Treatment failure after uterine artery embolization: Prospective cohort study with multifactorial analysis of possible predictors of long-term outcome

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• 作者：Christian Scheurig-Muenkler¹ ; ^{christian.scheurig@charite.de} ; Clemens Koesters¹ ; ^{clemens@koesters.org} ; Christian Grieser¹ ; ^{christian.grieser@charite.de} ; Bernd Hamm² ; ^{bernd.hamm@charite.de} ; Thomas J. Kroencke ; ^{thomas.kroencke@charite.de}
• 关键词：Uterine artery embolization ; Magnetic resonance imaging ; Leiomyoma ; Regression analysis ; Women's health
• 刊名：European Journal of Radiology
• 出版年：2012
• 出版时间：May, 2012
• 年：2012
• 卷：81
• 期：5
• 页码：e727-e731
• 全文大小：287 K

文摘

Purpose

To evaluate the impact of baseline characteristics and residual leiomyoma perfusion after uterine artery embolization (UAE) on clinical long-term outcome.

Materials and methods

One hundred fifteen patients underwent UAE. All patients were divided into three groups according to achieved infarction rate determined on contrast-enhanced magnetic resonance imaging within 48-72 h after UAE (I: 100 % , n = 60; II: 90-99 % , n = 32; and III: 0-89 % , n = 23). Treatment failure and subsequent re-interventions (surgery, repeat UAE) were assessed for each group and compared using Cox regression analysis (CRA) with respect to the following baseline variables: age, uterine and dominant fibroid volume, number of fibroids, location of largest fibroid, and clinical symptoms.

Results

Long-term follow-up was completed after a median of 7.2 years (range 5.1-9.6) with a response rate of 84 % . CRA revealed that patients in group III had a 22.2-fold higher risk (p < 0.001) of treatment failure than patients in group I, whereas groups I and II did not differ significantly (p = 0.578). For patients with bleeding-related symptoms only, CRA showed a 5.1-fold higher risk (p = 0.025) of treatment failure than for patients with equally dominant bleeding- and bulk-related symptoms. A 40.5-fold higher likelihood (p < 0.001) of treatment failure was observed for patients in group III with bleeding-related symptoms only compared to those in group I with combined bleeding- and bulk-related symptoms.

Conclusion

Incomplete fibroid infarction after UAE is strongly associated with the risk of experiencing treatment failure. Patients with bleeding-related complaints only face the highest likelihood of treatment failure if UAE results in less than 90 % fibroid devascularization.