Uterine Artery Embolization Decreases Deep Vein Compression Caused by Fibroids

Background
Uterine fibroids are a common benign neoplasm in women of reproductive age. They can cause a multitude of complications by exerting mass effect on the other organs in the pelvis. One of the complications that can occur is compression of the deep veins in the pelvis, which can cause venous stasis and long-term problems.

The objective of a recent study was to assess the deep venous narrowing caused by the uterine fibroids seen in a series of patients, and to measure the changes seen in the size of the veins after treatment with UAE with time-of-flight (TOF) MR venography (MRV).

Uterine artery embolization (UAE) decreases compression of the deep veins caused by uterine fibroids.

Design
Retrospective study.

Participants
Thirty-six women undergoing treatment of symptomatic uterine fibroids during a 12-month study interval.

Methodology
29 patients had unenhanced and enhanced MRI and TOF-MRV, both before and at four months after UAE. On the TOF-MRV, two blinded radiologists measured three deep veins, including the inferior vena cava (IVC) and bilateral common and external iliac veins.

The measurements were graded as 0 (venous diameter of most severe narrowing was ?50% of normal vein), 1 (venous diameter at most severe narrowing was <50% of normal vein), and 2 (at least one part of vein was collapsed). The baseline and the four-month scores were compared. Symptom severity scores were also compared.

Results
The deep venous scores decreased significantly between baseline MRI (mean score, 1.52) and the four-month MRI (mean score, 0.93). The uterine volume decreased significantly between the baseline MRI (948 mL) and the four-month MRI (617 mL). The deep venous score and symptom severity score correlated with uterine volume. The symptom severity scores decreased significantly as well.

Reviewer’s Comments This study showed that, based on TOF-MRV, the deep venous scores were improved by UAE and correlated with the uterine volume. Therefore, the presence of deep venous stasis was lowered by UAE, as seen in this study.

In some patients, hysterectomy has been performed to relieve venous stasis in patients who developed DVT secondary to the fibroids. In this study, venous compression was improved. These authors suggest that the shrinkage of the fibroid uterus caused relief of some deep venous compressions, therefore leading to less venous stasis.

The authors suggest that UAE may be a non-invasive way to treat venous stasis causing deep venous thrombosis in patients. The amount of improvement seen in the venous compression can be monitored via MRV, which has the advantage of having no radiation.

Author:Sharon Gonzales, MD

Reference:
Katsumori T, Kasahara T, et al. MR Venography of Deep Veins: Changes With Uterine Fibroid Embolization. Cardiovasc Intervent Radiol; 2009;32 (March): 284-288.