Uterine Fibroid Embolization for the Treatment of Symptomatic Leiomyomata

Maxim Itkin, MD, Richard Shlansky-Goldberg, MD

Disclosures

Appl Radiol. 2002;31(10) 

In This Article

Uterine and Ovarian Artery Anatomy

The main portion of the uterine artery can be divided into three parts.[17] The first part runs close to the lateral pelvic sidewall, the second part runs in the parametrium, and the third part, called the marginal artery, runs along the lateral margin of the uterus toward the uterine horn. The main branches from the uterine artery in the order of their branching are: the ureteric branch supplying the distal portion of the ureter (usually not visible); the cervico-vaginal branch supplying the vagina and cervix; the uterine intramural branches supplying the myometrium; and the terminal fundal branches supplying the fundus. In 9% of cases, the cervico-vaginal branch comes off of the internal iliac. Finally, the medial tubal and ovarian branches arise from the terminal uterine artery. In approximately 10% of cases, the blood to the uterine fundus is supplied by the ovarian arteries. Rarely, the ovarian artery may supply blood to most of or all of the uterus.

Generally the ovarian arteries arise from the ventral surface of the aorta in approximately 83% of cases, usually as a single origin but they may have multiple origins.[18] In 17% of cases, the ovarian arteries may arise from the renal arteries or other pelvic vessels. The blood supply to the ovaries comprises flow from the uterine artery from branches that create a tubal and ovarian arterial arcade and anastomose with the lateral tubal and ovarian branches from the ovarian artery. In 40% of cases, the ovarian artery solely supplies the ovary while there is a shared supply with the uterine artery in 30% of cases. In 10% of patients, the uterine artery is the main supply to the ovaries. The uterine artery supplies the fallopian tube in 60% of patients while there is shared supply in another 56% of cases. In only 4% of cases does the ovarian artery solely supply the fallopian tube.[17,18] Knowledge of these anastomoses is important since they provide for the collateral blood flow that may result in the failure of percutaneous embolization or ovarian nontarget embolization.

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