Outcomes Of Uterine Artery Embolization Research Articles

Long-term outcomes of uterine artery embolization in patients with early hypotonic postpartum hemorrhage

Introduction. Obstetric haemorrhage remains the number one cause of maternal death globally. Today, the frequency of hypotonic postpartum hemorrhage (PPH) reaches 80% in the obstetric hemorrhage profile.Objective. To evaluate the long-term outcomes of uterine artery embolization (UAE) for the treatment of early hypotonic postpartum hemorrhage (PPH).Material and methods. 136 patients were examined 2–8 years after UAE performed for early hypotonic postpartum hemorrhage. A survey was conducted for everyone. Ultrasound of the pelvic organs on the 5th–7th day of the menstrual cycle with an assessment of endometrial thickness, ovarian volume, number of antral follicles, and also Dopplerography were performed in 34 patients. Hormonal status was studied in 34 patients, that were examined in the first phase of the menstrual cycle, with an assessment of serum levels of anti-Mullerian hormone (AMH), follicle-stimulating (FSH) and luteinizing (LH) hormones.Results. 19.1% (26/136) of patients planned pregnancy. Pregnancy occurred in 61.5% (16/26). Term delivery occurred in 38.5% (10/26), PPH recurrence occurred in 30% (3/10), placenta accretion was not detected. 23.1% (6/26) patients were pregnant at the time of the survey. Neither morphological nor functional changes of the ovaries were detected in patients 2–8 years after UAE.Conclusions. Uterine artery embolization is a safe method of therapy of early hypotonic postpartum hemorrhage.

Efficacy of uterine artery embolization (UAE) for uterine fibroids according to FIGO classification: a single-center experience.

This study aims to retrospectively evaluate the outcomes of uterine artery embolization (UAE) for uterine fibroids (UFs), specifically submucosal UFs, according to the International Federation ofGynecologyand Obstetrics (FIGO) classification of UFs. Forty-two patients with symptomatic UFs underwent UAE with Embosphere® between July 2016 and November 2021. MRI was performed before, at 3and 6months after the UAE. At each examination, the volume of UF was measured, and the percentage volume reduction rate (VRR) was calculated. The technical success rate (TSR), symptom improvement rate (SIR), regrowth rate (RR) after 6months, and adverse events (AEs) were examined; VRR was compared between patients with submucosal UFs (FIGO types 0-2, group A), those with submucosal contacts (FIGO type 3, group B), and those without submucosal UFs (FIGO types 4-7, group C). Statistical analysis was performed on the difference in VRR between groups A, B, and C at 3 and 6months after UAE. The relationship with hormone levels before UAE and VRR was evaluated. Thirty-seven of the 42 patients were evaluated. Overall, VRR was 37.0% at 3months and 52.1% at 6months; TSR, SIR, and RR were 100%, 95.2%, and 5.4%, respectively; VRR at 6months was 80.7% for group A (n = 7), 57.8% for group B (n = 13), and 37.1% for group C (n = 17). Significant differences were found between A and C (p < 0.001) and B and C (p = 0.023). Hormone levels before UAE had no effect on VRR. There was no significant AEs other than grade 3 pulmonary embolism in one patient. UAE was effective for submucosal FIGO types 0-3. UAE was especially useful as an option for FIGO type 3 with a low protrusion rate that is difficult to treat with transcervical resection.

Contrast-Enhanced Ultrasound and High Sensitive Doppler for Monitoring Outcomes of Uterine Artery Embolization

To monitor fibroid microvascularity using contrast-enhanced ultrasound (CEUS) and a new high-sensitive Doppler mode (SMI) for assessment of uterine artery embolization (UAE) outcomes. Forty women with symptomatic uterine fibroids scheduled for UAE were enrolled in this Institutional Review Board-approved study. Subjects underwent three examinations (day 0, 15, and 90 post-UAE) with Color Doppler (CDI), power Doppler (PDI), color and monochrome SMI (cSMI and mSMI), and CEUS imaging of the fibroids. Clips were assessed by two radiologists classifying fibroids based on their vascularity. Fibroid fractional vascularity (FV; % of enhanced pixels within the fibroid) and flow intensity (as mean brightness level of the enhanced pixels) were quantified. Results were analyzed using repeated measures ANOVA and nonparametric Wilcoxon sign rank tests. Inter-reader agreement was assessed with κ-values. There was overall agreement between readers for all imaging modalities and examination times (P=.25; κ=0.70). The FV analysis showed statistically significant differences between CEUS and the Doppler imaging modes (CDI, PDI, cSMI, and mSMI) for the three examination times were compared (P<.0001). The comparison using CDI, PDI, and cSMI showed no statistically significant difference (P=.53). The flow intensity analysis comparison between the Doppler imaging modes (CDI, PDI, cSMI and mSMI) and examination times showed statistically significant differences between all the Doppler imaging modalities (P=.02), except for the 90days post-UAE (P=.34). When the comparison was made for CDI, PDI, and cSMI there was no statistically significant differences (P<.47). CEUS and SMI can accurately evaluate fibroid microvascularity, and therefore, can be a noninvasive and accurate method for monitoring outcomes following UAE treatment.

Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids of Different Sizes: A Single Center Experience.

The present study aimed to evaluate the clinical and radiological 1-year outcomes of uterine artery embolization (UAE) performed in a selected population of women with symptomatic myomas and who do not wish to conceive. Between January 2004 and January 2018, a total of 62 patients with pre-menopausal status and with no wish to conceive in the future underwent UAE for the treatment of symptomatic fibroids. All the patients underwent magnetic resonance imaging (MRI) and/or transvaginal ultrasonography (TV-US) before and after the procedure at 1-year follow-up. Clinical and radiological parameters were recorded, stratifying the population into 3 groups according to the size of the dominant myoma (group 1: <50 mm; group 2: ≥50 and ≤80 mm; group 3: >80 mm). Mean fibroid diameter was significantly reduced (42.6% ± 21.6%) at 1-year follow-up, with excellent improvements in terms of both symptoms and quality of life. No significant difference was observed regarding baseline dimension and the number of myomas. No major complications were reported (2.5%). The present study confirms the safety and efficacy of UAE in the treatment of symptomatic fibroids in pre-menopausal women with no desire to conceive.

Short-term outcomes of uterine artery embolization for urgent or emergent abnormal uterine bleeding.

To evaluate the outcomes of uterine artery embolization (UAE) for patients with urgent or emergent abnormal uterine bleeding (AUB). Retrospective review of all patients from 1/2009-12/2020 who were treated urgently or emergentlywith UAE for AUB. Urgent and emergent cases were defined as those requiring inpatient admissions. Demographic data were collected for each patient including hospitalizations related to bleeding and length of stay (LOS) for each hospitalization. Hemostatic interventions other than UAE were collected. Hematologic data were collected before and after UAE including hemoglobin, hematocrit, and transfusion products. Data specific to the UAE procedure included complication rates, 30-day readmission, 30-day mortality, embolic agent, site of embolization, radiation dose, and procedure time. 52 patients (median age: 39) underwent 54 urgent or emergent UAE procedures. The most common indications for UAE were malignancy (28.8%), post-partum hemorrhage (21.2%), fibroids (15.4%), vascular anomalies (15.4%), and post-operative bleeding (9.6%). There were no procedure-related complications. Following UAE, 44 patients (84.6%) achieved clinical success and required no additional intervention. Packed red blood cell transfusion decreased from a mean of 5.7 to 1.7 units (p < 0.0001). Fresh frozen plasma transfusion decreased from a mean of 1.8 to 0.48 units (p = 0.012). 50% of patients received a transfusion prior to UAE, while only 15.4% were transfused post-procedure (p = 0.0001). Emergent or urgent UAE is a safe and effective procedure to control AUB hemorrhage secondary to a variety of etiologies.

Uterine artery embolization for postpartum hemorrhage with placenta accreta spectrum.

The reported success rate of uterine artery embolization (UAE) for postpartum hemorrhage (PPH) differs by the cause of bleeding; in some reports, UAE shows less successful results in patients with placenta accreta spectrum (PAS). To evaluate the outcome of UAE for treating PPH associated with PAS. From September 2011 to September 2021, 227 patients (mean age = 34.67±4.06 years; age range = 19-47 years) underwent UAE for managing intractable PPH. Patients were divided into two groups: those with PAS (n = 46) and those without PAS (n = 181). Delivery details, embolization details, and procedure-related outcomes were compared between the two groups. P values <0.05 were considered statistically significant. The technical success rate was 96.9% (n = 222) and the clinical success rate was 93.8% (n = 215). There were no significant differences in outcome of UAE between the two patient groups. The technical success rate was 95.7% (n = 44) in patients with PAS and 98.3% (n = 178) in patients without PAS (P = 0.267). The clinical success rate was 91.3% (n = 42) in patients with PAS and 95.6% (n = 173) in patients without PAS (P = 0.269). There were 24 cases of immediate complications, including pelvic pain (n = 20), urticaria (n = 3), and puncture site hematoma (n = 1). No major complication was reported. UAE is a safe and effective method to control intractable PPH for patients with or without PAS.

