[Uterine artery embolization for myomas treatment]

Risk Factors of Complications After Uterine Artery Embolisation for Symptomatic Fibroids: A Case-Control Study

OBJECTIVE

We aim to clarify potential risk factors of complications after uterine artery embolisation (UAE).

SETTING

Complications after uterine artery embolisation (UAE) for symptomatic fibroids are rare, but failure of treatment occurs for approximately 13%-24% of patients at 10 years.

DESIGN

We conducted a case-control study including all complications post UAE over 15 years in our specialised unit.

POPULATION

All Grade 2 complications (or worse) for the Society of Interventional Radiology Standards of Practice Committee complications post UAE were considered. One thousand one hundred seventy-two UAE were performed.

METHODS

Complications were divided into two groups: early (< 1 month) or late (≥ 1 month) to differentiate complications from failure of procedure. Multinomial analysis was conducted to assess links between complications and potential risk factors.

RESULTS

Sixty-nine (0.06%) complications were found: 24.6% hospitalisation for pain (n = 17/69), 30.4% for infection (n = 21/69) and 2.9% expulsion of fibroid (n = 2/69). Overall, 31 patients underwent a second procedure (45%).

MAIN OUTCOME MEASURES

Intra-uterine device and multiple fibroids were strongly related to early complications (ORearly = 4.44, IC 95%: 1.5-13.3 and ORearly = 3.7, IC 95%: 1.2-11.3, respectively). The only factor that appeared to be associated with risk of early and late complications was the major fibroid's diameter (for an increased size of 25 mm, ORearly = 1.7, IC 95%: 1.1-2.6; ORlate = 1.5, IC 95%: 1.04-2.2).

CONCLUSION

Our study enlightens about the potential risk factors of UAE's complications and differentiate their impact between early and late complications.

MRI analysis of uterine ischaemia as a form of non-target embolisation following uterine artery embolisation: incidence, extent and outcome

AIM

To study the incidence, extent and fate of uterine ischaemia as one of the forms of non-target embolisation following uterine artery embolisation (UAE), as detected on immediate post-embolisation and contrast-enhanced magnetic resonance imaging (MRI) examinations at the 3-month follow-up.

MATERIALS AND METHODS

A retrospective study was undertaken comprising 43 women (mean age: 44.8 ± 3.79 years). MRI was performed before, immediately after (within 6 h), and 3 months after successful UAE. Areas of uterine ischaemia were identified on immediate post-embolisation MRI as regions of newly developed (compared to pre-embolisation MRI) absent enhancement within the uterus not corresponding to the location of the leiomyoma. The volume of the ischaemic region was calculated using the formula (height × length × width × 0.523).

RESULTS

Uterine ischaemia was encountered in 29 patients (67.44%). The mean volume of the ischaemic region immediately after UAE was 29.29 ± 19.15 ml (range: 7.36-87.71 ml). At 3-month follow-up, it was 0.35 ± 0.95 ml (range: 0-3.5 ml) with 25 (86%) patients showing complete resolution of the ischaemia. The mean reduction in the volume of the ischaemic region at the 3-month follow-up was 98.24 ± 5.72% (range: 72-100%). This volume reduction was statistically significant (p<0.0001).

CONCLUSION

Uterine ischaemia as a form of non-target embolisation following UAE might be encountered in up to two thirds of patients. These ischaemic areas are significantly reduced at the 3-month follow-up with up to 86% of cases showing complete reversibility of the ischaemia.

Is an abdominal cerclage indicated with a cervical myomectomy? A case report

INTRODUCTION

Cervical myomectomy can compromise cervical integrity and the risk of subsequent cervical incompetence is unclear. In this case report, the literature on cervical myomectomies is reviewed as well as that on the potential benefits of cervical cerclage.

CASE PRESENTATION

A 30-year-old woman, nulligravida, with a 12 cm cervical leiomyoma consulted for heavy menstrual bleeding and pelvic pain. After failure of multiple medical therapies, a laparoscopic cervical myomectomy was successfully performed after pre-operative uterine artery embolization using absorbable gelatin sponges to reduce surgical blood loss.

DISCUSSION

A concomitant laparoscopic cerclage was achieved in order to prevent cervical incompetence, given that the full thickness of the anterior cervix was penetrated during the myomectomy.