Uterine Artery Embolization for Mixed Adenomyosis and Fibroids: Outcomes According to Initial Particle Sizes

To characterize the effect of embolic particle size on outcomes of uterine artery embolization (UAE) for mixed adenomyosis/fibroids.

A single-center retrospective database was compiled of all patients with mixed adenomyosis/fibroids who underwent UAE with microspheres (Embosphere [Merit Medical, South Jordan, Utah] and Embozene [Varian, Palo Alto, California]) from September 2015 to May 2022 (n = 76; mean age, 46.7 years [standard deviation {SD} ± 5.7]). Demographic, clinical, imaging, procedural, and follow-up data were collected. Intraprocedurally, initial particle size was chosen according to proceduralist judgment and subsequently upsized as needed until near-stasis was achieved. Initial particle size was categorized as either small (Embosphere 300-500 μm and Embozene 500 μm) or large (Embosphere 500-700 μm and Embozene 700 μm). The effect of initial particle size on patient-reported symptomatic improvement was assessed with logistic regression, with preprocedural uterine volume, presence of focal adenomyoma, and total number of vials of embolic material as regression covariates.

Preprocedural symptoms included menorrhagia (89.5%), pelvic pain (53.9%), and bulk symptoms (60.5%). The baseline mean uterine volume was 748.5 mL (SD ± 543.9). Postprocedurally, 89.1%, 92.3%, and 97.4% reported improvement in menorrhagia, pelvic pain, and bulk symptoms, respectively. Initial embolic particle sizing was not significantly associated with patient-reported improvement in menorrhagia (P = .134), pelvic pain (P = .598), or bulk symptoms (P = .151), when controlling for covariates.

When controlling for covariates, smaller-calibrated microspheres had similar postprocedural pain outcomes as larger particles, with similar target outcomes in UAE for mixed adenomyosis/fibroids.