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PURPOSE: To evaluate the midterm results of limited embolization of the uterine arteries in the management of symptomatic uterine fibroids and to evaluate the efficacy and safety of limited uterine artery embolization (UAE) with use of calibrated tris-acryl gelatin microspheres in the management of symptomatic uterine fibroids. MATERIALS AND METHODS: Twenty women (mean age, 43 years) with symptomatic uterine fibroids underwent bilateral embolization of the uterine arteries with use of calibrated microspheres. Devascularization of the fibroids was achieved and the main uterine artery was left patent in all women. Embolization was offered as an alternative to surgery in all women who had been treated unsuccessfully with medical therapy. RESULTS: All procedures were technically successful. Microspheres 700–900 μm in diameter were used in 14 women (70%). After a mean follow-up duration of 30.2 months (range, 24–48 mo), all women reported improvement in their symptoms, with 85% reporting complete resolution of menorrhagia at the most recent follow-up. One woman with multiple fibroids required a second embolization procedure because of persisting symptoms at 6 months. She is currently symptom-free after 48 months. In two women with submucosal fibroids, expulsion of necrotic fibroids occurred 2 and 7 months after the procedure, respectively. All women resumed normal menstruation after the procedure. One woman had a successful full-term pregnancy after embolization. CONCLUSION: Early experience with UAE with use of calibrated tris-acryl gelatin microspheres indicates that it is safe and efficacious in controlling menorrhagia. [Copyright &y& Elsevier]

Purpose: To determine and compare the costs associated with uterine artery embolization (UAE) and abdominal myomectomy for the treatment of symptomatic leiomyomata.Materials and Methods: Charge information was gathered and analyzed from 23 patients who underwent UAE and 17 who underwent abdominal myomectomy in a single institution. The mean charges for each procedure were calculated from the patients' billing data. Cost-to-charge ratios were applied to the mean charges to estimate costs. The work relative value units (RVUs) for all physician services for each procedure were calculated. These total work RVUs for each intervention were multiplied by the appropriate Medicare conversion factors to estimate a uniform physician fee. These costs were totaled and compared with use of the unpaired t test to estimate the cost difference between UAE and abdominal myomectomy.Results: The estimated hospital cost for UAE was $3,193, which was significantly lower than the $5,598 estimated for abdominal myomectomy (P <.0001). The discrepancy was caused primarily by increased hospital care and operating room costs for abdominal myomectomy. The total professional costs were significantly higher for UAE ($2,220) than for abdominal myomectomy ($1,611) (P =.002). When all associated costs, including typical imaging costs, were considered, there was a trend toward lower costs for UAE ($6,708) compared to abdominal myomectomy ($7,630) (P =.086).Conclusion: UAE had lower procedure-related costs than abdominal myomectomy despite higher physician costs. When typical imaging costs were included, there was still a trend toward lower costs for UAE. [ABSTRACT FROM AUTHOR]

