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Ovarian arteries embolization in women with persistent symptoms following uterine arteries embolization for uterus fibroids

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

In patients with persisting symptoms after uterine arteries embolization (UAE), ovarian arteries embolization (OAE) may play a role to improve symptoms and decrease subsequent surgery rates. In a retrospective cohort, we aimed to investigate the efficacy and safety of OAE in females with recurrent or persistent symptoms following UAE.

Methods

We performed a retrospective analysis of prospectively collected cases at a single reference academic hospital; we identified patients who benefited from OAE for persisting symptoms following UAE from 2008 to 2021. Outcome variables included the rates of subsequent surgery, a quality-of-life questionnaire with the UFS-QOL tool, the MRI reduction in uterine and fibroids volumes and the fibroid devascularization rate.

Results

Among 1300 women treated with UAE during the study period, 18 eventually received OAE and were included (mean age 44 ± 4.3 SD). There was no OAE procedural complication.

There was a decrease in uterine volume and a complete devascularization of the dominant fibroid in 10/11 (90.9%) patients who underwent 12 months MRI. Three women underwent subsequent hysterectomy. Among 10/18 patients who answered the quality-of-life questionnaire after a mean follow-up of 70 months, eight reported an improvement or stability of symptoms.

Conclusion

OAE for persisting symptoms after UAE was associated with improvement or stability of quality-of-life in most study subjects and less than a fifth of the cohort underwent hysterectomy after OAE. This study highlights the role of OAE as an adjunct to UAE.

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Data availability

Aggregated data shall be made available to a qualified investigator upon reasonable request to the corresponding author.

References

  1. Stewart E, Cookson C, Gandolfo R, Schulze-Rath R (2017) Epidemiology of uterine fibroids: a systematic review. BJOG Int J Obstet Gynaecol 124:1501–1512. doi:https://doi.org/10.1111/1471-0528.14640

    Article  CAS  Google Scholar 

  2. Ravina, J. H., Herbreteau, D., Ciraru-Vigneron, N., Bouret, J. M., Houdart, E., Aymard, A., & Merland, J. J. (1995). Arterial embolisation to treat uterine myomata. Lancet (London, England), 346(8976), 671–672. doi:https://doi.org/10.1016/s0140-6736(95)92282-2

    Article  CAS  Google Scholar 

  3. Spies J (2013) Current Evidence on Uterine Embolization for Fibroids. Semin Interv Radiol 30:340–346. doi:https://doi.org/10.1055/s-0033-1359727

    Article  Google Scholar 

  4. Kisilevzky N Kisilevzky Nestor. Uterine embolization for management of symptomatic fibroids: quality-of-life impact. Radiol Bras [Internet]. 2007 Oct [cited 2021 Feb 05] ; 40( 5 ): 289-296. 8

    Article  Google Scholar 

  5. Kim HS, Paxton BE, Lee JM (2008) Long-term Efficacy and Safety of Uterine Artery Embolization in Young Patients with and without Uteroovarian Anastomoses. J Vasc Interv Radiol 19:195–200. doi:https://doi.org/10.1016/j.jvir.2007.08.014

    Article  PubMed  Google Scholar 

  6. Manyonda I, Belli A-M, Lumsden M-A, et al (2020) Uterine-Artery Embolization or Myomectomy for Uterine Fibroids. N Engl J Med 383:440–451. doi:https://doi.org/10.1056/NEJMoa1914735

    Article  PubMed  Google Scholar 

  7. Goodwin, S. C., Spies, J. B., Worthington-Kirsch, R., Peterson, E., Pron, G., Li, S., Myers, E. R., & Fibroid Registry for Outcomes Data (FIBROID) Registry Steering Committee and Core Site Investigators (2008). Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID Registry. Obstetrics and gynecology, 111(1), 22–33. doi:https://doi.org/10.1097/01.AOG.0000296526.71749.c9

