*2.1.3.5 Imaging evaluation*

MRI examination, ultrasonography, CT, and other assessments, which perform the planning of the surgical approach and reduce the blindness of the procedure, can improve the success rate of surgery. By contrast, most studies recommend MRI as the main preoperative evaluation method.

### *2.1.4 Operating process of UAE*

The patient was placed in supine position. Routine disinfection and draping were performed. After local anesthesia, the right femoral artery was punctured by Seldinger method. The catheter sheath was placed. A 5F Cobra catheter was inserted into the opening of bilateral uterine arteries for DSA. The dosage of contrast medium on each side was 6 ml and the flow rate was 2 ml/s. The uterus was significantly enlarged, the uterine artery was significantly thickened and tortuous, and the staining in the uterus was thickened. If there was uterine fibroids, the angiography showed the presence of "holding ball" abnormal vascular mass. The 3F microcatheter was used to superselect to the distal end of the main uterine artery, avoiding the ovarian artery. The uterine artery was embolized with embolic agent. The DSA was reexamined. The abnormal staining of the uterus disappeared, and the main uterine artery was retained. The operation could be ended.

## *2.1.4.1 Selection of embolic agent*

There are many embolization agents available for UAE. Generally, particle embolization agents are selected. Generally, they can be divided into absorbable and non-absorbable. Absorbable embolization agents are represented by gelatin sponge particles, and non-absorbable embolization agents are represented by polyvinyl alcohol embolization microspheres (embosphere). However, the commonly used embolic agents of other organs, such as steel ring, absolute ethanol, and super-liquid iodized oil, are not recommended for use in UAE. For the selection of embolic agent particle size, "sandwich embolization" should be used for embolization of uterine adenomyosis due to the small inner vascular network. First, particles with a diameter of 100–300 μm are selected for embolization of the inner vascular network, particles with a diameter of 300–500 μm are used for embolization of the outer vascular network, and finally particles with a diameter of 500–700 μm are used for trunk embolization [11]. The effect of arterial embolization is inversely proportional to the embolic agent particle size.

### *2.1.4.2 Degree of embolism*

Embolization is divided into two types: complete embolization and incomplete embolization. Patients with uterine adenomyosis require complete embolization of the inner vascular network of the uterus, and in DSA, imaging findings show complete disappearance of focal staining, visualization of the main trunk of the uterine artery, retention of contrast agent, and no clearance of contrast agent in five cardiac cycles.

**109**

surgical repair.

*Interventional Treatment of Endometriosis DOI: http://dx.doi.org/10.5772/intechopen.93054*

*2.1.5 Postoperative management of UAE*

*2.1.6 Complications of UAE*

treatment.

*2.1.6.1 Intraoperative complications*

encountered, homeopathic.

as secondary infection and thrombosis.

fever, and antibiotic treatment is usually not required.

*2.1.6.2 Postoperative complications*

For hemostasis by compression at the puncture site, the lower limbs were immobilized for 6 h. If a vascular sealer was used, the immobilization time could be shortened. After operation, it is necessary to observe the skin color and skin temperature of lower limbs, ask the dorsalis pedis artery pulse and mark it, and make regular observation to prevent thrombosis. Antibiotics were not routinely applied postoperatively.

1.Local bleeding or hematoma: bleeding or hematoma at the puncture site is a more common complication, and severe cases can cause large pelvic retroperitoneal hematoma. Hemostasis by compression was given for symptomatic

2.Arterial spasm: repeated stimulation of blood vessels or long operation time during surgery may cause arterial spasm, cause limb numbness and pain, affect intraoperative operation, and in severe cases, lead to limb ischemic necrosis. Analgesic drugs can be used to relieve pain and intraoperative

3.Arterial puncture injury: although arterial puncture injury caused by improper operation or traumatic operation is rare during the operation, because the pelvic artery is located in the retroperitoneum, once it occurs, it will be difficult to compress and stop bleeding, which can form retroperitoneal hematoma. Failure to timely detect it will threaten the patient's life and require emergency laparotomy for hemostasis. Therefore, intraoperative manipulation should be gentle, and the direction of the vessel should be identified when resistance is

1.Pain: almost all patients experience pain after surgery. At present, it is believed that pain is associated with ischemia of the lesion and uterus after UAE. The degree of pain varies from mild to severe colic. Analgesic methods depend on the severity of pain and preemptive non-steroidal anti-inflammatory drugs, patient-controlled analgesia, oral or parenteral administration of opioids using analgesic pumps are optional. The duration of pain varies and is generally gradually relieved 2 to 5 days after surgery. If the pain is more than 1 week and more severe, we should be alert to the possibility of serious complications such

2.Post-embolization syndrome: post-embolization syndrome is characterized by pelvic pain, nausea, vomiting, fever, fatigue, myalgia, discomfort, and leukocytosis. Most of them occurred within 24 h after surgery and gradually improved within 7 days. It is a common postoperative complication. Postoperative fever is generally no higher than 38°C, which is postoperative absorption

3.Arterial rupture or arterial dissection: it is a serious complication and requires

application of 2% lidocaine 5 ml local intra-arterial injection.
