title: Re-intervention after uterine leiomyoma embolisation is related to incomplete infarction and presence of submucous leiomyomas.
abstract: OBJECTIVE
  To evaluate outcome of invasive gynecological re-interventions after uterine artery embolisation (UAE) in relation to leiomyoma characteristics.
  
  
  METHODS
  A cohort of 114 women with symptomatic myomas underwent UAE. Myoma characteristics were determined by contrast-enhanced magnetic resonance imaging (MRI) before and 6 months after treatment. The median follow-up time after UAE was 55.9 months; (range 20-116). Data on gynecological re-interventions were obtained for all patients and were analysed using the Kaplan-Meier method. Data were obtained on frequency of invasive re-interventions: major myoma procedures (hysterectomy, re-embolisation, laparoscopic or abdominal myomectomy) and outpatient hysteroscopic myoma procedures. Myoma characteristics with impact on outcome of re-interventions were determined by statistical analysis.
  
  
  RESULTS
  Total re-intervention rate was 35.1%. Hysterectomy was performed due to myoma related symptoms in 6.1% of patients, but 23.7% of patients underwent additional uterine procedures, mainly outpatient hysteroscopy (15%). Major myoma re-intervention correlated with the extent of the infarct at follow-up MRI (n=107). Patients had undergone major re-intervention (3 years) as follows: infarct group C (<80%, n=16) 44%, infarct group B (80-99%, n=16) 19%, and infarct group A (100%, n=75) 10.1% ((p<0.01) for both A vs B+C and A+B vs C). Major re-interventions were not associated with the presence of submucous myomas; but the hazard ratio (CI 95%) for undergoing hysteroscopic re-intervention was 8.4 (2-29) (p=0.001) in patients with submucous myomas, but 12.7 (5-35) (p<0.0001) in patients with more than one submucous myomas.
  
  
  CONCLUSIONS
  Complete infarction after UAE reduces the need for major re-interventions. Assessment of complete infarction may be considered to improve quality in UAE procedures. Patients with more than one submucous myoma at UAE may often have hysteroscopic removal of residual myomas.
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus N, 8200, Denmark. Electronic address: dueholm@dadlnet.dk.
authors.forename: Margit
authors.initials: M
authors.lastname: Dueholm
authors.affiliation: Department of Radiology, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus N, 8200, Denmark.
authors.forename: Sten
authors.initials: S
authors.lastname: Langfeldt
authors.affiliation: Department of Radiology, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus N, 8200, Denmark.
authors.forename: Hossain M
authors.initials: HM
authors.lastname: Mafi
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus N, 8200, Denmark.
authors.forename: Gitte
authors.initials: G
authors.lastname: Eriksen
authors.affiliation: Department of Radiology, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus N, 8200, Denmark.
authors.forename: Edvard
authors.initials: E
authors.lastname: Marinovskij
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007238:Infarction / Q000473:pathology; D007889:Leiomyoma / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D012086:Reoperation; D055357:Uterine Artery Embolization; D014594:Uterine Neoplasms / Q000601:surgery*; D014599:Uterus
keywords: Leiomyoma; Outcome; Re-interventions; Uterine artery embolisation