Skip to main content
SpringerLink
Log in

Comparison of Uterine Necrosis After Uterine Artery Embolization with Soluble Gelatin Sponge Particles or Tris-acryl Gelatin Microspheres in Swine

  • Laboratory Investigation
  • Embolisation (arterial)
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To compare the recanalization of the uterine arteries and uterine necrosis after uterine artery embolization (UAE) using either soluble gelatin sponge particles (SGS), which dissolve in saline, or tris-acryl gelatin microspheres (MS), which are permanent embolic materials, in swine.

Methods

Fourteen uteri in seven swine were divided into two groups for embolization with either 500–1000 µm SGS (SGS group) or 500–700 µm MS (MS group) (seven uteri per group). The uterine arteries were embolized using SGS or MS, and angiography was performed to evaluate recanalization of the uterine arteries immediately, 1, 2, 3, 4, 5, and 6 h, and 3 days after embolization. On day 3, the uteri were removed to determine the macroscopic necrosis rate and for histopathologic examination.

Results

In the SGS group, four uterine arteries were completely recanalized, two were partially recanalized, and one was still occluded 5 h after embolization. In contrast, all seven uterine arteries in the MS group were still occluded 6 h after embolization. The complete recanalization rate at 3 days was significantly greater in the SGS group than in the MS group (100.0% vs. 14.3%, respectively; P = .0047). The mean uterine necrosis rate was not significantly different between the SGS and MS groups (15.0 ± 15.7% vs. 26.8 ± 13.3%, respectively; P = .096). The mean smallest arterial diameter containing embolic materials was 48.2 ± 22.0 μm (range 21–109 μm) for SGS and 446.7 ± 107.0 μm (range 352–742 μm) for MS (P < .0001).

Conclusion

The uterine arteries recanalized earlier in the SGS group than in the MS group and the uterine necrosis rates were similar in both groups. SGS have the potential for a more distal penetration in comparison with MS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Silberzweig JE, Powell DK, Matsumoto AH, Spies JB. Management of uterine fibroids: a focus on uterine-sparing interventional techniques. Radiology. 2016;280:675–92.

    Article  Google Scholar 

  2. Keung JJ, Spies JB, Caridi TM. Uterine artery embolization: A review of current concepts. Best Pract Res Clin Obstet Gynaecol. 2018;46:66–73.

    Article  Google Scholar 

  3. de Bruijn AM, Ankum WM, Reekers JA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol. 2016;215:745.

    PubMed  Google Scholar 

  4. Ananthakrishnan G, Murray L, Ritchie M, et al. Randomized comparison of uterine artery embolization (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): subanalysis of 5-year MRI findings. Cardiovasc Intervent Radiol. 2013;36:676–81.

    Article  Google Scholar 

  5. Manyonda IT, Bratby M, Horst JS, et al. Uterine artery embolization versus myomectomy: impact on quality of life–results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial. Cardiovasc Intervent Radiol. 2012;35:530–6.

    Article  Google Scholar 

  6. Pron G, Mocarski E, Bennett J, et al. Tolerance, hospital stay, and recovery after uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial. J Vasc Interv Radiol. 2003;14:1243–50.

    Article  Google Scholar 

  7. Spencer EB, Stratil P, Mizones H. Clinical and periprocedural pain management for uterine artery embolization. Semin Intervent Radiol. 2013;30:354–63.

    Article  Google Scholar 

  8. McLucas B, Voorhees WD 3rd, Elliott S. Fertility after uterine artery embolization: a review. Minim Invasive Ther Allied Technol. 2016;25:1–7.

    Article  Google Scholar 

  9. Mohan PP, Hamblin MH, Vogelzang RL. Uterine artery embolization and its effect on fertility. J Vasc Interv Radiol. 2013;24:925–30.

    Article  Google Scholar 

  10. Berkane N, Moutafoff-Borie C. Impact of previous uterine artery embolization on fertility. Curr Opin Obstet Gynecol. 2010;22:242–7.

    Article  Google Scholar 

  11. Ghanaati H, Sanaati M, Shakiba M, et al. Pregnancy and its outcomes in patients after uterine fibroid embolization: a systematic review and meta-analysis. Cardiovasc Intervent Radiol. 2020;43:1122–33.

    Article  Google Scholar 

  12. Das R, Champaneria R, Daniels JP, Belli AM. Comparison of embolic agents used in uterine artery embolisation: a systematic review and meta-analysis. Cardiovasc Intervent Radiol. 2014;37:1179–90.

