Long-term effects of uterine artery embolization caused by the embolic material

Abstract

Background and objectives. Uterine artery embolization (UAE), or uterine fibroid embolization (EFM), a technique introduced in the conservative treatment of uterine fibroids in the 1990s, has been increasingly used in the last decades. The data accumulated in time revealed also, besides the expected benefits, some undesirable complications, initially unanticipated. The study aims at analyzing the histological changes of myometrium occurred after uterine artery embolization for fibroids. Materials and method. Presentation of a series of three cases that have undergone gynecologic surgery in the Bucur Maternity of the “Sf. Ioan” Emergency Clinical Hospital, Bucharest, after the embolization of the uterine arteries performed (in the past) for fibroids. Results. In two of the three cases presented, it was practiced hysterectomy with bilateral anexectomy and in one case myometrectomy. At the histopathological examination, what was proven to be specific for the long-term effects of UAE was the thickening of vascular structures containing intraluminal amorphous material, with vascular and perivascular infiltration with giant multinucleated histiocytes around the foreign body. This histological aspect corresponds to a nonspecific granulomatous inflammation with giant cells. Conclusions. Embolization of the uterine arteries may cause a giant-cell type inflammation at the level of the myometrium and fibrosis, and this type of changes could be the cause of a poor prognosis for women who want a future pregnancy.