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Purpose: To evaluate the effects of a spherical embolic agent consisting of polyvinyl alcohol (PVA) and to compare this agent with commercially available embolization agents., Materials and Methods: Eleven miniature pigs were included in the study population. The upper poles of both kidneys were selected as the target organs for embolization. PVA spheres (700-900 micro m) were used in nine kidneys, PVA particles (500-710 micro m) were used in six kidneys, gelatin spheres (700-900 micro m) were used in five kidneys, and gold-colored gelatin spheres (700-900 micro m) were used in three kidneys. Two animals were killed immediately after embolization. In the remaining animals, angiography was performed before sacrifice 7 days (in five pigs) or 28 days (in four pigs) after embolization. Pathologic and histologic evaluation of the kidneys was performed., Results: All agents resulted in target vessel occlusion and end-organ infarction. All arteries embolized with spherical agents were recanalized at follow-up angiography. In vessels embolized with PVA particles, the occluding plug consisted of thrombus and PVA. In vessels embolized with spherical agents, the occluding plug consisted mostly of the embolic agent. PVA spheres were associated with the mildest inflammatory responses at 7 and 28 days when compared with PVA particles and gelatin-based microspheres. Arterial wall destruction was seen to a greater extent in kidneys embolized with gelatin-based microspheres than in those embolized with PVA-based agents., Conclusions: The spherical, PVA-based embolization agent resulted in target organ infarction and temporary arterial occlusion. The inflammatory response to PVA spheres was significantly less aggressive than the response to other agents tested. Further study with clinical and long-term pathologic follow-up is suggested to determine if these findings may have favorable clinical implications for patients undergoing embolization procedures.

Objective: This study was performed to evaluate the MR imaging appearance and clinical response of patients undergoing uterine artery embolization for the treatment of menorrhagia due to adenomyosis., Materials and Methods: A retrospective review of 15 patients with adenomyosis and menorrhagia who underwent uterine artery embolization was performed. The diagnosis of adenomyosis was based on established MR imaging criteria. Clinical response was assessed at a minimum of 3 months after embolization. Follow-up MR imaging was performed 6 months after embolization., Results: Of the 15 patients in this study, five had diffuse adenomyosis without evidence of uterine fibroids, one had focal adenomyosis without evidence of uterine fibroids, and the remaining nine had adenomyosis with one or more fibroids. At follow-up, 12 (92.3%) of the 13 patients reported significant improvement in presenting symptoms and quality of life. One patient continued experiencing menorrhagia, and one patient experienced amenorrhea during the 5 months of follow-up after embolization. MR imaging in nine patients, performed at a mean of 5.9 months after embolization, revealed significant reductions in median uterine volume (42%), median fibroid volume (71%), and mean-junctional-zone thickness (11 mm; 33%; p < 0.5). Six of the nine patients had subendometrial regions of decreased T2 signal intensity after embolization., Conclusion: Uterine artery embolization is a promising nonsurgical alternative for patients with menorrhagia and adenomyosis. Significant improvement in presenting symptoms and in quality of life is associated with decreases in uterine size and junctional zone thickness. Larger prospective studies are needed to establish the safety and efficacy of this procedure for patients with adenomyosis.

Purpose: To assess the feasibility of performing uterine artery embolization as an outpatient treatment for symptomatic uterine fibroids., Materials and Methods: Forty-nine consecutive patients (mean age, 44.5 years; range, 28-54 years) underwent uterine artery embolization during a 12-month period. Embolization was performed with 350-500 microm polyvinyl alcohol particles (44 of 49) or Gelfoam pledgets (five of 49). At discharge, patients were given instructions regarding the constitutional symptoms to expect after embolization. A specific medication regimen consisting of prochlorperazine, ketorolac, meperidine, and hydrocodone was prescribed for relief of these symptoms. All patients were telephoned within 24 hours of discharge. During long-term follow-up, a questionnaire was administered to all patients to evaluate the periprocedural experience. Three-month clinical follow-up was available in 26 patients and 6-month imaging follow-up was available in 16 patients., Results: Fourteen patients presented with menorrhagia, six had bulk-related symptoms (abdominal distension, stress incontinence, pelvic pain), and 29 had both. Technical success for bilateral embolization was 98%. Forty-seven of 49 patients were discharged to home 6-8 hours after the procedure; two patients required overnight observation in an ambulatory unit (one because of postprocedure hypertension and one because of a late procedure completion time). At the first follow-up phone call, reported symptoms included pelvic pain/cramping in 83.7% (41 of 49), fatigue in 75.5% (37 of 49), nausea/vomiting in 46.9% (23 of 49), and a nonpurulent vaginal discharge in 18.4% (nine of 49). These symptoms were satisfactorily controlled with discharge medications in 48 of 49 patients. No patients returned to the hospital or visited an emergency room during the first 48 hours after discharge. Forty-six of 49 patients were satisfied with the decision for home discharge. The average uterine volume reduction in 16 patients with 6-month imaging follow-up was 47.5%; 88.5%, of patients (23 of 26) with 3-month clinical follow-up reported improvement or elimination of symptoms., Conclusion: With defined telephone follow-up, staff availability, and a protocol designed to alleviate the postprocedure constitutional symptoms, uterine artery embolization is both safe and effective when performed as an outpatient procedure.