Advertisement

CardioVascular and Interventional Radiology

, Volume 38, Issue 1, pp 65–71 | Cite as

Uterine Artery Embolisation for Symptomatic Adenomyosis with Polyzene F-Coated Hydrogel Microspheres: Three-Year Clinical Follow-Up Using UFS–QoL Questionnaire

  • R. J. Nijenhuis
  • A. J. Smeets
  • M. Morpurgo
  • P. F. Boekkooi
  • P. J. H. M. Reuwer
  • M. Smink
  • W. J. van Rooij
  • P. N. M. Lohle
Clinical Investigation

Abstract

Purpose

This study was designed to assess midterm outcome of uterine artery embolisation (UAE) for women with therapy-resistant adenomyosis using polyzene F-coated hydrogel microspheres.

Methods

Between September 2006 and January 2010, 29 consecutive women with adenomyosis (15 in combination with fibroids) were treated with UAE using polyzene F-coated hydrogel microspheres. Junction zone thickness was assessed with MRI at baseline and 3 months. Women filled out the uterine fibroid symptom and quality of life questionnaire at baseline, 3 months and after a mean clinical follow-up of 37 months (median 35, range 29–64 months).

Results

At baseline, symptom severity score of 29 women was mean 67 (median 72, range 23–100). At 3 months, this score decreased to mean 22 (median 15, range 0–66) and mean 15 (median 17, range 0–34) at final follow-up. At final follow-up of mean 37 months (median 35, range 29–64 months), 22 of 29 (76 %) patients were asymptomatic. Of these 22 women, 3 underwent a second UAE at 6, 7, and 14 months. The remaining seven patients clinically improved but still had symptoms; one underwent a hysterectomy. There was no difference in outcome between women with pure adenomyosis and women with additional fibroids. The junction zone of 4 women with additional therapy was significantly thicker compared with the remaining 25 patients.

Conclusions

In women with therapy resistant adenomyosis, UAE using polyzene F-coated hydrogel microspheres resulted in 3 years preservation of the uterus in 28 of 29 (97 %) with good clinical outcome in the vast majority of patients. Initial thickness of the junction zone is related to additional therapy.

Keywords

Clinical practice Arterial intervention Embolisation Urogenital 

Notes

Conflict of interest

Nijenhuis, Smeets, Morpurgo, Boekkooi, Reuwer, Smink, and van Rooij has no conflict of interest. Lohle Consultant for Celonova Bio Sciences, San Antonio, TX.

