Initial experience with use of tris-acryl gelatin microspheres for uterine artery embolization for leiomyomata.

PURPOSE: To assess the safety and effectiveness of tris-acryl gelatin microspheres (Embospheres) in the treatment of leiomyomata by uterine artery embolization. MATERIALS AND METHODS: This was a Phase I study of 30 patients with symptomatic leiomyomata. Each patient underwent ultrasound imaging and completed questionnaires regarding symptoms and health status at baseline and 3 and 6 months after treatment. Bilateral embolization was performed with use of tris-acryl gelatin microspheres. Summary statistics were used to characterize the demographic and procedure data. Paired t-tests were used to assess change in the severity of menstrual bleeding and health-related quality of life. RESULTS: Bilateral embolization was technically successful in all patients. Three months after treatment, menstrual bleeding was markedly improved as assessed by menorrhagia questionnaire (P <.0001) and menstrual calendar (P <.0001). Pelvic pain and discomfort was improved in 92% of cases. Physical component summary scores of the SF-12 also increased from baseline at 3 months (P =.02) and at 6 months (P =.01). Minor complications occurred in nine patients; there were no major complications. CONCLUSION: Although limited, this initial experience suggests that tris-acryl gelatin microspheres are an effective and safe embolic agent for the treatment of uterine leiomyomata.

Vaginal expulsion of submucosal fibroids after uterine artery embolization. A report of three cases.

BACKGROUND: Since October 1996, at our fibroid center, we have been using the uterine artery embolization (UAE) procedure as a nonsurgical means to treat patients with fibroids and menorrhagia. We have performed this procedure on over 180 patients, 3 of whom experienced vaginal expulsion of submucosal fibroids from two to seven months later. CASES: A 37-year-old woman underwent UAE in November 1997 and expelled five submucosal fibroids two to three months later. A 43-year-old woman underwent UAE in August 1997 and expelled a submucosal fibroid four months later. A 46-year-old woman underwent UAE in April 1997 and expelled a submucosal fibroid seven months later. CONCLUSION: The use of UAE to treat patients with fibroids and menorrhagia is relatively new. Our experience has revealed that a significant percentage of patients who have had the embolization procedure will have reduction in menorrhagia and also in the volume of their fibroids. Complications and side effects have been few. Vaginal expulsion of submucosal fibroids can be viewed as a side effect of the procedure, and, to the best of our knowledge, these are the first reported cases of this postembolization occurrence.

Uterine arterial embolization for the management of leiomyomas: quality-of-life assessment and clinical response.

PURPOSE: To determine the effectiveness of uterine arterial embolization as a primary therapy in the management of symptomatic leiomyomas. MATERIALS AND METHODS: Uterine arterial embolization was performed in 53 patients (age range, 33-58 years) with menorrhagia, bulk-related symptoms (frequency of urination, sensation of pressure, sensation of mass), or both, due to leiomyomas. The effectiveness of this therapy in the control of symptoms and the patients' acceptance of the treatment were measured by means of the information from patient interviews 3 months after the procedure. RESULTS: Fifty-two (98%) of the 53 patients had technically successful procedures and were interviewed 3 months after embolization. Forty-six (88%) of these patients reported marked improvement in their abnormal bleeding. Twenty-nine (94%) of the 31 patients with bulk-related symptoms reported marked improvement in these symptoms. Follow-up ultrasonographic examinations showed a mean 46% reduction in uterine volume. Forty-one patients interviewed (79%) would choose this procedure again, eight (15%) would consider choosing this procedure again, and only three (6%) would choose another treatment option. CONCLUSION: Uterine arterial embolization is an effective therapy in the management of symptomatic leiomyomas and may prove to be a valuable alternative to myomectomy, hysterectomy, or other surgical procedures. Further investigation is warranted.

Pulmonary artery pseudoaneurysm. A potential complication of pulmonary artery catheterization.

A 70-year-old woman with pulmonary hypertension due to severe chronic obstructive pulmonary disease and long-standing mitral stenosis developed hemoptysis and a right upper lobe infiltrate during manipulation of a balloon-tipped flow-directed pulmonary artery catheter. Hemoptysis resolved spontaneously over several minutes, and the right upper lobe infiltrate cleared over several weeks, during which time a new right upper lobe nodule became apparent. Angiography disclosed the presence of a late-filling well-circumscribed saccular pseudoaneurysm. This was obliterated with an acute infiltrate with or without hemoptysis in the area subtended by a flow-director pulmonary artery catheter, and particularly when it is associated with manipulation of that catheter, the differential diagnosis should include pulmonary artery perforation as well as infarction. If the patient survives the episode, the possibility that a pseudoaneurysm has formed must be actively entertained and aggressively evaluated, since pseudoaneurysm is a potentially fatal lesion that is treatable.