title: Long-term results of uterine artery embolization for symptomatic adenomyosis.
abstract: OBJECTIVE
  Controversy exists regarding the effectiveness of uterine artery embolization (UAE) in the management of symptomatic adenomyosis. The aim our study was to determine the long-term clinical efficacy of UAE in the management of symptomatic adenomyosis without fibroids.
  
  
  METHODS
  The cases of all patients who underwent UAE for adenomyosis without fibroids between 1998 and 2000 were analyzed. This study was a retrospective review of a prospectively collected database. Of the 66 patients, 54 patients with a follow-up period of 3 years or longer were enrolled in the study. Twelve patients were lost to follow-up. The patients' ages ranged from 29 to 49 years (mean, 40.2 years). The mean follow-up period was 4.9 years (range, 3.5-5.8 years). The primary embolic agent was polyvinyl alcohol particles (250-710 microm). All patients underwent MRI before UAE. Long-term follow-up MRI was performed on 29 patients; 22 of these patients had undergone short-term (3.5 months) follow-up MRI. Uterine volume was calculated with MR images. Symptom status in terms of menorrhagia and dysmenorrhea was scored on a scale of 0-10, 0 being no symptoms and 10 being the baseline, or initial symptoms.
  
  
  RESULTS
  Thirty-one (57.4%) of the 54 women who underwent follow-up had long-term success. Four had immediate treatment failure, and 19 had relapses. Changes in mean menorrhagia and dysmenorrhea scores at long-term follow-up were -5.3 and -5.1, respectively (p < 0.001), representing significant relief of symptoms. The time between UAE and recurrence of symptoms ranged from 4 to 48 months (mean, 17.3 months). Five patients underwent hysterectomy because of symptom recurrence. Mean reduction in volume of the uterus was 26.3% at short-term follow-up and 27.4% at long-term follow-up.
  
  
  CONCLUSIONS
  We found that UAE is effective in the management of symptomatic adenomyosis and has an acceptable long-term success rate. UAE should be considered a primary treatment method for patients with symptomatic adenomyosis. However, all patients should be given an explanation of the possibility of treatment failure, recurrence, and the need for hysterectomy.
authors.affiliation: Department of Diagnostic Radiology, Bundang CHA General Hospital, Pochon CHA University, 351 Yatap-dong, Bundang-gu, Sungnam-si, Kyonggi-do, 463-712, Republic of Korea. mdkim@cha.ac.kr
authors.forename: Man Deuk
authors.initials: MD
authors.lastname: Kim
authors.forename: Sehuyn
authors.initials: S
authors.lastname: Kim
authors.forename: Nahk Keun
authors.initials: NK
authors.lastname: Kim
authors.forename: Mee Hwa
authors.initials: MH
authors.lastname: Lee
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Ahn
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Cho
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Cha
mesh_terms: D000328:Adult; D004621:Embolization, Therapeutic / Q000379:methods*; D004715:Endometriosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014599:Uterus / Q000098:blood supply* / Q000601:surgery*