1 Department of Clinical Medicine - Department of Obstetrics and Gynaecology, Department of Clinical Medicine, Health, Aarhus University2 Department of Clinical Medicine - Røntgen og Skanning, SKS, Department of Clinical Medicine, Health, Aarhus University3 Center of Magnetic Resonance, Faculty of Health Sciences, Aarhus University, Aarhus University4 Department of Clinical Medicine - Department of Obstetrics and Gynaecology, Department of Clinical Medicine, Health, Aarhus University5 Department of Clinical Medicine - Røntgen og Skanning, SKS, Department of Clinical Medicine, Health, Aarhus University
Objective To evaluate outcome of invasive gynecological re-interventions after uterine artery embolisation (UAE) in relation to leiomyoma characteristics. Design 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.
European Journal of Obstetrics and Gynecology and Reproductive Biology, 2014, Vol 178, p. 100-106