    Article  PubMed  Google Scholar 

  8. Andrews RT, Bromley PJ, Pfister ME (2000) Successful Embolization of Collaterals from the Ovarian Artery during Uterine Artery Embolization for Fibroids: A Case Report. J Vasc Interv Radiol 11:607–610. doi:https://doi.org/10.1016/S1051-0443(07)61613-3

    Article  CAS  PubMed  Google Scholar 

  9. Matson M, Nicholson A, Belli A-M (2000) Anastomoses of the Ovarian and Uterine Arteries: A Potential Pitfall and Cause of Failure of Uterine Embolization. Cardiovasc Intervent Radiol 23:393–396. doi:https://doi.org/10.1007/s002700010090

    Article  CAS  PubMed  Google Scholar 

  10. Abbara S, Nikolic B, Pelage J-P, et al (2007) Frequency and Extent of Uterine Perfusion via Ovarian Arteries Observed During Uterine Artery Embolization for Leiomyomas. Am J Roentgenol 188:1558–1563. doi:https://doi.org/10.2214/AJR.05.1383

    Article  Google Scholar 

  11. Pelage JP, Walker WJ, Le Dref O, Rymer R. Ovarian artery: angiographic appearance, embolization and relevance to uterine fibroid embolization. Cardiovasc Intervent Radiol. 2003 May-Jun;26(3):227-33.

    Article  CAS  Google Scholar 

  12. Razavi MK, Wolanske KA, Hwang GL, Sze DY, Kee ST, Dake MD. Angiographic classification of ovarian artery-to-uterine artery anastomoses: initial observations in uterine fibroid embolization. Radiology. 2002; 224:707–712.

    Article  Google Scholar 

  13. Barth MM, Spies JB. Ovarian artery embolization supplementing uterine embolization for leiomyomata. J Vasc Interv Radiol. 2003 Sep;14(9 Pt 1):1177-82.

    Article  Google Scholar 

  14. Hu NN, Kaw D, McCullough MF, Nsouli-Maktabi H, Spies JB. Menopause and menopausal symptoms after ovarian artery embolization: a comparison with uterine artery embolization controls. J Vasc Interv Radiol. 2011 May;22(5):710-715.e1.

    Article  Google Scholar 

  15. Campbell J, Rajan DK, Kachura JR, et al. Efficacy of ovarian artery embolization for uterine fibroids: clinical and magnetic resonance imaging evaluations. Can Assoc Radiol J. 2015 May;66(2):164-70.

    Article  Google Scholar 

  16. Von Elm E, Altman DG, Egger M, et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457. doi:https://doi.org/10.1016/S0140-6736(07)61602-X

    Article  Google Scholar 

  17. Spies JB, Coyne K, Guaou Guaou N, Boyle D, Skyrnarz-Murphy K, Gonzalves SM. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol. 2002 Feb;99(2):290-300.

    PubMed  Google Scholar 

  18. Salazar GMM, Gregory Walker T, Conway RF, et al (2013) Embolization of Angiographically Visible Type I and II Utero-ovarian Anastomoses during Uterine Artery Embolization for Fibroid Tumors: Impact on Symptom Recurrence and Permanent Amenorrhea. J Vasc Interv Radiol 24:1347–1352. doi:https://doi.org/10.1016/j.jvir.2013.05.043

    Article  PubMed  Google Scholar 

  19. Pelage JP, Le Dref O, Soyer P, et al (1999) Arterial anatomy of the female genital tract: variations and relevance to transcatheter embolization of the uterus. Am J Roentgenol 172:989–994. doi:https://doi.org/10.2214/ajr.172.4.10587133

    Article  CAS  Google Scholar 

  20. Kozik W, Czerwiński F, Pilarczyk K, Partyka C. Arteries of the hilum and parenchymal part of the ovary in reproductive age in microangiographic studies. Ginekol Pol. 2002 Dec;73(12):1173-8.

