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CardioVascular and Interventional Radiology

, Volume 37, Issue 5, pp 1179–1190 | Cite as

Comparison of Embolic Agents Used in Uterine Artery Embolisation: A Systematic Review and Meta-Analysis

  • Raj DasEmail author
  • Rita Champaneria
  • Jane P. Daniels
  • Anna-Maria Belli
Clinical Investigation

Abstract

Purpose

This study was designed to undertake systematic review and meta-analysis of published comparative trials comparing embolic agents used in uterine artery embolisation (UAE) for uterine leiomyomata.

Methods

Systematic literature searches were performed in MEDLINE, Embase, PubMed, and Cochrane Central databases from database inception to July 2012. Randomised and nonrandomised trials comparing two or more embolic agents used in UAE were included. Assessment included five widely used embolic agents: nonspherical polyvinyl alcohol (PVA) (Contour PVA, Boston Scientific or PVA Cook Medical); spherical PVA (Contour SE, Boston Scientific); acrylamido PVA (Beadblock, Biocompatibles, Terumo); tris-acryl gelatin microspheres (TAGM) (Embospheres, Merit Medical Inc); and polyzene-F hydrogel microspheres (Embozenes, CeloNova Biosciences). Outcomes assessed included: quality of life (QOL), assessment, magnetic resonance imaging (MRI), uterine and fibroid volumes and degrees of MRI fibroid enhancement and devascularisation. A total of 262 citations were reviewed with 5 randomised, controlled trials involving 295 women and 5 non-RCTs involving 617 women included.

Results

No evidence of superiority of any embolic agent was demonstrated. Meta-analysis was performed between TAGM (Embospheres) and spherical PVA microspheres. Two RCTs found a trend toward greater uterine and dominant fibroid volume reductions with Embospheres but the combined differences were not statistically significant (p = 0.78 and p = 0.94 respectively). Embospheres demonstrated greater percentage fibroid devascularisation than spherical PVA (p = 0.039).

Conclusions

This study confirms that the current evidence demonstrates superiority of Embospheres over spherical PVA but no reported differences in outcomes between any of the other agents. Comparison of embolic agents was limited by lack of RCT data and further research is warranted.

Keywords

Uterine Leiomyoma Fibroid Embolisation Embolic agent Particles 

Notes

Acknowledgments

The authors thank the authors of the included trials who responded to our queries. No further acknowledgements.

Conflict of interest

Drs. Raj Das, Rita Champaneria, Jane Daniels, and Professor Anna Maria Belli have no conflict of interest.

Details of Ethical Approval

No ethical approval was required.

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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  • Raj Das
    • 1
    Email author
  • Rita Champaneria
    • 2
  • Jane P. Daniels
    • 2
  • Anna-Maria Belli
    • 1
  1. 1.Department of RadiologySt George’s HospitalLondonUnited Kingdom
  2. 2.Birmingham Clinical Trials Unit, School of Cancer Sciences, Robert Aitken InstituteUniversity of BirminghamBirminghamUnited Kingdom

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