Utero-ovarian Anastomoses and Their Influence on Uterine Fibroid Embolization

• Published in: Journal of vascular and interventional radiology Vol. 23; no. 5; pp. 595 - 601
• Main Authors: Lanciego, Carlos, MD, PhD, Diaz-Plaza, Isabel, MD, Ciampi, Juan-José, MD, Cuena-Boy, Rafael, MD, Rodríguez-Martín, Nieves, MD, Maldonado, Maria-Dolores, MD, Rodriguez-Gómez, Olga, MD, Cañete, Maria-Luisa, MD, García-García, Lorenzo, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2012
• Subjects: Adult; Amenorrhea - etiology; Chi-Square Distribution; Collateral Circulation; Female; Humans; Kaplan-Meier Estimate; Leiomyoma - blood supply; Leiomyoma - complications; Leiomyoma - diagnostic imaging; Leiomyoma - therapy; Middle Aged; Odds Ratio; Ovary - blood supply; Pain - etiology; Radiography; Radiology; Recurrence; Regional Blood Flow; Retrospective Studies; Risk Assessment; Risk Factors; Spain; Time Factors; Treatment Outcome; Uterine Artery - diagnostic imaging; Uterine Artery - physiopathology; Uterine Artery Embolization - adverse effects; Uterine Hemorrhage - etiology; Uterine Neoplasms - blood supply; Uterine Neoplasms - complications; Uterine Neoplasms - diagnostic imaging; Uterine Neoplasms - therapy; UAE; FSH; follicle-stimulating hormone; utero-ovarian anastomoses; UOA; uterine artery embolization
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2012.01.077

Abstract Purpose To correlate clinical outcomes after uterine artery embolization (UAE) performed to treat uterine fibroids with the presence of varying types of utero-ovarian anastomoses (UOA). Materials and Methods A retrospective analysis was performed of all uterine angiograms from 202 patients (mean age 42 y, range 28–54 y) who underwent UAE because of heavy menstrual bleeding, dysmenorrhea, or anemia or a combination of these symptoms. UOA were classified as absent or present, unilateral or bilateral. The effects of UOA on long-term outcomes (clinical endpoints such as control of bleeding and pain) and complications (amenorrhea) were assessed statistically using Kaplan-Meier curves and χ2 and log-rank tests. Results Of the UOA in 104 women, 38 anastomoses were bilateral, and 66 were unilateral. Type III was the most common type of anastomosis (66 cases) followed by type Ia (22 cases) and type Ib (18 cases); there were no type II anastomoses. Amenorrhea was reported in 27 (14%) women at 5-year follow-up after UAE (only 3% in women < 45 y old). There were 10 cases of clinical failure with a median follow-up of > 4 years. Bilateral or unilateral presence of UOA had no statistically significant effect on outcomes or on complications. Conclusions Recurrence rates, clinical failure, and amenorrhea after UAE do not seem to be influenced by the presence or absence of UOA. However, further studies are needed to confirm these findings.