Technical results and effects of operator experience on uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial.
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.
Pron
Gaylene
G
Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada. g.pron@utoronto.ca
Bennett
John
J
Common
Andrew
A
Sniderman
Kenneth
K
Asch
Murray
M
Bell
Stuart
S
Kozak
Roman
R
Vanderburgh
Leslie
L
Garvin
Greg
G
Simons
Martin
M
Tran
Cuong
C
Kachura
John
J
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*