title: MRI assessment of uterine artery patency and fibroid infarction rates 6 months after uterine artery embolization with nonspherical polyvinyl alcohol.
abstract: OBJECTIVE
  We have observed significant rates of uterine artery patency after uterine artery embolization (UAE) with nonspherical polyvinyl alcohol (nsPVA) on 6 month follow-up MR scanning. The study aim was to quantitatively assess uterine artery patency after UAE with nsPVA and to assess the effect of continued uterine artery patency on outcomes.
  
  
  METHODS
  A single centre, retrospective study of 50 patients undergoing bilateral UAE for uterine leiomyomata was undertaken. Pelvic MRI was performed before and 6 months after UAE. All embolizations were performed with nsPVA. Outcome measures included uterine artery patency, uterine and dominant fibroid volume, dominant fibroid percentage infarction, presence of ovarian arterial collaterals, and symptom scores assessed by the Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL).
  
  
  RESULTS
  Magnetic resonance angiographic evidence of uterine artery recanalization was demonstrated in 90 % of the patients (64 % bilateral, 26 % unilateral) at 6 months. Eighty percent of all dominant fibroids demonstrated >90 % infarction. The mean percentage reduction in dominant fibroid volume was 35 %. No significant difference was identified between nonpatent, unilateral, and bilateral recanalization of the uterine arteries with regard to percentage dominant fibroid infarction or dominant fibroid volume reduction. The presence of bilaterally or unilaterally patent uterine arteries was not associated with inferior clinical outcomes (symptom score or UFS-QOL scores) at 6 months.
  
  
  CONCLUSIONS
  The high rates of uterine artery patency challenge the current paradigm that nsPVA is a permanent embolic agent and that permanent uterine artery occlusion is necessary to optimally treat uterine fibroids. Despite high rates of uterine artery recanalization in this cohort, satisfactory fibroid infarction rates and UFS-QOL scores were achieved.
authors: Department of Radiology, St George's Healthcare NHS Trust, Blackshaw, London, SW17 0QT, UK, rajdas@nhs.net.
authors: Raj
authors: R
authors: Das
authors: Michael
authors: M
authors: Gonsalves
authors: Ioannis
authors: I
authors: Vlahos
authors: Issac
authors: I
authors: Manyonda
authors: Anna-Maria
authors: AM
authors: Belli
mesh_terms: D000704:Analysis of Variance; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D011142:Polyvinyl Alcohol / Q000627:therapeutic use*; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055988:Uterine Artery / Q000473:pathology*; D055357:Uterine Artery Embolization / Q000379:methods*; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*; D014654:Vascular Patency / Q000187:drug effects
chemical_list: D003287:Contrast Media; D011142:Polyvinyl Alcohol