title: Treatment failure after uterine artery embolization: prospective cohort study with multifactorial analysis of possible predictors of long-term outcome.
abstract: OBJECTIVE
  To evaluate the impact of baseline characteristics and residual leiomyoma perfusion after uterine artery embolization (UAE) on clinical long-term outcome.
  
  
  METHODS
  One hundred fifteen patients underwent UAE. All patients were divided into three groups according to achieved infarction rate determined on contrast-enhanced magnetic resonance imaging within 48-72 h after UAE (I: 100%, n=60; II: 90-99%, n=32; and III: 0-89%, n=23). Treatment failure and subsequent re-interventions (surgery, repeat UAE) were assessed for each group and compared using Cox regression analysis (CRA) with respect to the following baseline variables: age, uterine and dominant fibroid volume, number of fibroids, location of largest fibroid, and clinical symptoms.
  
  
  RESULTS
  Long-term follow-up was completed after a median of 7.2 years (range 5.1-9.6) with a response rate of 84%. CRA revealed that patients in group III had a 22.2-fold higher risk (p<0.001) of treatment failure than patients in group I, whereas groups I and II did not differ significantly (p=0.578). For patients with bleeding-related symptoms only, CRA showed a 5.1-fold higher risk (p=0.025) of treatment failure than for patients with equally dominant bleeding- and bulk-related symptoms. A 40.5-fold higher likelihood (p<0.001) of treatment failure was observed for patients in group III with bleeding-related symptoms only compared to those in group I with combined bleeding- and bulk-related symptoms.
  
  
  CONCLUSIONS
  Incomplete fibroid infarction after UAE is strongly associated with the risk of experiencing treatment failure. Patients with bleeding-related complaints only face the highest likelihood of treatment failure if UAE results in less than 90% fibroid devascularization.
authors.affiliation: Department of Radiology, Charité Universtätsmedizin Berlin, Augustenburger Platz 1, 13359 Berlin, Germany. christian.scheurig@charite.de
authors.forename: Christian
authors.initials: C
authors.lastname: Scheurig-Muenkler
authors.forename: Clemens
authors.initials: C
authors.lastname: Koesters
authors.forename: Christian
authors.initials: C
authors.lastname: Grieser
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kroencke
mesh_terms: D000328:Adult; D015897:Comorbidity; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D008137:Longitudinal Studies; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000706:statistics & numerical data*; D014592:Uterine Hemorrhage / Q000453:epidemiology* / Q000473:pathology; D014594:Uterine Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*