    Article  Google Scholar 

  13. Blaine G. Absorbable gelatin sponge in experimental surgery. Lancet. 1951;258:427–9.

    Article  Google Scholar 

  14. Yadavali R, Ananthakrishnan G, Sim M, et al. Randomised trial of two embolic agents for uterine artery embolisation for fibroids: Gelfoam versus Embospheres (RAGE trial). CVIR Endovasc. 2019;2:4.

    Article  CAS  Google Scholar 

  15. Takasaka I, Kawai N, Sato M, et al. A new soluble gelatin sponge for transcatheter hepatic arterial embolization. Cardiovasc Intervent Radiol. 2010;33:1198–204.

    Article  Google Scholar 

  16. Kanayama Y, Aoki C, Sakai Y. Development of low endotoxin gelatin for regenerative medicine. Biol Pharm Bull. 2007;30:237–41.

    Article  CAS  Google Scholar 

  17. Sonomura T, Kawai N, Ikoma A, et al. Uterine damage in swine following uterine artery embolization: comparison among gelatin sponge particles and two concentrations of N-butyl cyanoacrylate. Jpn J Radiol. 2013;31:685–92.

    Article  CAS  Google Scholar 

  18. Sone M, Osuga K, Shimazu K, et al. Porous gelatin particles for uterine artery embolization: an experimental study of intra-arterial distribution, uterine necrosis, and inflammation in a porcine model. Cardiovasc Intervent Radiol. 2010;33:1001–8.

    Article  Google Scholar 

  19. Sanda H, Kawai N, Sato M, et al. Synthesis of 24-h soluble gelatin sponge particles and their effect on liver necrosis following hepatic artery embolization: results of in vitro and in vivo studies. Hepatol Res. 2016;46:335–42.

    Article  CAS  Google Scholar 

  20. Sato M, Yamada R. Experimental and clinical studies on the hepatic artery embolization for treatment of hepatoma. Nippon Acta Radiologica. 1983;43:977–1005.

    Google Scholar 

  21. Kawai N, Sato M, Minamiguchi H, et al. Clinical evaluation of transcatheter arterial chemoembolization with 2-day-soluble gelatin sponge particles for hepatocellular carcinoma-comparison with insoluble gelatin sponge particles. J Vasc Interv Radiol. 2013;24:1383–90.

    Article  Google Scholar 

  22. Weichert W, Denkert C, Gauruder-Burmester A, et al. Uterine arterial embolization with tris-acryl gelatin microspheres: a histopathologic evaluation. Am J Surg Pathol. 2005;29:955–61.

    Article  Google Scholar 

  23. Sonomura T, Yamada R, Kishi K, et al. Dependency of tissue necrosis on gelatin sponge particle size after canine hepatic artery embolization. Cardiovasc Intervent Radiol. 1997;20:50–3.

    Article  CAS  Google Scholar 

  24. Laurent A, Wassef M, Namur J, et al. Recanalization and particle exclusion after embolization of uterine arteries in sheep: a long-term study. Fertil Steril. 2009;91:884–92.

    Article  Google Scholar 

  25. Katsumori T, Miura H, Arima H, et al. Tris-acryl gelatin microspheres versus gelatin sponge particles in uterine artery embolization for leiomyoma. Acta Radiol. 2017;58:834–41.

    Article  Google Scholar 

  26. Ruuskanen A, Sipola P, Hippeläinen M, et al. Pain after uterine fibroid embolisation is associated with the severity of myometrial ischaemia on magnetic resonance imaging. Eur Radiol. 2009;19:2977–85.

    Article  Google Scholar 

Download references

Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510, Japan

    Hirotatsu Sato, Tetsuo Sonomura, Saeko Onishi, Masataka Koike, Ryota Tanaka, Shota Ueda, Ryuta Okuhira, Atsufumi Kamisako, Takao Koyama, Nozomu Shima & Akira Ikoma

  2. Technical Center, Jellice Co., Ltd, Miyagi, Japan

    Shoko Yamamoto & Yasuo Sakai

  3. Department of Human Pathology, Wakayama Medical University, Wakayama, Japan

    Shin-ichi Murata

Authors
  1. Hirotatsu Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tetsuo Sonomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Saeko Onishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masataka Koike
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryota Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shota Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ryuta Okuhira
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Atsufumi Kamisako
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Takao Koyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Nozomu Shima
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shoko Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yasuo Sakai
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Shin-ichi Murata
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Akira Ikoma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hirotatsu Sato.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sato, H., Sonomura, T., Onishi, S. et al. Comparison of Uterine Necrosis After Uterine Artery Embolization with Soluble Gelatin Sponge Particles or Tris-acryl Gelatin Microspheres in Swine. Cardiovasc Intervent Radiol 44, 1780–1789 (2021). https://doi.org/10.1007/s00270-021-02905-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-021-02905-2

Keywords

Search

Navigation