Abstract
To prospectively compare the therapeutic effect, pain and inflammatory response after uterine artery embolization (UAE) using nonspherical polyvinyl alcohol (PVA) or tris-acryl gelatin microsphere (TGM). 54 patients were randomized into two groups, PVA group (355-550 μm, n = 27) and TGM group (500-700 μm, n = 27). Both groups received fentanyl-based intravenous patient-controlled analgesia during the 24 hours after UAE and additional analgesics were allowed as needed. Inflammatory responses were assessed by white blood cell count (WBC), neutrophil to lymphocyte count (NLR) and platelet to lymphocyte count (PLR) at 24 hours post UAE. Contrast-enhanced MRI was performed 1 day after UAE to evaluate the necrosis of the predominant fibroids (F1) and degree of ischemia of normal myometrium. Health-related quality of life (HRQOL) and symptom severity score (SSS) were compared before and 3 months after the procedure. There was no significant difference in the clinical outcomes (HRQOL and SSS) 3 months after UAE between two groups. Although pain scores were similar (P >0.999), the amount of additional analgesics was significantly higher in the PVA group (P = 0.0495) The cumulative dose of fentanyl was higher in the PVA group than TMG group without a statistical significance (981 μg versus 858 μg P = 0.492). Inflammatory markers including WBC count, NLR and PLR were significantly higher in the PVA group (P = 0.0462, P = 0.0477 and P = 0.0417, respectively). The rates of complete necrosis of the F1 were not significantly different in both groups (P = 0.671), but the rates of incomplete necrosis of the F1 was higher in the TGM group, which did not reach a statistical significance (14.8% versus 0%, P = 0.111). Severe degree of transient ischemia in the normal myometrium was more common in the PVA group (P = 0.038). There were no significant differences in terms of therapeutic effects and pain after UAE between the two groups. However, in the PVA group, more analgesics were required and higher degree of inflammatory response and severe ischemia in the normal myometrium were provoked. This may suggest that nonspherical PVA (355-550 μm) is associated with more potent embolization effect than TGM.
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