fibroid through an open myomectomy. We must remember that embolization is not all patients are candidates and we must see the prognosis and especially the age and what it is for; whether fertility or not, because it is not always the most appropriate in the first instance. See, we are morcellating it but we wanted to show you so you can see a little…

Practically this superficial crust is pure calcium, so that is what often leaves a sequel, because this is soft, the tissue is half necrotic but the outside is completely calcified and it is even very difficult, look how the heat does not penetrate, you have to give it like holes to make a kind of fracture on the superficial shell of that bark, because that bark is completely calcified, so what is the risk of this? There is no good differentiation and everything that is the connective muscle tissue of the vessels of the uterus adheres a lot to the fibroid and sometimes it is a little more bleeding. Look, we have already finished the large fibroid, see the difference between this thing that is like an eggshell and the necrotic tissue, it is not a fibroid that looks like this, see this one is just beginning to calcify, but this is a whiter fibroid. less, there pearly and we end up with this myomite and that’s it. Look closely, here we have the right ovary that looks very good, it has a little endometriosis.

In the part down here… I’m going to remove the vacuum cleaner so it doesn’t make so much noise, look how thick the round ligament is, which is this part here, it’s thick and here is the right fallopian tube. She is already 40 years old and is going to undergo an in vitro technique, but if she wanted to show you that she has her endometrosis, the ovary was a little fixed, here was the lesion, see where we removed the fibroid. This is the fibroid that was on the anterior surface, right horn and the intramural fibroid, this is the incision that was left, it is a uterus that is large and over here we have the left tube, see the vein there, fimbria, very good and its ovary, for 40 years old you have very good ovaries.

So this patient, fortunately, although she comes from Ensenada, already commented that we surely hope to have a testimonial from her, but after the surgery or the embolization that was six years ago she had not been able to get pregnant and also since she started having metrorrhagias she came to us, He is going to follow up here at Creafam, as the surgery was a little big, obviously we have to wait four months or so, but then look for pregnancy. Here the most important thing is no longer the surgery as such, or the history but that she is already 40 so we have to do a treatment faster, it will surely be an in vitro fertilization technique, but in 6 months if everything goes well she will being pregnant, after six years ago she began treating fibroids and wanting to get pregnant.