title: Technical results and effects of operator experience on uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial.
abstract: OBJECTIVE
  To document the technical results and spectrum of practice of uterine artery embolization (UAE) for fibroids in the health care setting in Canada. The effects of interventional radiologist's (IR's) experience with UAE on procedure and fluoroscopy time were also investigated.
  
  
  METHODS
  The study involved a multicenter prospective single-arm clinical treatment trial and included the practices of 11 IRs at eight university-affiliated teaching and community hospitals. Vascular access with percutaneous femoral artery approach was followed by transcatheter delivery of polyvinyl alcohol (PVA) particles into uterine arteries with fluoroscopic guidance. Technical success, complications, procedural time, fluoroscopy time, and effects of operator experience were outcomes analyzed.
  
  
  RESULTS
  Between November 1998 and November 2000, 570 embolization procedures were performed in 555 patients. UAE was bilaterally successful in 97% (95% CI: 95%-98%). Variant anatomy was the most common reason for failure to embolize bilaterally. The procedural complication rate was 5.3% (95% CI: 3.6%-7.4%). Of the 30 events, three involved major complications (one seizure and two allergic reactions) that resulted in additional care or extended hospital stay. Procedure time and fluoroscopy time averaged 61 minutes (95% CI; 58-63 minutes) and 18.9 minutes (95% CI; 18-19.8) and varied significantly among IRs (P <.001; P <.001). The average 27% reduction in procedure time (20 minutes; P <.001) and 24% reduction in fluoroscopy time (5.1 minutes; P <.001) with increasing UAE experience were significant.
  
  
  CONCLUSIONS
  A high level of technical success with few complications was obtained with a variety of operators in diverse practice settings. Increased experience in UAE significantly reduced procedure and fluoroscopy time.
authors.affiliation: Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada. g.pron@utoronto.ca
authors.forename: Gaylene
authors.initials: G
authors.lastname: Pron
authors.forename: John
authors.initials: J
authors.lastname: Bennett
authors.forename: Andrew
authors.initials: A
authors.lastname: Common
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sniderman
authors.forename: Murray
authors.initials: M
authors.lastname: Asch
authors.forename: Stuart
authors.initials: S
authors.lastname: Bell
authors.forename: Roman
authors.initials: R
authors.lastname: Kozak
authors.forename: Leslie
authors.initials: L
authors.lastname: Vanderburgh
authors.forename: Greg
authors.initials: G
authors.lastname: Garvin
authors.forename: Martin
authors.initials: M
authors.lastname: Simons
authors.forename: Cuong
authors.initials: C
authors.lastname: Tran
authors.forename: John
authors.initials: J
authors.lastname: Kachura
mesh_terms: D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction; D001158:Arteries; D004522:Educational Status; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007889:Leiomyoma / Q000098:blood supply / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000706:statistics & numerical data; D011871:Radiology / Q000193:education; D014594:Uterine Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000628:therapy*; D014599:Uterus / Q000098:blood supply*