Abstract:
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Purpose: Uterine fibroid embolization has been shown to be an effective & cost efficient alternative to hysterectomy for symptomatic uterine leiomyomata. Various materials may be used to achieve microscopic embolization. Our aim was to prospectively compare fibroid embolisation using calibrated microspheres (Biosphere Medical, Rockland MA) with polyvinyl alcohol particles in order to determine if any additional clinical benefit was conferred with the use of the newer and more expensive embolic material. The clinical outcomes,radiological reduction in dominant uterine leiomyoma size and post procedural complication rates in the two patient groups were assessed.
Methods and Materials: 60 women (mean age 43.6 years) entered the study over a 14 month period beginning May 2000 and were randomly assigned to either group. Indications for treatment were menorrhagia and uterine bulk-related symptoms. Bilateral embolisation of the uterine arteries was performed using PVA particles (300-500um) or calibrated microspheres (300-700um).Ultrasound was performed pre-procedure in 11 patients. MRI was performed in the remainder of patients pre-procedure and all patients had follow-up with MRI post embolisation. Clinical evaluation was made at regular intervals up to 1 year.
Results: Technically successful embolisation was accomplished in 98% of cases. Clinical follow-up to 12 months was completed in all cases. Symptom resolution rate and percentage decrease in size of dominant leiomyoma did not differ statistically between the microsphere and PVA groups. The rate of symptom improvement was 79.3% in the PVA group (23/29 patients) and 83.3% (25/30 patients) in the microsphere group. One major infective complication occurred in the PVA group. Minor complication rates were comparable and did not differ statistically between the groups. Early minor complications (groin haematoma, urinary retention, post embolisation syndrome, non target organ embolisation) occurred in 6/29 patients (20.7%) in the PVA group and 7/30 patients (23.3%) in the calibrated microsphere group. Late minor complications (ovarian failure, fibroid expulsion, endometritis) occurred in 3/29 patients and 3/30 patients in these respective groups.
Conclusion: Both calibrated microspheres and PVA particles are effective embolic agents in UFE. No statistical difference in clinical outcome or complication rate was found. Personal preference and cost are likely to be deciding factors in the choice of agent used.
Johnston MD, C,
Calibrated Microspheres vs Polyvinyl Alcohol Particles in Uterine Fibroid Embolization: Does Choice of Embolic Material Affect Outcome?. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3105186.html