P14.01: Evaluation of intramural fibroid vascularisation after uterine artery embolisation by 3D power Doppler ultrasound

Abstract

The popularity of minimally invasive techniques for the treatment of symptomatic uterine fibroids as an alternative to surgical procedures is increasing. The most widely used procedure of this type is uterine artery embolisation (UAE). During UAE embolic material is administered into bilateral uterine arteries to reduce the tumour's blood supply. This results in necrosis, fibroid volume reduction and relief of symptoms. In some cases tumour regrowth and recurrence of clinical symptoms after UAE are observed, due to fibroid revascularisation. In this study uterine fibroid vascularisation changes after UAE were analysed during a 3 months follow-up period. 64 premenopausal patients with symptomatic intramural fibroids qualified for UAE in the 3rd Chair and Department of Gynecology, Medical University of Lublin, were included in the study. Dominant fibroid vascularisation was evaluated before UAE, 24 hours and 3 months after UAE using the VOCAL technique by calculating the vascular-flow index (VFI). Data were analysed using the repeated measures ANOVA with the post hoc Fisher's test. P values below 0,05 were considered significant. Mean fibroid VFI before UAE was estimated at 0,85 (±0,11 SE), 24 hours after UAE at 0,03 (±0,01 SE), and after 3 months at 0,08 (±0,02 SE). Analysis of variance showed a significant (p <0.0001) effect of time after UAE on the vascularisation of uterine fibroids. A post hoc analysis showed that the fibroid VFI's assessed after 24 hours and 3 months after UAE were significantly lower than before UAE (p <0,0001). Fibroid VFI assessed 24 hours after UAE was not significantly different from VFI 3 months after UAE (p = 0.62). Statistically significant fibroid vascular-flow index reduction was observed at 24 hours after UAE. Three months after UAE this effect was maintained, with an insignificant increase of VFI between 24 hours and 3 months post UAE.