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  • Title: Re-intervention after uterine leiomyoma embolisation is related to incomplete infarction and presence of submucous leiomyomas.
    Author: Dueholm M, Langfeldt S, Mafi HM, Eriksen G, Marinovskij E.
    Journal: Eur J Obstet Gynecol Reprod Biol; 2014 Jul; 178():100-6. PubMed ID: 24813085.
    Abstract:
    OBJECTIVE: To evaluate outcome of invasive gynecological re-interventions after uterine artery embolisation (UAE) in relation to leiomyoma characteristics. DESIGN: A cohort of 114 women with symptomatic myomas underwent UAE. Myoma characteristics were determined by contrast-enhanced magnetic resonance imaging (MRI) before and 6 months after treatment. The median follow-up time after UAE was 55.9 months; (range 20-116). Data on gynecological re-interventions were obtained for all patients and were analysed using the Kaplan-Meier method. Data were obtained on frequency of invasive re-interventions: major myoma procedures (hysterectomy, re-embolisation, laparoscopic or abdominal myomectomy) and outpatient hysteroscopic myoma procedures. Myoma characteristics with impact on outcome of re-interventions were determined by statistical analysis. RESULTS: Total re-intervention rate was 35.1%. Hysterectomy was performed due to myoma related symptoms in 6.1% of patients, but 23.7% of patients underwent additional uterine procedures, mainly outpatient hysteroscopy (15%). Major myoma re-intervention correlated with the extent of the infarct at follow-up MRI (n=107). Patients had undergone major re-intervention (3 years) as follows: infarct group C (<80%, n=16) 44%, infarct group B (80-99%, n=16) 19%, and infarct group A (100%, n=75) 10.1% ((p<0.01) for both A vs B+C and A+B vs C). Major re-interventions were not associated with the presence of submucous myomas; but the hazard ratio (CI 95%) for undergoing hysteroscopic re-intervention was 8.4 (2-29) (p=0.001) in patients with submucous myomas, but 12.7 (5-35) (p<0.0001) in patients with more than one submucous myomas. CONCLUSIONS: Complete infarction after UAE reduces the need for major re-interventions. Assessment of complete infarction may be considered to improve quality in UAE procedures. Patients with more than one submucous myoma at UAE may often have hysteroscopic removal of residual myomas.
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