Beckenarterienembolisationen bei
gynäkologischen Blutungen

Zusammenfassung

Gynäkologische Blutungen können schwangerschaftsbedingt sein, oder durch Myome oder maligne Tumore hervorgerufen werden. In allen Fällen ist die Transkatheterembolisation ein effektives therapeutisches Verfahren. Die angewandte Embolisationstechnik hängt von der Ätiologie der Blutung ab. Bei schwangerschaftsbedingten Blutungen ist ein temporärer Embolisationseffekt erwünscht, die Embolisation erfolgt daher mit Spongostan. Bei Myomen und Malignomen wird ein permanenter Embolisationseffekt durch die Verwendung von PVA-Partikeln angestrebt. Der technische und klinische Erfolg der Embolisation liegt unabhängig von der Ätiologie der Blutungen über 90 %. In der Regel wird bei Embolisationen von Myomen und Malignomen ein Postembolisationssyndrom mit Schmerzen und Fieber beobachtet. Diese Symptome bilden sich jedoch meist innerhalb von 2 - 3 Tagen zurück. Bei sorgfältiger Beachtung der angiographischen Technik sowie der Technik der Einschwemmembolisation sind Komplikationen durch ischämische Schädigung gesunder Organstrukturen selten. Bei gynäkologischen Blutungen sollte die Transkatheterembolisation als therapeutische Option stets in Betracht gezogen werden.

Abstract

The most common reasons for gynecological bleeding are pregnancy-related disorders, fibroids of the uterus, and gynecological malignances. Transarterial embolization is an effective treatment modality for gynecological bleeding regardless of its etiology. Depending on the underlying disease, a different technique of embolization is applied. In postpartal bleeding a temporary effect of embolization is desired, therefore gelatine sponge is used as embolizing agent. In fibroids and malignant tumors the effect should permanent, therefore PVA particles are used. Regardless the etiology, the technical and clinical success of transarterial embolization is at least 90 %. In nearly every patient a post-embolization syndrome can be observed, represented by local pain and fever. This post-embolization syndrome usually does not last longer than 3 days. If embolization is performed with meticulous attention to angiographic technique and handling of embolic material, ischemic damage of adjacent organs is rarely observed. Transarterial embolization should be an integrative modality in the treatment of gynecological bleeding.

Schlüsselwörter

Gynäkologische Blutung - Schwangerschaft - Uterusmyom - Malignom - Embolisation

Key words

Gynecological bleeding - Pregnancy - Fibroma - Uterus - Malignancy - Embolization

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