title: Embolization of angiographically visible type I and II utero-ovarian anastomoses during uterine artery embolization for fibroid tumors: impact on symptom recurrence and permanent amenorrhea.
abstract: OBJECTIVE
  To compare the incidences of symptom recurrence and permanent amenorrhea following uterine artery embolization (UAE) for symptomatic fibroid tumors in patients with type I and II utero-ovarian anastomoses (UOAs) with versus without ovarian artery embolization (OAE).
  
  
  METHODS
  A retrospective, institutional review board-approved study of 99 women who underwent UAE for symptomatic fibroid tumors from April 2005 to October 2010 was conducted to identify patients who had type I or II UOAs at the time of UAE. Based on the embolization technique, patients were categorized into standard (ie, UAE only), combined (ie, UAE and OAE), and control (patients without UOAs who underwent UAE) groups. Data collected included patient characteristics, procedural technique and findings, symptom recurrence, secondary interventions, and permanent amenorrhea. Statistical analysis was performed with the Fisher exact test, with significance reached at P < .05.
  
  
  RESULTS
  Twenty patients (20.2%; mean age, 46.9 y ± 6.3) had type I (n = 3) or II (n = 17) UOAs. Thirteen (65%) underwent UAE only (standard group) and seven (35%) underwent UAE and OAE (combined group). There were no significant differences between groups in demographics or in the incidence of permanent amenorrhea after procedures (follow-up, 561 d ± 490). There was a significantly higher incidence of symptom recurrence in the standard group compared with the control group (P = .01), with no differences between combined and control groups (P = 1).
  
  
  CONCLUSIONS
  There were no statistical differences in permanent amenorrhea rates in the groups studied, with significantly higher symptom recurrence rates observed when OAE was not performed in the setting of UOA.
authors.affiliation: Department of Imaging, Division of Vascular Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St., Gray Bigelow 293, Boston, MA 02114, USA. gmsalazar@partners.org
authors.forename: Gloria M M
authors.initials: GM
authors.lastname: Salazar
authors.forename: T
authors.initials: T
authors.lastname: Gregory Walker
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Conway
authors.forename: Kalpana
authors.initials: K
authors.lastname: Yeddula
authors.forename: Stephan
authors.initials: S
authors.lastname: Wicky
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Waltman
authors.forename: Sanjeeva P
authors.initials: SP
authors.lastname: Kalva
mesh_terms: D000568:Amenorrhea / Q000000981:diagnostic imaging / Q000453:epidemiology*; D000792:Angiography / Q000706:statistics & numerical data; D001900:Boston / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D008875:Middle Aged; D010053:Ovary / Q000000981:diagnostic imaging; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D017211:Treatment Failure; D016896:Treatment Outcome; D055988:Uterine Artery / Q000000981:diagnostic imaging*; D055357:Uterine Artery Embolization / Q000706:statistics & numerical data*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*
keywords: DSA; OAE; PVA; UAE; UOA; digital subtraction angiography; ovarian artery embolization; polyvinyl alcohol; uterine artery embolization; utero-ovarian anastomosis