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Uterine fibroid embolization

Poster No.: C-0068

Congress: ECR 2013

Type: Scientific Exhibit

Authors: S. Cea Pereira, M. C. Neches Rodríguez, L. Dominguez-VigueraFernández, E. Boullosa Seoane, M. Casal Rivas; Vigo/ES

Keywords: Interventional vascular

DOI: 10.1594/ecr2013/C-0068

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Purpose

To evaluate midterm results, clinical outcome, grade of fibroid necrosis and patient'ssatisfaction after uterine fibroid embolization (UFE) in women with symptomatic uterinefibroids.

Methods and Materials

• Retrospective review of 217 UFE performed in 211 women.• Age 24-59 years old (average: 44 y. o.).• Follow up: 6-159 months (average: 47 months).• All patients were evaluated by an interventional radiologist (IR) in external

consultation before and after intervention and there were admitted to thehospital assigned to IR (Table 1).

• MR before embolization:

- Number of fibroids: 1 (33%); 2 or more (67%)

- Dominant fibroid from 10 to 150 mm ( ½ 72mm)

- 8 patients had coexistent adenomyosis

• Symptomatic fibroid(s) with no contraindication (Table 2)

- Bleeding: meno-metrorrhagia;+/- anemia

- Mass effect: UG tract; GI tract.

- Pain: dysmenorrhea; dyspareunea; pelvic or low back pain

• Technique (images 1,2,3)

- Antibiotic prophylaxis

- Under conscious sedation (Anesthetist).

- Unilateral Femoral Artery approach; 4F sheath.

- The uterine arteries (UA) are catheterized selectively in turn.

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- Microcatheters (2.4F-2.9F) to avoid spasm and ensure a good position for embolizationon the transverse segment of the uterine artery.

- Objective: Complete devascularisation of all fibroids.

- Embolic agent: Gelatin-coated micorespheres: 500-700 micra (700/900 micra if verylarge UA)

- After UFE: analgesics and anti-inflammatories for 5 days

Images for this section:

Table 1

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Table 2

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Fig. 1: a. Right internal iliac arteriography displayed a large uterine artery that myomavascularization. b. Right internal iliac arteriography post-UAE

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Fig. 2: a.Left internal iliac arteriography viewing uterine artery that supplies myoma. b.Superselective catheterization of uterine artery 2.7F microcatheter (arrow). c. Full Controlof post-embolization left uterine artery.

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Fig. 3: a and b. Right internal iliac arteriography early and late phase. Great myoma. c.Selective catheterization of uterine artery horizontal portion. d. Control post-embolization

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Results

• Technical success (ability to catheterize and embolize both uterine arteries)100% (only in one case it was impossible to catheterize small right uterineartery)

• Hospital nights after UFE: 1-7 (1.3). Increasing nights: pain; intolerance oralintake .

• Post Embolization Syndrome(low grade pyrexia, discomfort and malaise inpostoperative days 3-7)

• 50% patients: low or slight pain / discomfort.• 19% patients: moderate / intense pain.• 31% patients: very high symptoms.• 13 patients increased their admission to hospital because

uncontrolled pain.• Post UFE MR (table 3)• Clinical improvement in 85% of women two months after UFE and 87% 13

months after UFE (table 4)• Complications (table 5)• There were needed 22 additional interventions: Results• Additional interventions: 23 patients

• Urgent intervention (hysterectomy): 4 patients (1.4%)• Programmed intervention : 18 patients (8.1%). 6 re-

embolization (effectives in 5); 4 myomectomy; 8 hysterectomy.• It was made a phone interviewed in order to analyzed grade of satisfaction

and patients complaints about the intervention (table 6)

Images for this section:

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Table 3

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Table 4

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Table 5

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Table 6

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Conclusion

• UFE is safe and effective with low grade of complications.• The midterm results show significant improvement of symptoms and

satisfaction in the majority of women.

References

Goodwin SC, Spies JB. Uterine fibroid embolization. N Engl J Med. 2009 Aug13;361(7):690-7.

Popovic M, Berzaczy D, Puchner S, Zadina A, Lammer J, Bucek RA. Long-term qualityof life assessment among patients undergoing uterine fibroid embolization. AJR Am JRoentgenol. 2009 Jul;193(1):267-71.

Smeets AJ, Nijenhuis RJ, van Rooij WJ, Weimar EA, Boekkooi PF, Lampmann LE,Vervest HA, Lohle PN. Uterine artery embolization in patients with a large fibroid burden:long-term clinical and MR follow-up. Cardiovasc Intervent Radiol. 2010 Oct;33(5):943-8.

Kroencke TJ, Scheurig C, Poellinger A, Gronewold M, Hamm B. Uterine arteryembolization for leiomyomas: percentage of infarction predicts clinical outcome.Radiology. 2010 Jun;255(3):834-41.

Freed MM, Spies JB. Uterine artery embolization for fibroids: a review of

current outcomes. Semin Reprod Med. 2010 May;28(3):235-41.

Stokes LS, Wallace MJ, Godwin RB, Kundu S, Cardella JF; Society of

Interventional Radiology Standards of Practice Committee. Quality improvementguidelines for uterine artery embolization for symptomatic leiomyomas. J Vasc IntervRadiol. 2010 Aug;21(8):1153-63.

Narayan A, Lee AS, Kuo GP, Powe N, Kim HS. Uterine artery embolization versusabdominal myomectomy: a long-term clinical outcome comparison. J Vasc Interv Radiol.2010 Jul;21(7):1011-7.

Smeets AJ, Nijenhuis RJ, Boekkooi PF, Vervest HA, van Rooij WJ, Lohle PN. Long-TermFollow-up of Uterine Artery Embolization for Symptomatic Adenomyosis. CardiovascIntervent Radiol. 2011 Jun 30

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