Uterine artery embolization for pedunculated subserosal fibroids.

OBJECTIVE: The objective of our study was to assess the outcomes of uterine artery embolization as a treatment for pedunculated subserosal fibroids, which we defined as those in which the diameter of the stalk was 50% narrower than the diameter of the fibroid. MATERIALS AND METHODS: During a 72-month period, 196 consecutive women underwent embolization for treatment of symptomatic uterine fibroids that were confirmed on baseline sagittal and axial MR images. We identified those women with pedunculated subserosal fibroids treated with embolization and retrospectively assessed complications and out-comes of embolization using a serial questionnaire and MRI. RESULTS: Of the 196 women, 12 (age range, 34-48 years; mean age, 42.3 years) had one or more pedunculated subserosal fibroids. Fifteen pedunculated subserosal fibroids were identified on baseline MR images in the 12 patients. The mean tumor diameter was 8.3 cm (range, 4.0-15.5 cm; 95% confidence interval [CI], 6.7-9.9 cm). The mean stalk diameter was 3.1 cm (range, 2.0-5.5 cm; 95% CI, 2.5-3.7 cm). The follow-up period ranged from 5 to 51 months (mean, 18.1 months). No serious complications such as separation of the tumors from the uterus, torsion of the tumors, or infection occurred after embolization. Enhanced MR images obtained 1 week after embolization showed that complete devascularization of the tumors had been achieved in 73% (11/15) of the tumors. The rates of mean tumor volume reduction were 41% (range, 12-73%) 4 months and 53% (range, 31-85%) 1 year after embolization. The mean stalk diameter was 3.2 cm (range, 1.7-5.4 cm; 95% CI, 2.5-3.9 cm) 4 months and 2.9 cm (range, 1.1-4.2 cm; 95% CI, 1.8-3.9 cm) 1 year after embolization. No significant difference in stalk diameters was noted 4 months (p=0.617) or 1 year (p=0.963) after embolization compared with the diameters before the treatment. The rates of mean uterus volume reduction were 35% (range, 15-47%) 4 months and 47% (range, 35-60%) 1 year after embolization. Marked or moderate improvement in bulk-related symptoms was achieved in 100% (10/10) of the women at 4-month follow-up, 100% (5/5) at 1-year follow-up, and 100% (2/2) at 2-year follow-up. CONCLUSION: We found no serious complications after embolization for pedunculated subserosal fibroids with stalk diameters of 2 cm or larger. Successful outcomes can be obtained in such tumors.

Is a large fibroid a high-risk factor for uterine artery embolization?

OBJECTIVE: The objective of our study was to determine whether tumor size, specifically uterine fibroids of 10 cm or larger, predisposes a patient to an unacceptably high risk at uterine artery embolization. MATERIALS AND METHODS: One hundred fifty-two consecutive women underwent embolization for uterine fibroids. Complications and outcomes were analyzed using questionnaires and serial MRI between women with one or more uterine fibroids of 10 cm or larger diameter (mean, 12.4 cm; range, 10-19 cm) (n = 47, group 1) and women with each uterine fibroid of less than 10 cm diameter (mean, 6.8 cm; range, 2-9.5 cm) (n = 105, group 2). RESULTS: Thirty complications (19.7%, 30/152), which occurred in 27 women (17.8%, 27/152), were noted. However, 25 of 30 complications were minor, requiring no or nominal therapy. They occurred in 19.1% (9/47) of group 1 and in 15.2% (16/105) of group 2 women (p = 0.637). Major complications requiring major therapy, unplanned increased level of care, or unanticipated prolonged hospitalization (> 48 hr) or including permanent adverse sequelae were noted in 6.4% (3/47) of group 1 and in 1.9% (2/105) of group 2 women (p = 0.172). Of these five women, four underwent surgery because of sloughing fibroids. Permanent adverse sequelae were observed in one woman of group 1, who has had sexual dysfunction after embolization. No deaths occurred in either group. There was no significant difference in most outcomes or in intervals until the complete disappearance of postprocedural pain and full recovery between the two groups. CONCLUSION: We found no increased risk to patients undergoing uterine artery embolization for fibroids on the basis of tumor size. Successful outcomes can be obtained for such lesions.

Uterine leiomyoma after embolization by means of gelatin sponge particles alone: report of a case with histopathologic features.

We describe the histopathologic features of uterine leiomyoma after uterine artery embolization (UAE) in a 42-year-old woman. This patient, who was taking antiplatelet drugs for the treatment of cerebral disease, successfully underwent UAE using only gelatin sponge particles for a symptomatic uterine leiomyoma. Although menorrhagia improved moderately after the procedure, she underwent abdominal hysterectomy 11 months later because of recurrent uterine bleeding. Histopathology revealed that most of the area of the uterine leiomyoma was characterized by extensive coagulation necrosis, which support the positive result of the procedure. No significant abnormalities were noted in either the myometrium or endometrium, which also suggested that UAE using only gelatin sponge particles is an appropriate procedure to preserve the uterus. The histologic and radiologic features of this case are discussed. To the best of our knowledge, this is the first reported case of uterine leiomyoma after UAE using only gelatin sponge particles as a primary embolic agent.

Uterine artery embolization using gelatin sponge particles alone for symptomatic uterine fibroids: midterm results.

OBJECTIVE: The purpose of this study was to assess the safety and effectiveness of uterine artery embolization using gelatin sponge particles alone for women with symptomatic uterine fibroids. SUBJECTS AND METHODS: During 38 months, 60 patients (age range, 32-52 years; mean age, 42.5 years) with symptomatic uterine fibroids underwent uterine artery embolization. Only gelatin sponge particles, approximately 500-1000 microm in diameter, were used in all patients. The improvement of clinical symptoms was assessed by questionnaire. Reduction of the largest tumor and uterine volume reductions were assessed using MR imaging. The follow-up period ranged from 1 to 38 months (mean, 10.6 months). RESULTS: Menorrhagia improved markedly or moderately in 41 (98%) of 42 of patients 4 months after embolization and in 20 (100%) of 20 patients 1 year after embolization. Bulk-related symptoms improved markedly or moderately in 31 (97%) of 32 of patients 4 months after embolization and in 19 (100%) of 19 of patients 1 year after embolization. MR imaging revealed that the mean largest tumor volume reduction rates were 55% at 4 months and 70% at 1 year after embolization, and the mean uterine volume reduction rates were 40% at 4 months and 56% at 1 year after embolization. Follow-up MR imaging showed no new fibroids and no regrowth of existing fibroids. No major complications were observed in any women. CONCLUSION: We suggest that uterine artery embolization with gelatin sponge particles alone is a safe and effective treatment for symptomatic fibroids. The outcomes bear comparison with those of uterine artery embolization using polyvinyl alcohol particles, which have been reported in the literature.