Kalpana Yeddula MBBS, Presenter: Nothing to Disclose

Raymond F. Conway MD, Abstract Co-Author: Nothing to Disclose

Sanjeeva P. Kalva MD, Abstract Co-Author: Research grant, AngioDynamics, Inc

Thomas Gregory Walker MD, Abstract Co-Author: Scientific Advisory Board, Medtronic, Inc

Stephan Wicky MD, Abstract Co-Author: Consultant, Johnson & Johnson

Gloria Maria Martinez Salazar MD, Abstract Co-Author: Nothing to Disclose

To compare resumption of menses in patients with angiographically visible utero-ovarian anastomosis at the time of UAE with or without ovarian artery embolization  

This is an IRB-approved retrospective study of 144 women who underwent UAE for symptomatic fibroids from 1/2004-1/2010. The medical records and procedural images were reviewed to identify angiographically visible utero-ovarian anastomoses at the time of UAE. Patients were categorized based on procedural technique: combined embolization (uterine and ovarian artery) and standard embolization (uterine artery only). Data collected included patient characteristics, procedural technique, imaging findings, post-UAE resumption of menses and treatment failure incidence. Statistical analysis was performed with chi-square test with significance reached at p< 0.05.

26/144 (18%) patients (median age 48 years; range 38-56) had utero-ovarian anastomoses and collateral ovarian arterial supply to the fibroids. 25/26 (96%) patients underwent uterine artery embolization and 12/26 (46%) patients had concurrent ovarian artery embolization. The decision to perform ovarian embolization was based on the anatomy and patient’s desire to preserve ovarian function. Embolic agents included trys acryl, gelfoam and polyvinyl alcohol particles for both uterine and ovarian artery embolization. The mean follow-up was 22 months (range 2-55 months). Three patients had no clinical follow-up. There were no significant differences in demographics nor in resumption of menses after UAE for both groups. There was a significant difference (p= 0.037) in the UAE failure rate of symptom relief based on reintervention requirements, with 21.4 % (standard group) requiring hysterectomy, and 8.3% (combined group) requiring myomectomy.

There is no significant difference in the resumption of menses in patients with angiographically visible utero-ovarian anastomosis with or without ovarian artery embolization for fibroid treatment. However there is a significant impact on long-term outcomes, with a higher treatment failure rate when ovarian embolization is not performed.

Embolization of collateral ovarian arterial supply to uterine fibroids provides better treatment outcomes following UAE with minimal effect on resumption of menses.

Yeddula, K, Conway, R, Kalva, S, Walker, T, Wicky, S, Salazar, G, Ovarian Artery Embolization in Patients Undergoing Uterine Artery Embolization (UAE) for Treatment of Uterine Fibroids with Angiographically Visible Utero-Ovarian Anastomosis: Is There a Difference in Resumption of Menses?   .  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9009251.html