Angiographic classification of ovarian artery-to-uterine artery anastomoses: initial observations in uterine fibroid embolization.
OBJECTIVE
To prospectively study and classify the anastomoses between the ovarian and uterine arteries in women undergoing uterine fibroid embolization, and to compare the presence of such with procedural failures and premature menopause.


METHODS
Angiographic ovarian artery-to-uterine artery anastomoses were studied in 76 consecutive patients undergoing uterine fibroid embolization. Mean patient age was 44.7 years (range, 29-56 years). Clinical follow-up consisted of a standard questionnaire. Procedural failure and complications were compared with the presence of various types of ovarian artery-to-uterine artery connections.


RESULTS
Three types of anastomoses were identified. In type I (33 [21.7%] of 152 arteries), flow from the ovarian artery to the uterus was through anastomoses with the main uterine artery. In type II (six arteries [3.9%]), the ovarian artery supplied the fibroids directly. In type III (10 arteries [6.6%]), the major blood supply to the ovary was from the uterine artery. Seven patients (9%) were considered to have clinical failure, with three of the six women with type II anastomoses being in this group. Three of the five women who experienced menopause after fibroid embolization had bilateral ovarian artery-to-uterine artery anastomoses that were classified as high risk.


CONCLUSIONS
Delineation of ovarian artery-to-uterine artery anastomosis is of practical relevance in avoiding nontarget ovarian embolization, in identification of those who would be at risk of uterine artery embolization or ovarian failure, and in those in whom the ovarian artery can be embolized safely.
Razavi
Mahmood K
MK
Department of Vascular and Interventional Radiology, Stanford University Vascular Center, 300 Pasteur Dr, H-3651, CA 94305, USA. mrazavi@stanford.edu
Wolanske
Kristen A
KA
Hwang
Gloria L
GL
Sze
Daniel Y
DY
Kee
Stephen T
ST
Dake
Michael D
MD
D000328:Adult; D000792:Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000098:blood supply / Q000628:therapy*; D008875:Middle Aged; D010053:Ovary / Q000098:blood supply*; D014594:Uterine Neoplasms / Q000098:blood supply / Q000628:therapy*; D014599:Uterus / Q000098:blood supply*