title: Comparison of embolic agents used in uterine artery embolisation: a systematic review and meta-analysis.
abstract: OBJECTIVE
  This study was designed to undertake systematic review and meta-analysis of published comparative trials comparing embolic agents used in uterine artery embolisation (UAE) for uterine leiomyomata.
  
  
  METHODS
  Systematic literature searches were performed in MEDLINE, Embase, PubMed, and Cochrane Central databases from database inception to July 2012. Randomised and nonrandomised trials comparing two or more embolic agents used in UAE were included. Assessment included five widely used embolic agents: nonspherical polyvinyl alcohol (PVA) (Contour PVA, Boston Scientific or PVA Cook Medical); spherical PVA (Contour SE, Boston Scientific); acrylamido PVA (Beadblock, Biocompatibles, Terumo); tris-acryl gelatin microspheres (TAGM) (Embospheres, Merit Medical Inc); and polyzene-F hydrogel microspheres (Embozenes, CeloNova Biosciences). Outcomes assessed included: quality of life (QOL), assessment, magnetic resonance imaging (MRI), uterine and fibroid volumes and degrees of MRI fibroid enhancement and devascularisation. A total of 262 citations were reviewed with 5 randomised, controlled trials involving 295 women and 5 non-RCTs involving 617 women included.
  
  
  RESULTS
  No evidence of superiority of any embolic agent was demonstrated. Meta-analysis was performed between TAGM (Embospheres) and spherical PVA microspheres. Two RCTs found a trend toward greater uterine and dominant fibroid volume reductions with Embospheres but the combined differences were not statistically significant (p = 0.78 and p = 0.94 respectively). Embospheres demonstrated greater percentage fibroid devascularisation than spherical PVA (p = 0.039).
  
  
  CONCLUSIONS
  This study confirms that the current evidence demonstrates superiority of Embospheres over spherical PVA but no reported differences in outcomes between any of the other agents. Comparison of embolic agents was limited by lack of RCT data and further research is warranted.
authors.affiliation: Department of Radiology, St George's Hospital, Blackshaw Road, London, SW17 0QT, United Kingdom, rajdas@nhs.net.
authors.forename: Raj
authors.initials: R
authors.lastname: Das
authors.forename: Rita
authors.initials: R
authors.lastname: Champaneria
authors.forename: Jane P
authors.initials: JP
authors.lastname: Daniels
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Belli
mesh_terms: D000180:Acrylic Resins / Q000627:therapeutic use*; D005260:Female; D005780:Gelatin / Q000627:therapeutic use*; D006801:Humans; D007889:Leiomyoma / Q000628:therapy*; D008863:Microspheres; D011142:Polyvinyl Alcohol / Q000627:therapeutic use*; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*; D014594:Uterine Neoplasms / Q000628:therapy*
chemical_list: D000180:Acrylic Resins; C496735:trisacryl gelatin microspheres; D005780:Gelatin; D011142:Polyvinyl Alcohol