Δευτέρα 29 Οκτωβρίου 2018

Five-year clinical outcomes of uterine artery embolization for symptomatic leiomyoma: an analysis of risk factors for reintervention

Publication date: Available online 28 October 2018

Source: European Journal of Radiology

Author(s): Kyung Yoon Ja, Kichang Han, Man-Deuk Kim, Gyoung Min Kim, Joon Ho Kwon, Jong Yun Won, Yun Lee Do

Abstract
Objectives

The objective of this study is to investigate the five year reintervention rate of uterine artery embolization (UAE) and to identify potential predictive factors of reintervention.

Methods

From March 2011 to February 2012, 92 consecutive women (mean age 41.9 years, range 28–55 years) underwent bilateral UAE for leiomyoma. Contrast-enhanced magnetic resonance imaging (MRI) was performed at three month follow-up. After annual follow-up, a survey on clinical outcome and reintervention incidences were performed at five year follow-up. Potential predictive factors of reintervention were evaluated.

Results

Of the 67 patients, menorrhagia and/or bulk-related symptoms were resolved after UAE in all but one patient (98.5%). At median follow-up of 60 months (range, 5-60 months), reintervention rate was 10.4%, with seven reintervention cases (five myomectomy and two hysterectomy cases). Complete (100%) or near complete (90-99%) infarction rate of the dominant leiomyoma was 96.4% (54 of 56). Independent factors of reintervention on multivariate logistics regression analysis included near complete or partial (<90%) infarction of the dominant leiomyoma (odds ratio [OR] 22.238; 95% confidence interval [CI] 2.405–205.620; p =  0.006) and the presence of non-dominant viable leiomyomas (OR 12.134; 95% CI 1.213–121.409; p =  0.034).

Conclusion

UAE provides excellent and sustained symptom improvement with low reintervention rate. In addition to near complete or partial infarction of the dominant leiomyoma on follow-up MRI, the presence of viable non-dominant leiomyomas indicates higher risk of reintervention.



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