Abstract No. 146 Effect of Embolic Particle Size on Outcomes of Uterine Artery Embolization for Mixed Adenomyosis/Fibroids: Are Smaller Particles Needed?

Abstract No. 146 Effect of Embolic Particle Size on Outcomes of Uterine Artery Embolization for Mixed Adenomyosis/Fibroids: Are Smaller Particles Needed?

Recurrent postpartum hemorrhage at subsequent pregnancy in patients with prior uterine artery embolization: angiographic findings and outcomes of repeat embolization.

To evaluate angiographic findings and outcomes of uterine artery embolization (UAE) for recurrent postpartum hemorrhage (PPH) in a subsequent pregnancy in patients with a history of prior UAE. Between March 2004 and February 2021, UAE was performed for PPH with gelatin sponge slurry in 753 patients. Among these, 13 underwent repeat UAE for recurrent PPH after subsequent delivery. The causes of PPH, angiographic findings, hemostasis, and adverse events were evaluated. The causes of recurrent PPH included retained placental tissue (n = 9) and uterine atony (n = 4). On angiography, unilateral or bilateral uterine arteries were obliterated due to prior UAE in 10 patients (76.9%). The uterine collateral vessels were embolized (anterior division of the internal iliac artery [n = 10], round ligament [n = 5], and ovarian [n = 4] artery). In the remaining three patients with recanalized or patent (not embolized at prior UAE) uterine arteries, both uterine arteries were embolized. Immediate hemostasis was achieved in nine patients (69.2%). The remaining four patients (30.8%) with obliterated uterine arteries required hysterectomy. There were three mild adverse events (pelvic pain [n = 2] and fever [n = 1]). UAE with gelatin sponge slurry frequently causes permanent uterine artery obliteration. In cases of recurrent PPH occurring in subsequent pregnancy, repeat UAE may be less likely to achieve hemostasis (69.2%). 1. UAE with gelatin sponge slurry frequently caused permanent uterine artery obliteration.2. In recurrent PPH occurring in subsequent pregnancy, the repeat UAE may be less likely to achieve hemostasis than initial UAE.

Clinical outcomes of uterine artery embolization and experience of postoperative transvaginal fibroid expulsion: a retrospective analysis.

To explore the efficacy of uterine artery embolization (UAE) in the treatment of uterine fibroid and share the experience of transvaginal fibroid expulsion (FE) after UAE. We retrospectively analyzed the changes in uterine and fibroid volume in 152 patients with symptomatic uterine fibroid after UAE at Fujian Provincial Hospital and Fujian Longyan People Hospital from March 2014 to March 2020. After a 12-month follow-up, the improvement in postoperative clinical symptoms and the incidence of complications were evaluated. We also shared the clinical features and imaging findings of four patients with FE after UAE. All 152 patients successfully underwent UAE. After a 12-month follow-up, the postoperative volumes of the uterus and fibroid at 3, 6, and 12months were significantly reduced or disappeared compared to those before surgery (P < 0.05). Clinical symptoms, such as menorrhagia, dysmenorrhea, prolonged menstrual period, anemia, increased leucorrhea, pelvic discomfort, and urinary tract compression, were significantly improved after UAE. Among the 152 patients, the incidences of postoperative fever, nausea, vomiting, lower abdominal pain, and increased vaginal secretion were 7.89%, 7.24%, 3.95%, 19.08%, and 4.61%, respectively. Additionally, there were six cases of FE, with an incidence of 3.95%. Three cases of fibroid specimens and pathological images of fibroid biopsy, which were expelled through the vagina, were also provided. UAE is a satisfactory alternative surgical method for symptomatic uterine fibroid with definitive efficacy and high safety. However, it is necessary to guard against the occurrence of postoperative complications such as FE.

Uterine Fibroid Embolization in a Series of Women Older Than 50 Years: An Observational Study.

