Ewha Med J.  2012 Sep;35(2):102-109. 10.12771/emj.2012.35.2.102.

Treatment Failure after Uterine Artery Embolization for Symptomatic Uterine Fibroids: Significance of Ovarian Arterial Collateral Vessels in Predicting the Outcome

• Kang BC

• KMID: 2284000
• DOI: http://doi.org/10.12771/emj.2012.35.2.102

Abstract

OBJECTIVES
To evaluate the treatment failure (TF) rate of leiomyoma after uterine artery embolization (UAE) for uterine leiomyomas in cases of the presence of anastomoses between the ovarian arteries (OA) and uterine arteries (UA).
METHODS
The results of 163 consecutive UAE for uterine fibroid were reviewed. Mean patient age was 42.8 years (range, 25 to 57 years). TF was evaluated according to the anastomoses between OA and UA on pre-embolization angiography. Magnetic resonance images (MRIs) were obtained at 1~6 months or 12 months after UAE. MRIs were gadolinium (Gd)-enhanced images and/or T2-weighted images. MRIs exhibited focal enhancement portion on fibroid and evaluated the TF rate of the leiomyoma in patients of presence of anastomoses between OA and UA.
RESULTS
Fifty six patients had anastomoses between UA and OA on pre-embolization angiography (56/163, 34.4%). Angiographic subtypes were type Ia (n=19), type Ib (n=16), type II (n=11) and type III (n=10). Of all patients, 10 patients showed the focal enhancements of the leiomyomas on follow-up enhanced MRIs (10/163, 6.1%). Three treatments failed in patients demonstrated type Ia (3/19, 15,8%). One had type Ib (1/16, 6.3%). Other 6 had no anastomoses. There was no TF rate difference between patients with communication (4/56, 7.1%) and without communication (6/107, 5.7%). However, TF rate in patients with type Ia communication (15.8%) was higher than that without communication (5.7%; P<0.05).
CONCLUSION
Type Ia utero-ovarian anastomoses communication could be a contraindication for embolization treatment for leiomyoma.

Keyword

Leiomyoma; Treatment failure; Uterine artery embolization

MeSH Terms

Angiography
Arteries
Follow-Up Studies
Gadolinium
Humans
Leiomyoma
Magnetic Resonance Spectroscopy
Treatment Failure
Uterine Artery
Uterine Artery Embolization
Gadolinium

Figure

• 

  Fig. 1 Types of ovarian artery to uterine artery anastomoses. (A) Type I ovarian artery to uterine artery anastomoses. The ovarian artery connects to the intramural uterine artery before the fibroid supply through the tubo-ovarian segment (arrow). (B) Type II ovarian artery to uterine artery anastomosis. The ovarian artery supplies the fibroid directly, without prior connection to the uterine artery. (C) Type III ovarian artery to uterine artery anastomosis. The ovarian supply is at least in part from the uterine artery, with flow in the tubo-ovarian segment toward the ovary. Arrow indicates the direction of flow. OA, ovarian artery; UA, uterine artery.

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  Fig. 2 Bilateral type Ia anastomoses in a 46-year-old woman with treatment failure. (A) Pre-embolization anteroposterior abdominal aortogram shows opacification of the both ovarian arteries (arrows). (B, C) Selective right uterine angiograms in anteroposterior projection show typical myomatous blush without evidence of contrast material reflux into the tubo-ovarian segment (arrows). (D) MR image 4 months after uterine artery embolization shows focal peripheral enhancements (white arrows).

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  Fig. 3 Treatment failure in a 35-year-old woman without anastomosis between ovarian artery-to-uterine artery. (A) Pre-embolization anteroposterior abdominal aortogram and (B) left uterine selective uterine angiogram shows myomatous blushes without opacification of contrast material without evidence into the tubo-ovarian segment. (C) MR image 2 months after uterine artery embolization shows focal peripheral enhancement (white arrows).

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