Utero-ovarian anastomoses and their influence on uterine fibroid embolization

To correlate clinical outcomes after uterine artery embolization (UAE) performed to treat uterine fibroids with the presence of varying types of utero-ovarian anastomoses (UOA).

A retrospective analysis was performed of all uterine angiograms from 202 patients (mean age 42 y, range 28-54 y) who underwent UAE because of heavy menstrual bleeding, dysmenorrhea, or anemia or a combination of these symptoms. UOA were classified as absent or present, unilateral or bilateral. The effects of UOA on long-term outcomes (clinical endpoints such as control of bleeding and pain) and complications (amenorrhea) were assessed statistically using Kaplan-Meier curves and χ(2) and log-rank tests.

Of the UOA in 104 women, 38 anastomoses were bilateral, and 66 were unilateral. Type III was the most common type of anastomosis (66 cases) followed by type Ia (22 cases) and type Ib (18 cases); there were no type II anastomoses. Amenorrhea was reported in 27 (14%) women at 5-year follow-up after UAE (only 3% in women < 45 y old). There were 10 cases of clinical failure with a median follow-up of > 4 years. Bilateral or unilateral presence of UOA had no statistically significant effect on outcomes or on complications.

Recurrence rates, clinical failure, and amenorrhea after UAE do not seem to be influenced by the presence or absence of UOA. However, further studies are needed to confirm these findings.