Aims and objectives
Uterine artery embolisation (UAE) is an efficacious and less invasive alternative to surgery that results in infarction,
coagulative necrosis,
and eventual shrinkage of uterine fibroids [1,2].
The procedure is generally associated with a low risk of complications,
but in approximately 2.5% of patients,
there is passage of the fibroid tissue through the uterine wall,
resulting in symptoms of pain,
infection,
or bleeding [3].
In some cases,
the fibroid is fully expelled,
but in others,
the fibroid may simply travel across the uterine wall,
in what...
Methods and materials
Patient selection: A retrospective study identified consecutive non-randomised patients (mean age: 45 years; age range: 30-60) who referred for UAE for symptomatic fibroids at one centre,
in one year.
As per recommended UAE standard protocol,
all patients were required to have underwent a pre-procedural MRI and a post-procedural MRI,
six months after embolization.
Patients without these images were excluded from the study and thus a total study group of 64 women were identified.
Data acquisition: All MRI scans were performed using a 1.5 Tesla (T)...
Results
Of the 64 dominant fibroids,
35 (55%) were intramural,
and of these 13 (37%) either migrated migrated to become submucosal (n=8),
partially expelled (n=2),
or completely expelled (n=3).
Table 1summarises the parameters measured in each dominant intramural fibroid.
Of note,
statistical significance wasachievedin the pre-procedural mean minimal endometrial distance and mean maximal fibroid diameter between migrating and non-migrating intramural fibroids.
Upon re-assessing the images for migrating non-dominant fibroids,
we identified four intramural fibroids that had migrated - their measurements are summarised in Table 2.
Conclusion
The expulsion of fibroid tissue is understandably distressing to patients,
especially if not expected.
Further pain,
after undergoing a treatment intended to resolve that very issue,
can be frustrating.
Our study identified specific fibroid characteristics on a pre-procedural MRI that can predict potential migration of an intramural fibroid,
and hence,
the symptoms associated with the passage of a fibroid through the uterine wall.
According to our findings,
if an intramural fibroid on the pre-procedural MRI has both,
(a) a minimum distance to the endometrium between...
References
Manyonda IT,
Bratby M,
Horst JS,
Banu N,
Gorti M,
Belli AM (2012) Uterine artery embolization versus myomectomy: impact on quality of life-results of the FUME (fibroids of the uterus: myomectomy versus embolization) trial.
Cardiovasc Interv Radiol 35(3):530–536
Goodwin SC,
Spies JB (2009) Uterine fibroid embolization.
N Engl J Med 361(7):690–697
Spies JB,
Spector A,
Roth AR,
et al.
Complications After Uterine Artery Embolization for Leiomyomas.
Obstet Gynaecol 2002; 100(5 Pt 1):873-880
Bulman JC,
Ascher SM,
Spies JB.
Current Concepts in Uterine Fibroid Embolization.
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