Treatment Failure after Uterine Artery Embolization for Symptomatic Uterine Fibroids: Significance of Ovarian Arterial Collateral Vessels in Predicting the Outcome

Objectives: To evaluate the treatment failure (TF) rate of leiomyoma after uterine artery embolization (UAE) for uterine leiomyomas in cases of the presence of anastomoses between the ovarian arteries (OA) and uterine arteries (UA). Methods: The results of 163 consecutive UAE for uterine fibroid were reviewed. Mean patient age was 42.8 years (range, 25 to 57 years). TF was evaluated according to the anastomoses between OA and UA on pre-embolization angiography. Magnetic resonance images (MRIs) were obtained at 16 months or 12 months after UAE. MRIs were gadolinium (Gd)-enhanced images and/or T2-weighted images. MRIs exhibited focal enhancement portion on fibroid and evaluated the TF rate of the leiomyoma in patients of presence of anastomoses between OA and UA. Results: Fifty six patients had anastomoses between UA and OA on pre-embolization angiography (56/163, 34.4%). Angiographic subtypes were type Ia (n=19), type Ib (n=16), type II (n=11) and type III (n=10). Of all patients, 10 patients showed the focal enhancements of the leiomyomas on follow-up enhanced MRIs (10/163, 6.1%). Three treatments failed in patients demonstrated type Ia (3/19, 15,8%). One had type Ib (1/16, 6.3%). Other 6 had no anastomoses. There was no TF rate difference between patients with communication (4/56, 7.1%) and without communication (6/107, 5.7%). However, TF rate in patients with type Ia communication (15.8%) was higher than that without communication (5.7%; P0.05).