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Treatment failure after uterine artery embolization: Prospective cohort study with multifactorial analysis of possible predictors of long-term outcome

2012; Elsevier BV; Volume: 81; Issue: 5 Linguagem: Inglês

10.1016/j.ejrad.2012.01.031

1872-7727

Christian Scheurig‐Muenkler, Clemens Koesters, Christian Grieser, Bernd Hamm, Thomas Kroencke,

Endometrial and Cervical Cancer Treatments

To evaluate the impact of baseline characteristics and residual leiomyoma perfusion after uterine artery embolization (UAE) on clinical long-term outcome.One hundred fifteen patients underwent UAE. All patients were divided into three groups according to achieved infarction rate determined on contrast-enhanced magnetic resonance imaging within 48-72 h after UAE (I: 100%, n=60; II: 90-99%, n=32; and III: 0-89%, n=23). Treatment failure and subsequent re-interventions (surgery, repeat UAE) were assessed for each group and compared using Cox regression analysis (CRA) with respect to the following baseline variables: age, uterine and dominant fibroid volume, number of fibroids, location of largest fibroid, and clinical symptoms.Long-term follow-up was completed after a median of 7.2 years (range 5.1-9.6) with a response rate of 84%. CRA revealed that patients in group III had a 22.2-fold higher risk (p<0.001) of treatment failure than patients in group I, whereas groups I and II did not differ significantly (p=0.578). For patients with bleeding-related symptoms only, CRA showed a 5.1-fold higher risk (p=0.025) of treatment failure than for patients with equally dominant bleeding- and bulk-related symptoms. A 40.5-fold higher likelihood (p<0.001) of treatment failure was observed for patients in group III with bleeding-related symptoms only compared to those in group I with combined bleeding- and bulk-related symptoms.Incomplete fibroid infarction after UAE is strongly associated with the risk of experiencing treatment failure. Patients with bleeding-related complaints only face the highest likelihood of treatment failure if UAE results in less than 90% fibroid devascularization.