First Versus Second Uterine Artery Embolization for Symptomatic Leiomyoma.

Area of Science:

• Interventional Radiology
• Gynecologic Oncology
• Vascular Imaging

Background:

• Uterine leiomyomas (fibroids) are common benign tumors causing significant symptoms.
• Uterine artery embolization (UAE) is a minimally invasive treatment option for symptomatic leiomyomas.
• Repeat UAE may be considered for recurrent or persistent fibroid symptoms.

Purpose of the Study:

• To compare the effectiveness of a second uterine artery embolization (UAE) versus a first UAE in treating symptomatic uterine leiomyomas.
• To evaluate key outcomes including tumor infarction and uterine volume reduction.

Main Methods:

• Retrospective analysis of 434 patients undergoing UAE for leiomyoma between 1997 and 2016.
• Primary endpoint: tumor infarction rate assessed by postprocedural contrast-enhanced MRI.
• Secondary endpoints: angiographic findings, embolization details, MRI, and clinical outcomes at 1-year follow-up.

Main Results:

• While technical outcomes were similar, second UAE showed significantly lower tumor infarction rates (69.8% vs 96.8%, p=0.025).
• The rate of uterine volume reduction at 1 year was also significantly lower after second UAE (33.4% vs 46.9%, p=0.008).
• Increased collateral vessel formation was noted in the second UAE group.

Conclusions:

• Second UAE is an effective treatment for uterine leiomyomas but demonstrates inferior outcomes compared to the first UAE.
• Lower tumor infarction and uterine volume reduction rates suggest reduced efficacy with repeat embolization procedures.