Objective: Women older than 50 years, and in particular postmenopausal, are not usually considered candidate for uterine artery embolization (UAE). We reviewed the outcome of UAE in a series of women older than 50 years, who presented with different symptoms of uterus enlargement.Population: Women referred to the radiologist from gynecologists in the United Kingdom with minimal age over 50 years.Methods: This is a retrospective observational study. The clinical criteria are women older than 50 years with symptoms related to large fibroids affecting their quality of life, who underwent UAE over a 4-year period at Royal Surrey Foundation Trust Hospital and London Clinic between 2012 and 2016. We retrieved the information from the patients' hospital notes and respective images, including magnetic resonance and ultrasound of the pelvis, and from questionnaires and telephone reviews.Main Outcome Measures: We measured the reduction of uterine size, complications, and overall satisfaction of patients.Results: The overall reduction of uterine size 8 weeks following UAE was between 50% and 64% in 12 out of 23 patients. Thirty-five percent of patients (8/23) experienced a reduction of over 65% of overall uterine volume. Only on 2 occasions, the reduction was below 50%. We asked the patients if they would recommend this operation. Twenty out of 23 would recommend it. Improvement of symptoms was measured with a scale between 0 and 5. Twelve out of 23 had total resolution of symptoms—no change in 1 case. One patient underwent a hysterectomy as symptoms persisted.Conclusions: In our series of women older than 50 years, UAE was an effective alternative to surgery, with reduction in fibroid size and improvement of symptoms.

Nomogram for predicting the long-term outcomes of uterine artery embolization for adenomyosis

ObjectiveThe present study aimed to develop a nomogram to predict long-term outcomes of uterine artery embolisation (UAE) for treating adenomyosis. Materials and methodsWe reviewed data of 221 patients with adenomyosis who underwent UAE between May 2016 and January 2018. Predictive factors were identified using multivariate logistic regression analysis. A nomogram to predict the outcome of UAE was created for the training set. The performance of the predictive model was assessed by discrimination (quantified using the area under the curve, AUC) and calibration (evaluated by calibration curves and Hosmer–Lemeshow test) internally within the training set. Finally, an independent external validation was conducted using the validation set. ResultsIn total, 201 patients were included. In the training set (n = 137), 96 (70.1%) exhibited a good response (GR), and 41 (39.9%) showed a poor response (PR). In the validation set (n = 64), 44 (68.7%) showed GR and 20 (31.3%) showed PR. The dysmenorrhoea score, T2 signal type, CA125, apparent diffusion coefficient, accompanying endometriosis, and accompanying fibroids were identified as associated factors and used in the nomogram. The AUC of the nomogram was 0.800 (95% confidence interval [CI] 0.724–0.877) and 0.798 (95% CI 0.686–0.909) in the training and validation sets, respectively. The calibration curves and Hosmer–Lemeshow test showed optimal agreement between predicted and actual probabilities (training set: P = 0.754; validation set: P = 0.453). ConclusionsWe developed a nomogram that could predict the outcome of UAE in patients with adenomyosis. This model has the potential to select patients for UAE.

Uterine Artery Embolization with Small-Sized Particles for the Treatment of Symptomatic Adenomyosis: A 42-Month Clinical Follow-Up

PurposeTo assess the long-term outcome of performing uterine artery embolization (UAE) using small particles in women with symptomatic adenomyosis (AD).MethodsTwenty-seven consecutive women (median age 42 years, range 29–53 years) with AD, in eight cases AD combined with fibroids, who underwent UAE between February 2015 and January 2019, were retrospectively analyzed. The embolization was performed using small-sized polyvinyl alcohol particles (100 μm and 300 μm). The patients completed the Uterine Fibroid Symptom and Quality of Life questionnaire at baseline and at a 42-month follow-up (range 24–71). The junction zone (JZ) thickness and uterine volume were also calculated at baseline and at a three-month follow-up.ResultsThe total symptom severity score (SSS) decreased from a median of 59 (range 34–78) at baseline to a median of 9 (range 3–47) at the end of this study; the health-related quality of life score (HRQOL) increased from a median of 38 (range 23–49) at baseline to a median of 84 (range 46–97) at 42 months. Twenty of the 27 patients were asymptomatic. The clinical response of the remaining seven women was little improvement in their symptoms, and one of the seven women underwent a hysterectomy at 35 months. Twenty-six of the 27 (96%) patients had a preserved uterus at the 42-month follow-up. There was no difference after UAE in SSS, HRQOL, junction zone (JZ) thickness, and uterus volume between patients with pure AD and those with AD combined with fibroids (p = 0.729, 0.710, 0.973, and > 0.99). There was no difference in the JZ thickness and uterus volume at baseline between the asymptomatic women and the women with an insufficient response (p = 0.854 and 0.253), and there were no major complications afterwards.ConclusionFrom the long-term follow-ups, it could be seen that UAE using small particles is safe and effective in treating AD, especially in preserving the uterus. There is no relationship between the clinical outcomes and the initial presence of AD, with or without fibroids, and the JZ thickness at baseline does not seem to be a predictor for the long-term outcome of UAE.

