Abstract
PurposeTo study the therapeutic effects of uterine artery embolization (UAE) on adenomyosis and to investigate the association between uterine blood supply and artery embolization treatment outcomes.MethodsUsing digital subtraction angiography (DSA) imaging data, we retrospectively evaluated the vascular features of 252 adenomyosis patients treated with UAE. The cases were classified based on the equality of uterine blood supply (equal and unequal subgroups) and the degree of vascularity at the adenomyosis lesion site (hypervascular, isovascular and hypovascular subgroups). Patients were followed-up for 5 years after UAE. Improvements in dysmenorrhea and menorrhagia were evaluated based on the relief of the patients’ symptoms. The improvement rates among the different subgroups were analyzed and compared.ResultsThe improvement rates of dysmenorrhea and menorrhagia were 74.0% and 70.9%, respectively, at the short-term (12-month) follow-up and 70.4% and 68.8%, respectively, at the long-term (5-year) follow-up. No statistically significant differences were observed in the improvement rates for dysmenorrhea or menorrhagia between the equal and unequal blood supply subgroups at either the short- or long-term follow-up. The improvement rates for dysmenorrhea among the hypervascular, isovascular and hypovascular subgroups were 86.5%, 71.8% and 58.8%, respectively, at the short-term follow-up (p = 0.002) and 83.6%, 67.3% and 52.8%, respectively, at the long-term follow-up (p = 0.005). The improvement rates for menorrhagia in the hypervascular, isovascular and hypovascular subgroups were 81.0%, 68.3% and 60.7%, respectively, at the short-term follow-up (p = 0.024) and 79.4%, 61.4% and 62.2%, respectively, at the long-term follow-up (p = 0.052).ConclusionUAE is effective in treating patients with adenomyosis in both the short and long term. The outcomes of patients with adenomyosis were significantly correlated with lesion vascularity.
Highlights
Adenomyosis is a common gynecological condition characterized by the diffuse or local growth of endometrial glandular tissue, which invades the muscular layer of the uterus
The improvement rates of dysmenorrhea and menorrhagia were 74.0% and 70.9%, respectively, at the short-term (12-month) follow-up and 70.4% and 68.8%, respectively, at the long-term (5-year) follow-up
No statistically significant differences were observed in the improvement rates for dysmenorrhea or menorrhagia between the equal and unequal blood supply subgroups at either the short- or long-term follow-up
Summary
Adenomyosis is a common gynecological condition characterized by the diffuse or local growth of endometrial glandular tissue, which invades the muscular layer of the uterus. Since 2001, when Siskin reported using UAE to treat 15 patients with adenomyosis [4], it has been tested by different institutions and determined to be an effective treatment for adenomyosis, in patients who are resistant to routine medicine therapy and those who wish to preserve their uterus [5,6,7,8,9,10,11,12,13,14,15,16,17] In this vascular imaging-guided procedure, a gynecologist or interventional radiologist uses a catheter to deliver small particles to block the blood supply to targeted lesions, which are selected based on the diameter of the uterine artery and the degree of blood supply to the lesion. It is necessary to validate the efficacy of UAE in larger patient populations and with longer follow-up periods and to identify the factors that can predict the therapeutic effects and facilitate decision-making for both trained gynecologists and patients
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