References

  1. 1.
    Azzir R (1989) Adenomyosis: current perspectives. Obstet Gynecol Clin N Am 16:221–235Google Scholar
  2. 2.
    Wood C (1998) Surgical and medical treatment of adenomyosis. Hum Reprod Update 4:323–336PubMedCrossRefGoogle Scholar
  3. 3.
    Goodwin SC, McLucas B, Lee M et al (1999) Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J Vasc Interv Radiol 10(9):1159–1165PubMedCrossRefGoogle Scholar
  4. 4.
    Smith SJ, Sewall LE, Handelsman A (1999) A clinical failure of uterine fibroid embolization due to adenomyosis. J Vasc Interv Radiol 10(9):1171–1174PubMedCrossRefGoogle Scholar
  5. 5.
    Siskin GP, Tubulin ME, Stainken BF, Dowling K, Dolen EG (2001) Uterine artery embolisation for the treatment of adenomyosis: clinical response and evaluation with MR imaging. AJR Am J Roentgenol 177:297–302PubMedCrossRefGoogle Scholar
  6. 6.
    Pelage JP, Jacob D, Fazel A et al (2005) Midterm results of uterine artery embolisation for symptomatic adenomyosis: initial experience. Radiology 234:948–953PubMedCrossRefGoogle Scholar
  7. 7.
    Lohle PN, De Vries J, Klazen CA et al (2007) Uterine artery embolization for symptomatic adenomyosis with or without uterine leiomyomas with the use of calibrated tris-acryl gelatin microspheres: midterm clinical and MR imaging follow-up. J Vasc Interv Radiol 18(7):835–841PubMedCrossRefGoogle Scholar
  8. 8.
    Stampfl S, Bellemann N, Stampfl U et al (2009) Arterial distribution characteristics of Embozene particles and comparison with other spherical embolic agents in the porcine acute embolisation model. J Vasc Interv Radiol 20(12):1597–1607PubMedCrossRefGoogle Scholar
  9. 9.
    Harding G, Coyne KS, Thompson CL, Spies JB (2008) The responsiveness of the uterine fibroid symptom and health-related quality of life questionnaire (UFS–QOL). Health Qual Life Outcomes 6:99PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Spies JB, Coyne K, Guaou Guaou N et al (2002) The UFS–QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 99:290–300PubMedCrossRefGoogle Scholar
  11. 11.
    Reinhold C, McCarthy S, Bret PM et al (1996) Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology 199(1):151–158PubMedCrossRefGoogle Scholar
  12. 12.
    Bazot M, Cortez A, Darai E et al (2001) Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod 16(11):2427–2433PubMedGoogle Scholar
  13. 13.
    Jha RC, Takahama J, Imaoka I et al (2003) Adenomyosis: MRI of the uterus treated with uterine artery embolisation. AJR Am J Roentgenol 181:851–856PubMedCrossRefGoogle Scholar
  14. 14.
    Kitamura Y, Allison SJ, Jha RC et al (2006) MRI of adenomyosis: changes with uterine artery embolisation. AJR Am J Roentgenol 186:855–864PubMedCrossRefGoogle Scholar
  15. 15.
    Spies J, Niedzwiecki G, Goodwin S et al (2001) Training standards for physicians performing uterine artery embolisation for leiomyomata: consensus statement developed by the Task Force on Uterine Artery Embolisation and the standards division of the Society of Cardiovascular and Interventional Radiology. J Vasc Interv Radiol 12(1):19–21PubMedCrossRefGoogle Scholar
  16. 16.
    Worthington-Kirsch R, Spies JB, Myers ER et al (2005) The Fibroid Registry for outcomes data (FIBROID) for uterine embolisation: short-term outcomes. Obstet Gynecol 106(1):52–59. Erratum in: Obstet Gynecol 106(4):869Google Scholar
  17. 17.
    Goodwin SC, Spies JB (2009) Uterine fibroid embolisation. N Engl J Med 361(7):690–697PubMedCrossRefGoogle Scholar
  18. 18.
    Froeling V, Scheurig-Muenkler C, Hamm B et al (2012) Uterine artery embolisation to treat uterine adenomyosis with or without leiomyomata: results of symptom control and health related quality of life 40 months after treatment. Cardiovasc Interv Radiol 35:523–529CrossRefGoogle Scholar
  19. 19.
    Smeets AJ, Nijenhuis RJ, van Rooij WJ et al (2010) Embolization of uterine leiomyomas with polyzene F-coated hydrogel microspheres: initial experience. J Vasc Interv Radiol 21(12):1830–1834PubMedCrossRefGoogle Scholar
  20. 20.
    Chua GC, Wilsher M, Young MP et al (2005) Comparison of particle penetration with non-spherical polyvinyl alcohol versus trisacryl gelatin microspheres in women undergoing premyomectomy uterine artery embolization. Clin Radiol 60(1):116–122PubMedCrossRefGoogle Scholar
  21. 21.
    Smeets AJ, Nijenhuis RJ, Boekkooi PF et al (2012) Long-term follow-up of uterine artery embolisation for symptomatic adenomyosis. Cardiovasc Interv Radiol 35:815–819CrossRefGoogle Scholar
  22. 22.
    Sluzewski M, van Rooij WJ, Lohle PN et al (2013) Embolization of meningiomas: comparison of safety between calibrated microspheres and polyvinyl-alcohol particles as embolic agents. AJNR 34(4):727–729PubMedCrossRefGoogle Scholar
  23. 23.
    Kim MD, Kim S, Kim NK et al (2006) Long-term results of uterine artery embolisation for symptomatic adenomyosis. AJR Am J Roentgenol 186:855–864CrossRefGoogle Scholar
  24. 24.
    Froeling V, Scheurig-Muenkler C, Hamm B et al (2012) Uterine artery embolisation to treat uterine adenomyosis with or without uterine leiomyomata: results of symptom control and health-related quality of life 40 months after treatment. Cardiovasc Interv Radiol 35(3):523–529CrossRefGoogle Scholar
  25. 25.
    Popovic M, Puchner S, Berzaczy D, Lammer J, Bucek RA (2011) Uterine artery embolisation for the treatment of adenomyosis: a review. J Vasc Interv Radiol 22:901–909PubMedCrossRefGoogle Scholar
  26. 26.
    Dutton S, Hirst A, McPherson K, Nicholson T, Maresh MA (2007) A UK multicentre retrospective cohort study comparing hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids (HOPEFUL study): main results on medium-term safety and efficacy. BJOG 114:1340–1351PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2014

Authors and Affiliations

  • R. J. Nijenhuis
    • 1
  • A. J. Smeets
    • 1
  • M. Morpurgo
    • 1
  • P. F. Boekkooi
    • 2
  • P. J. H. M. Reuwer
    • 2
  • M. Smink
    • 2
  • W. J. van Rooij
    • 1
  • P. N. M. Lohle
    • 1
  1. 1.Department of RadiologySt. Elisabeth ZiekenhuisTilburgThe Netherlands
  2. 2.Department of Obstetrics and GynecologySt. Elisabeth ZiekenhuisTilburgThe Netherlands

Personalised recommendations