Purpose: To determine if magnetic resonance (MR) imaging significantly alters the diagnostic thinking and treatment plans of interventional radiologists during the evaluation of women for uterine fibroid embolization (UFE) for presumed uterine fibroids.Materials and Methods: At a single institution, interventional radiologists prospectively completed questionnaires (n = 60) before and after MR imaging was performed in their evaluation of women presenting for potential UFE. The questionnaires asked these physicians the probability (0%-100%) of their most likely diagnosis before MR imaging and after receiving the MR imaging information. They were also asked their anticipated and final treatment plans. Diagnostic confidence gains and the proportion of patients with changed initial diagnoses or anticipated management were calculated. The Wilcoxon signed-rank test was used to assess gains in diagnostic confidence.Results: MR imaging caused a mean gain in diagnostic confidence of 22% (P <.0001). MR imaging changed initial diagnoses in 11 patients (18%). Immediate clinical management changed in 13 patients (22%). UFE was not performed in 11 of 57 women (19%) who were anticipated before MR imaging to receive UFE.Conclusions: MR imaging significantly alters the diagnoses and treatment plans of interventional radiologists evaluating women with presumed symptomatic fibroids. MR imaging should be considered in all patients before UFE. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate how uterine artery embolization (UAE) treatment for uterine fibroids (UF) affects ovarian function in young Middle Eastern women.Materials and Methods: In this prospective study, 32 patients (mean age, 34 y; range, 26-45 y) underwent UAE treatment of symptomatic fibroids. Serum follicle-stimulating hormone (FSH) levels were measured before and after the embolization treatment. Preprocedural levels were determined on the second day of the menstrual cycle. Postprocedural levels were measured 3 months and 6 months after embolization. A detailed history of menstrual cycles was obtained before and after UAE.Results: Thirty premenopausal patients had normal menses before UAE. Mean FSH levels before and 3 months after UAE were 6.83 IU/L +/- 1.8 and 6.99 IU/L +/- 1.67, respectively (P =.66). Normal menstruation resumed 2-3 months after the procedure. In two perimenopausal women, who had irregular menses and decreased ovarian reserve, mean FSH levels increased transiently from 22 and 30 IU/L to 40 and 48 IU/L, respectively, 3 months after UAE; they developed transient amenorrhea.Conclusion: In this study, UAE had no clinically relevant adverse effects on normally functioning ovaries and could be used safely in the treatment of symptomatic fibroids in premenopausal women. Larger studies are required for further support of this observation. [ABSTRACT FROM AUTHOR]

Purpose: To determine the imaging outcome after uterine artery embolization (UAE) with use of tris-acryl gelatin microspheres (Embospheres).Materials and Methods: A retrospective analysis of magnetic resonance (MR) images was performed comparing studies completed 3-4 months after UAE to those performed before UAE. Twenty-three patients with 61 leiomyomata (as many as three fibroids per patient) were examined. Orthogonal T2, axial T1-weighted fat-saturated, sagittal T2 fast spin-echo, and dynamic T1-weighted sagittal images after Gadolinium injection were analyzed. Two abdominal imaging specialists examined the volume and uterine and leiomyoma perfusion. The Wilcoxon signed-rank test was used for inferences in leiomyoma size difference, infarction, and volume of fibroid tissue perfused.Results: Median volume of all leiomyomata (n = 61) decreased by 52% (P <.001). For dominant fibroids alone (n = 23), a median 52% volume decrease (P <.001) was also noted, whereas the median uterine volume decreased 32%. Median perfused volume of all fibroids decreased from 31 mL to 0 mL, signifying a 100% decrease (P <.001). For dominant fibroids, a 100% median perfused volume decrease from 116 mL to 0 mL was noted (P <.001). Fifty-two of 61 fibroids (85%) and 20 of 23 dominant fibroids (87%) were completely devascularized and two fibroids disappeared. There was no myometrial ischemia identified.Conclusions: Tris-acryl gelatin microspheres (Embospheres) are an effective embolic agent for UAE, causing infarction and significant decrease in leiomyoma volume. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to evaluate the rabbit model for studies of particulate uterine artery embolization (UAE). Rabbits were chosen because it was believed that their year-round breeding time and short duration of pregnancy would be useful in studies of fertility and pregnancy after UAE.Materials and Methods: Bilateral UAE was performed in 12 adult female New Zealand White rabbits weighing 4-5.2 kg. All animals were proven to be breeders before treatment. Each uterine artery was embolized to stasis with use of 180-300- microm polyvinyl alcohol (PVA) particles (n = 9 animals), 500-710- microm PVA particles (n = 1), or tris-acryl 500-700- microm gelatin microspheres (n = 2).Results: Two rabbits died 7 days after embolization and the other 10 rabbits had to be killed because of malaise and weight loss 4-8 d after embolization. In all animals, necropsy demonstrated extensive uterine necrosis sparing only the tip of the uterine horn.Conclusion: Rabbits are an unsuitable model for studies of UAE with the embolic agents in clinical use. [ABSTRACT FROM AUTHOR]

The authors report a case of an unusual anatomic variation encountered during uterine embolization, that of absence of a uterine artery, with replacement by an enlarged round ligament artery. This case highlights the importance of understanding the arterial anatomy of the uterus and its potential variations and their potential impact on the outcome of the procedure. [Copyright &y& Elsevier]