Technical Guidelines

Guidelines for the Use of Bead Block® in Uterine Fibroid Embolisation

Patient Selection

  • Women with symptomatic fibroids who have not responded to hormonal treatment
  • Contraindications
  • Pedunculated fibroids
  • Desire for fertility
  • Carcinoma of pelvic organs
  • Previous pelvic irradiation
  • Bleeding diathesis and vasculitis
  • History of allergy to contrast medium

Product Selection

  • Bead Block® size and volume
  • 700-900μm increasing the microsphere size to 900-1200μm after 6ml if desired endpoint is not reached

Technique Selection

Addition of contrast medium

  • Directly aspirate 5ml non-ionic contrast media into the Bead Block® (700-900μm) syringe to obtain an approximate 50% contrast 50% saline solution mix
  • Gently invert the 20ml syringe and wait several minutes to allow the Bead Block® microspheres to evenly suspend. Draw the Bead Block® microspheres/contrast solution into the injection syringe slowly and gently to minimise the potential of introducing air into the system. Purge all air from the system prior to injection

Catheter position

  • The embolic agent is delivered via a catheter placed in the uterine artery under fluoroscopic guidance.  

Technique Selection continued

Administration

  • Inject the 700-900mm Bead Block® microspheres/contrast solution from the injectionsyringe under fluoroscopic visualisation using a slow pulsatile action whilst observing the contrast flow rate
  • If there is no effect on the flow rate, repeat the delivery process with additionalinjections of Bead Block® increasing the microsphere size to 900-1200μm after 6ml if desired endpoint is not reached

End point

  • The angiographic end-point is described as near-stasis in the uterine artery withsluggish antegrade flow in the horizontal segment of the uterine artery
  • Neither the ascending part nor uterine side branches should remain open
  • In order to avoid a false endpoint with early recanalisation wait 5 minutes and reconfirm the end point angiographically. If there has been any settling of the microspheres then additional Bead Block® can be injected