4:21 PM Abstract No. 311 Preoperative uterine artery embolization may reduce blood loss during hysterectomy for select uterine leiomyomata

Abstract

To determine the effect of preoperative uterine artery embolization (UAE) on blood loss during hysterectomy. A retrospective query of internal databases selected patients who underwent UAE prior to hysterectomy from 2012-2016. Estimated blood loss (EBL) during hysterectomy, as documented by the gynecological surgeon, was compared between patients who received preoperative UAE and a control group of similarly sized uteri from a previously published study of women undergoing hysterectomy alone. An alternative method for measuring blood loss, as calculated using the Gross Equation, was also compared to EBL for study subjects as a secondary outcome. Data was stratified based on uterine weight. Unpaired Student’s t-test calculated the statistically significant relationships between blood loss in patients who received a preoperative UAE and those who underwent hysterectomy alone. 19 patients underwent UAE prior to hysterectomy. There was no significant difference in EBL between the control and the preoperative UAE cohort (427.7 ± 305.0 mL vs. 421.3 ± 400.3 mL; p = 0.929). When stratifying according to uterine weight, hysterectomy of intermediate and small uteri trended toward decreased blood loss when preceded by UAE with EBL of 464.3 ± 285.2 mL vs. 337.5 ± 47.9 mL (p = 0.381) and 387.6 ± 281.4 mL vs. 225.0 ± 311.3 mL (p = 0.137), respectively. There was significantly more blood loss on overall and sub-group analysis when blood loss was estimated using the Gross Equation rather than surgical documentation. Although logical and employed in clinical practice, there is little evidence to date supporting the use of prehysterectomy UAE to decrease blood loss during surgery. While this study is limited by sample size and does not show a significant decrease in EBL with preoperative UAE, it does suggest a benefit for patients with small and intermediate size uteri. Larger uteri may have a highly collateralized blood supply, decreasing the efficacy of embolization on intraoperative hemostasis. Further investigation with higher power and more robust measurements of blood loss should be conducted to more clearly elucidate the benefits of UAE prior to hysterectomy.