Clinical investigation of fertility after uterine artery embolization

Uterine artery embolization is an effective and safe technique for the treatment of uterine fibroids, but its use remains controversial for women who wish to procreate. This study aimed to study the clinical, anatomic, and obstetrical results of uterine artery embolization in patients of childbearing age not eligible for myomectomy. This was a retrospective cohort study of 398 female patients under the age of 43 years who were treated by uterine artery embolization between 2003 and 2017 for symptomatic fibroids and/or adenomyosis. Uterine artery embolization was performed according to a standardized procedure (fertility-sparing uterine artery embolization technique), with ovarian protection in the event of dangerous utero-ovarian anastomosis. Magnetic resonance imaging and pelvic ultrasounds were performed before and after uterine artery embolization. The overall clinical success rate (ie, resolution of preembolization symptoms such as heavy menstrual bleeding, iron-deficiency anemia, pelvic pressure) was 91.2%, and there were no major complications. One year after uterine artery embolization, we observed a mean 73% reduction in myoma volume. A total of 108 patients (49.3%) presented with dangerous utero-ovarian anastomosis and 33 (14.5%) benefited from ovarian protection. In our group, there were 148 pregnancies and 109 live births; 74 children were born at term; 23 were born preterm, on average at 35.12±2.78 weeks. Including preterm births, the mean birthweight and birth length of the children were within normal limits. Restoration of uterine anatomy and ovarian protection were identified as the main predictive factors for obstetrical success. Restoration was also a major predictive factor for clinical success and was associated with a lower rate of miscarriage. This study provided detailed clinical and obstetrical outcomes for 398 female patients who underwent uterine artery embolization for fibroid treatment; it contributes to the identification of anatomic and technical factors that could have an impact on fertility after uterine artery embolization. Further controlled clinical trials are needed to confirm our findings and reevaluate this procedure's indications and limitations for women with a desire to procreate.

Timing of Uterine Artery Embolization for Leiomyoma during the Menstrual Cycle

PurposeTo investigate differences in outcomes of uterine artery embolization (UAE) for leiomyoma when performed during different phases of the menstrual cycle. Materials and MethodsIn this single-institution retrospective analysis, 111 premenopausal patients (median [range] age, 44 [33–52] years) undergoing UAE for symptomatic leiomyoma between June 2014 and February 2020 were included. Twenty-one patients underwent UAE in the menstrual phase (the early follicular phase), 27 in the late follicular phase, and 63 in the luteal phase. Baseline characteristics and technical and peri-procedural outcomes were compared among groups. Leiomyoma infarction on contrast-enhanced magnetic resonance imaging 1 week after UAE and 4-month outcomes, including changes in the Uterine Fibroid Symptom and Quality of Life questionnaire scores, the volume reduction rates of the uterus and largest leiomyoma, follicle stimulating hormone values, adverse events, and amenorrhea, were compared among groups. ResultsA 4-month follow-up was completed for all patients. No significant differences were observed among groups in baseline characteristics or technical and peri-procedural outcomes. There were no significant differences in the multivariate-adjusted 1-week infarction rates of all leiomyoma volumes (P = .161) or multivariate-adjusted 4-month outcomes, including changes in the Uterine Fibroid Symptom and Quality of Life questionnaire symptoms and total scores (P = .864 and P = .798, respectively), the volume reduction rates of the uterus and the largest leiomyoma (P = .865 and P = .965, respectively), and follicle stimulating hormone values (P = .186) among the groups. No significant differences were noted in the 4-month adverse events (P = .260) or amenorrhea (P = .793) among the groups. ConclusionsThe present study demonstrated no significant differences in the outcomes of UAE for leiomyoma when performed during different phases of the menstrual cycle.

Comparing Perioperative Outcomes of Uterine Artery Embolization and Hysterectomy in Insurer and Demographically Diverse Populations: A Retrospective, Multi-Center Database Study.