    PubMed  Google Scholar 

  21. Riu P, Vallone C, Rigon G, Signore F (2013) Anomalous ovarian artery vascularisation of a large uterine fibroid: successful embolisation. Case Rep 2013:bcr2012008106–bcr2012008106. doi:https://doi.org/10.1136/bcr-2012-008106

    Article  Google Scholar 

  22. Nikolic, B., Spies, J. B., Abbara, S., & Goodwin, S. C. (1999). Ovarian artery supply of uterine fibroids as a cause of treatment failure after uterine artery embolization: a case report. Journal of vascular and interventional radiology : JVIR, 10(9), 1167–1170. doi:https://doi.org/10.1016/s1051-0443(99)70215-0

    Article  CAS  PubMed  Google Scholar 

  23. Pelage J-P, Cazejust J, Pluot E, et al (2005) Uterine Fibroid Vascularization and Clinical Relevance to Uterine Fibroid Embolization. RadioGraphics 25:S99–S117. doi:https://doi.org/10.1148/rg.25si055510

    Article  PubMed  Google Scholar 

  24. Kim HS, Tsai J, Patra A, et al (2006) Effects of Utero-ovarian Anastomoses on Clinical Outcomes and Repeat Intervention Rates after Uterine Artery Embolization. J Vasc Interv Radiol 17:783–789. doi:https://doi.org/10.1097/01.RVI.0000209342.02567.C2

    Article  PubMed  Google Scholar 

  25. The French Society of Interventional and cardiovascular Imaging (SFICV) research group, Kovacsik HV, Herbreteau D, et al (2017) Evaluation of Changes in Sexual Function Related to Uterine Fibroid Embolization (UFE): Results of the EFUZEN Study. Cardiovasc Intervent Radiol 40:1169–1175. doi:https://doi.org/10.1007/s00270-017-1615-3

    Article  Google Scholar 

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Funding

No funding was obtained for this study.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France

    Héloïse Ifergan, Thomas Perus, Kevin Janot, Basile Kerleroux, Richard Bibi, Grégoire Boulouis & Denis Herbreteau

  2. Department of Radiology, Alleray Labrouste Clinic, Paris, France

    Jonathan Ifergan

  3. Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital of Tours, Tours, France

    Henri Marret

  4. Department of Gynecologic and Breast Oncological Surgery, Georges-Pompidou European Hospital, APHP. Centre, Paris, France

    Henri Azaïs

Authors
  1. Héloïse Ifergan
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  2. Thomas Perus
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  3. Kevin Janot
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  4. Basile Kerleroux
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  5. Jonathan Ifergan
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  7. Henri Marret
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  9. Henri Azaïs
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  10. Denis Herbreteau
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Contributions

HI: Study planification, data acquisition, drafting, statistical analysis, revision for critical content. TP: data acquisition, revision for critical content. KJ: data acquisition, revision for critical content. BK: data acquisition, revision for critical content. JI: data acquisition, revision for critical content. RB: data acquisition, revision for critical content. HM: Study planification, data acquisition, revision for critical content. GB: data acquisition, revision for critical content, statistical analysis, supervision. HA: revision for critical intellectual content. DH: Study planification, data acquisition, drafting, statistical analysis, revision for critical content, study supervision.

Corresponding author

Correspondence to Héloïse Ifergan.

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The authors report no conflict of interest and no competing interest with regard to this study.

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Patients were informed they could oppose the use of their health-related data for research purposes, and written informed consent was waived for this specific study.

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All authors approved the submitted version of the manuscript and agreed to be accountable for all aspects of the submitted work.

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Ifergan, H., Perus, T., Janot, K. et al. Ovarian arteries embolization in women with persistent symptoms following uterine arteries embolization for uterus fibroids. Abdom Radiol 46, 5707–5714 (2021). https://doi.org/10.1007/s00261-021-03255-w

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  • DOI: https://doi.org/10.1007/s00261-021-03255-w

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