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Unilateral Uterine Artery Embolization in Patients with Dominant Uterine Artery Can Be Effective

April 11, 2008
Written by: , Filed in: Interventional Radiology
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Background
Bilateral UAE is a recognized safe and effective minimally invasive means of treating symptomatic uterine fibroids. This is usually accompanied by significant reduction in the size of the uterus and the bulk symptoms associated with it. Sometimes the ovarian artery feeds some of the fibroids and may be embolized if symptoms do not abate.

The objective of a recent study was to evaluate clinical outcomes of unilateral UAE.

The study has concluded that unilateral uterine artery embolization (UAE) can be effective in relieving symptoms in patients with a dominant uterine artery supplying the fibroid(s), and as long as there is no persistent fibroid vascularity post-procedure.

Methodology
In this retrospective review, of 1600 patients treated, only 48 had unilateral UAE. Data evaluation determined that most of these patients fell into two categories, and the groups were analyzed accordingly.

In the first group of 12 patients, unilateral embolization occurred as a result of technical failure secondary to the operator’s inability to catheterize and embolize one of the two uterine arteries due to artery tortuosity or other anatomic factors. In this group, called the “technical failure group,” the intent was to treat both uterine arteries.

The second group of 30 patients had “elective” unilateral UAE, in which one uterine artery was judged to be supplying only normal myometrium based on angiographic findings and correlation with pre-procedure imaging.

Therefore, this artery was not embolized rather, the dominant, larger, and more tortuous uterine artery that was supplying the fibroids was embolized. They called this group the “dominant uterine artery” group, and the intent was to only treat one uterine artery.

In the remaining 6 patients, there was either congenital absence of or surgical ligation of the contralateral uterine artery. Clinical response was determined by analysis of post-procedure questionnaires completed by patients six months later, one year later, then once yearly thereafter.

Symptoms analyzed were dysmenorrhea, menorrhagia, and bulk symptoms. Radiological response was determined by evaluation of the change in fibroid vascularity and the change in size of the uterus/dominant fibroid by ultrasound or MRI.

Interventional Radiology Review
 University of California San Francisco Department of Radiology
  Interventional Radiology Review is an excellent program to view a wide variety of unknown cases. Topics covered include Vascular Interventions and Non Vascular interventions such as:
 
 • Evaluation of Vascular Trauma
 • Arterial and Venous Catheter Angiography
 • Magnetic Resonance Angiography
 • Cholangiography
 • Chest Interventions
 • Nephrostomy and Ureteral Stents
 
  Earn up to 26 AMA PRA Category 1 Credits™.  
  Click here to read more or order: Interventional Radiology Review

Results of the Study/Conclusions
In the dominant uterine artery group, there was a 48.6% reduction in volume of the uterus/dominant fibroid. Persistent vascularity in fibroids was seen in 17.4%. These patients with persistent vascularity usually required further interventions for symptom resolution.

In the technical failure group, there was a 46.9% reduction in volume of the uterus/dominant fibroid. Persistent vascularity within the fibroid was seen in 89.0%; these patients had ongoing symptoms requiring further interventions. In 5 patients, repeat UAE was performed, with technical failure in 3 patients. Patients who had subsequent successful bilateral UAE had complete resolution of symptoms.

Reviewer’s Comments
There was a statistically significant difference (P =0.001) in the dominant uterine artery group and the technical failure group in terms of persistent vascularity, which seems to correlate well with persistent symptoms. The reduction in volume, which was similar in both groups, did not correlate well with resolution of symptoms.

Author: Sharon Gonzales, MD

Reference
Bratby MJ, Hussain FF, Walker WJ. Outcomes After Unilateral Uterine Artery Embolization: A Retrospective Review. Cardiovasc Intervent Radiol; 2008; 31 (March-April): 254-259:

Interventional Radiology Review
 University of California San Francisco Department of Radiology
  Interventional Radiology Review is an excellent program to view a wide variety of unknown cases. Topics covered include Vascular Interventions and Non Vascular interventions such as:
 
 • Evaluation of Vascular Trauma
 • Arterial and Venous Catheter Angiography
 • Magnetic Resonance Angiography
 • Cholangiography
 • Chest Interventions
 • Nephrostomy and Ureteral Stents
 
  Earn up to 26 AMA PRA Category 1 Credits™.  
  Click here to read more or order: Interventional Radiology Review
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