Introduction: Past studies comparing perioperative outcomes of hysterectomy (HYST) and uterine artery embolization (UAE) do not control for demographically and insurer diverse populations. This study sought to identify the 30‑day readmission, 15‑day complication, and minimum 1‑year surveillance reintervention rates of diverse, propensity matched patients undergoing UAE or HYST for uterine leiomyoma.Methods: Adults from the New York’s Statewide Planning and Research Cooperative System (SPARCS) database 2009‑2013 who underwent HYST or UAE for uterine leiomyoma were retrospectively reviewed and 1:1 propensity matched. Univariate analysis compared demographics, complications, readmissions, and reintervention rates. Binary logistic and linear regression models identified independent predictors of outcomes.Results: A total of 682 patients were identified, where the number (n) of patients in each cohort was n=341, HYST, and n=341, UAE. Significance levels are shown with p values. No significant differences were identified between HYST and UAE demographics, complication (2.60% HYST vs 2.90% UAE, p=0.816) or readmission rates (3.20% HYST vs 3.80% UAE, p=0.678); 0.30% of UAE patients had a reintervention UAE and 2.90% of UAE patients had reintervention hysterectomy. HYST patients had a significantly longer average length of stay (2.59 days HYST vs 1.63 days UAE, p<0.001). The Deyo-Charlson (Deyo) comorbidity score positively predicted any complication with odds ratio=34.262, 95% confidence interval [4.938, 237.725], and p<0.001, but did not predict readmissions.Conclusion: HYST patients had significantly longer hospital stays. UAE and HYST had comparable readmission and complication rates. The Deyo comorbidity score was a significant predictor of any complication. This study supports the safety and efficacy of UAE when compared to HYST in demographic and insurer diverse populations.

Uterine Artery Embolization and Methotrexate Infusion as Sole Management for Caesarean Scar and Cervical Ectopic Pregnancies: A Single-Center Experience and Literature Review

IntroductionThe incidence of caesarean scar pregnancy (CSP) and cervical pregnancy (CP) has increased significantly in recent years. The related hemorrhage can be lethal and often needs hysterectomy. This study aims to assess the technical and clinical results of uterine artery embolization (UAE) combined with intra-arterial methotrexate (MTX) infusion for CSP and CP. MethodsA retrospective study was conducted for 11 patients (age range from 25–40 years, mean; 31.8 y) with CSP (7/11) and CP (4/11). The diagnosis was confirmed by elevated b-hCG levels (mean 31.245 mIU/mL) with sonography and/or magnetic resonance imaging. They were treated with UAE using particulate embolic material. In all patients, the infusion of MTX (50 mg/m2) was performed before UAE. Follow-up periods after UAE ranged between 6-24 months included weekly sonography and b-hCG level assessment. A literature review was performed using standard online search tools. ResultsIn 10 patients, UAE controlled active vaginal bleeding and reduced post-procedural b-hCG levels significantly by the second week. One patient presented with persistent elevated b-hCG level and vaginal rebleeding. The rebleeding was successfully controlled by second UAE procedure. The ectopic pregnancies were resolved, and the uterus was preserved in all patients. No major complications were detected. Normal menses resumed within 2 months after UAE. Two patients had subsequent natural successful intrauterine pregnancies. ConclusionUAE combined with intra-arterial MTX infusion resulted in resolution of ectopic pregnancies with control of hemorrhage and without hysterectomy in this small group of patients.

Optimization the results of uterine artery embolization by dynamic contrast enhanced MR-perfusion

Optimization the results of uterine artery embolization by dynamic contrast enhanced MR-perfusion

Five-year clinical outcomes of uterine artery embolization for symptomatic leiomyomas: An analysis of risk factors for reintervention

