Repeat uterine artery embolization: indications and technical findings

Area of Science:

• Interventional Radiology
• Gynecology
• Vascular Imaging

Background:

• Uterine artery embolization (UAE) is a common treatment for symptomatic uterine leiomyomas.
• Recurrence or persistence of symptoms after UAE can necessitate repeat procedures.
• Understanding the indications and outcomes of repeat UAE is crucial for patient management.

Purpose of the Study:

• To determine the indications for repeat uterine artery embolization (UAE).
• To evaluate the technical aspects of repeat UAE procedures.
• To assess the outcomes of repeat UAE in patients with recurrent or persistent symptoms.

Main Methods:

• Retrospective review of 24 patients undergoing repeat UAE at a single center.
• Comparison of pre-embolization magnetic resonance (MR) imaging findings with earlier studies.
• Assessment of tumor infarction extent and identification of new or existing tumors.
• Review and summarization of angiographic findings from initial and repeat embolization procedures.

Main Results:

• Repeat UAE was performed 6-66 months after initial embolization for symptoms like bulk symptoms (n=15), heavy bleeding (n=12), and pain (n=7).
• Incomplete tumor infarction was observed in 22 of 24 patients; new tumors were identified in 12 patients.
• Ovarian artery embolization was required in 37% of cases.
• Symptom control was achieved in 90% of patients with clinical follow-up after repeat UAE.

Conclusions:

• Repeat UAE for recurrent uterine leiomyomas is typically due to regrowth of incompletely infarcted tumors.
• Ovarian artery embolization is frequently needed during repeat UAE.
• Repeat UAE demonstrates good symptom control for uterine leiomyomas, despite challenges.