title: Long-term efficacy and safety of uterine artery embolization in young patients with and without uteroovarian anastomoses.
abstract: OBJECTIVE
  To assess long-term clinical efficacy of uterine artery embolization (UAE) in young women and the clinical significance of patent anastomoses between uterine and ovarian arteries.
  
  
  METHODS
  Consecutive women no older than 39 years of age treated with UAE for symptomatic uterine leiomyomata with at least 3 years of follow-up were included in the study. Analysis includes angiographic images, pre- and postoperative magnetic resonance (MR) images, and symptom evaluations. Clinical evaluation and symptom severity scores (SSSs) were obtained at 6 months and yearly. Leiomyomata volume change, SSS, and repeat intervention rates were compared for patients with and without anastomoses between uterine and ovarian arteries.
  
  
  RESULTS
  The study cohort included 87 patients, including 30 white patients (34.4%), 49 black patients (56.3%), and eight patients of other ethnicities (9.2%). Anastomoses were demonstrated in 41 patients (47.1%). Seventy patients (80.5%) completed the long-term follow-up, of whom 35 had an anastomosis (85.4% of the 41 patients with anastomoses) and 35 did not (76.1% of the 46 patients without anastomoses). Mean leiomyoma volume reduction was 49.1% (P = .018), and reduction of uterine volume was 36.0% (P < .001). Mean clinical follow-up duration was 45 months. Overall, 18 of 70 patients (25.7%) underwent repeat interventions, including 13 (37.1%) with anastomoses and five (14.3%) without anastomoses (P = .029). One patient (1.4%) developed natural amenorrheic change in the long term after UAE. Nineteen patients (27.1%) attempted pregnancy after UAE, and 12 patients had 15 pregnancies, with six pregnancies to full term.
  
  
  CONCLUSIONS
  UAE in young patients achieves significant dominant leiomyoma volume reduction and symptomatic improvements, with overall repeat intervention rates of 25.7% in the long term. Uteroovarian anastomoses in young patients are associated with higher rates of repeat intervention after UAE.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 545, Baltimore, MD 21287-4010, USA. sikhkim@jhmi.edu
authors.forename: Hyun S
authors.initials: HS
authors.lastname: Kim
authors.forename: Ben E
authors.initials: BE
authors.lastname: Paxton
authors.forename: Judy M
authors.initials: JM
authors.lastname: Lee
mesh_terms: D000328:Adult; D001163:Arteriovenous Anastomosis; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000628:therapy*; D010053:Ovary / Q000098:blood supply*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000628:therapy*; D014599:Uterus / Q000098:blood supply*