ObjectivesThe objective of this study is to investigate the five-year reintervention rate of uterine artery embolization (UAE) for symptomatic leiomyomas and to identify potential predictive factors of reintervention. MethodsFrom March 2011 to February 2012, 92 consecutive women (mean age 41.9 years, range 28–55 years) underwent bilateral UAE. Contrast-enhanced magnetic resonance imaging (MRI) was performed at three-month follow-up. After annual follow-up, a survey on clinical outcome and reintervention incidences was performed at five-year follow-up. Potential predictive factors of reintervention were evaluated. ResultsOf the 67 patients, menorrhagia and/or bulk-related symptoms were resolved after UAE in all but one patient (98.5%). At median follow-up of 60 months (range, 5–60 months), reintervention rate was 10.4%, with seven reintervention cases (five myomectomy and two hysterectomy cases). Complete (100%) or near complete (90–99%) infarction rate of the dominant leiomyoma was 96.4% (54 of 56). Independent factors of reintervention on multivariate logistics regression analysis included near complete or partial (<90%) infarction of the dominant leiomyoma (odds ratio [OR] 22.238; 95% confidence interval [CI] 2.405–205.620; p = 0.006), as well as the presence of non-dominant viable leiomyomas (OR 12.134; 95% CI 1.213–121.409; p = 0.034). ConclusionUAE provides excellent and sustained symptom improvement of symptomatic leiomyomas with a low reintervention rate at five-year follow-up. In addition to near complete or partial infarction of the dominant leiomyoma on follow-up MRI, the presence of viable non-dominant leiomyomas indicates a higher risk of reintervention.

Primary postpartum hemorrhage: outcome of uterine artery embolization.

To assess the efficacy of uterine artery embolization (UAE) for the management of primary postpartum hemorrhage (PPH) and to determine the factors associated with clinical outcomes especially in relation to the ovarian artery. A retrospective analysis of 33 patients who underwent UAE for primary PPH was performed. Clinical data were used regarding maternal characteristics, cause of bleeding, mode of delivery, bleeding onset after delivery, risk factors for PPH, presence of coagulopathy, details regarding the UAE procedure, and types of ovarian artery flow. We defined two types of ovarian artery flow by initial aortography before UAE (Type A: ovarian artery flow arose directly from the aorta to the uterine artery; Type B: ovarian artery flow that did not obviously arise from the aorta). Clinical success was defined as cessation of bleeding after UAE without the need for hysterectomy. Univariate analysis was performed to determine factors related to clinical outcomes. The major indication of UAE was uterine atony (82%; 27/33). Extravasation of contrast medium was observed in 15 (45%) patients. The clinical success rate was 85% (28/33). In five patients, embolization failed, and these patients were managed by hysterectomy. Univariate analysis showed that retained placental tissue (p < 0.001), type of ovarian artery (p < 0.001) and the existence of extravasation of contrast medium (p = 0.049) were related to the clinical success rate. The clinical success rate was 85% (28/33), and some PPH patients were thought to need ovarian artery embolization in addition to UAE. Advances in knowledge: Initial aortography before UAE may be useful to predict the failure of UAE and the need of ovarian artery embolization. Obvious ovarian arterial blood flow to the uterus by aortography could be a warning sign.

Outcome of Uterine Artery Embolization in the Treatment of Uterine Leiomyomas in Mongolia

Objective: To evaluate and determine treatment efficacy of uterine artery embolization versus uterine myomectomy in treating uterine leiomyomas. Methods: In 2010-2013, 94 women between the ages of 23-50 years were recruited in the study. They were divided into 2 treatment groups: uterine artery embolization and myomectomy (control) group and were followed up for two consecutive years. Results: After uterine artery embolization, the volume of leiomyomas decreased 56%-91% (p&lt;0.05). Menorrhagia in the uterine artery embolization versus myomectomy group was 95.2% and 92.8% (p&gt;0.05), anemia 87.5% and 85.7% (p&gt;0.05), pain subsided 72.2% versus 86.8% and "bulk" symptoms 87.5% versus 100% respectively (p&gt;0.05). Overall health-related quality of life score +27.6 versus +17.1 and SS score -34.0 versus -32.8, patient satisfaction 89.4% versus 72.3% (p=0.001). Re-growth after uterine artery embolization 2.1% versus myomectomy 23.4% (p=0.0001), Post-treatment conception 25.5% versus 31.9% and cesarean delivery rate 88.9% versus 90% respectively (p&gt;0.05). Duration of the procedure 38.9±4.8 minutes versus 54.0±26.3 minutes (p=0.0001), length of hospital stay 2.4±0.9 days versus 6.9±2.3 days (p=0.0001), days to recovery 10.6±3.0 versus 26.2±17.9 (p=0.0001). Conclusion: Uterine artery embolization treatment effectively decreases the size of leiomyomas (p=0.015), it particularly improves menorrhagia. The quality of life and patient satisfaction scores after uterine artery embolization are better (p=0.001). There was no statistically significant difference with regard to conception rate or the need for cesarean delivery (p&gt;0.05).