Uterine Artery Embolization for Symptomatic Adenomyosis: A New Technical Development of the 1-2-3 Protocol and Predictive Factors of MR Imaging Affecting Outcomes

Limited Efficacy of Uterine Artery Embolization for Cervical Leiomyomas

“…We began the procedure by using 150 -250-m PVA particles and progressively increased the particle size to 250 -355 m and then to 355-500 m until the endpoint, which is similar to that for the treatment of adenomyosis (20). In one of the two patients, we succeeded; however, the other showed PN with thick rim enhancement.…”

Uterine Artery Embolization for Adenomyosis: Percentage of Necrosis Predicts Midterm Clinical Recurrence

“…Pelage et al (7) reported that all women undergoing hysterectomy after UAE because of recurrent symptoms had viable areas of adenomyosis and suggested that infarction of adenomyosis may lead to durable clinical improvement. Kim et al (9) reported that 12.5% of patients (2 of 16) with complete necrosis presented with symptom recurrence, whereas 80% of patients (4 of 5) without necrosis had symptom recurrence on midterm follow-up, supporting the view that necrosis after UAE is an important factor for therapeutic durability.…”

“…The primary embolic agent was nonspherical polyvinyl alcohol particles (Contour; Boston Scientific, Marlborough, Massachusetts) mixed with 60 mL of 1:1 saline-contrast material mixture. The size of polyvinyl alcohol increased from 150-250 μm to 250-355 μm and then to 355-500 μm in serial order (9). The endpoint of the procedure was when blood flow became completely stagnant in the uterine artery for 10 cardiac beats.…”

“…Factors influencing the durability of symptom relief have not been identified yet. Several previous studies (6,7,9,12) focused on the relationship between MR imaging findings and clinical outcome. Pelage et al (7) reported that all women undergoing hysterectomy after UAE because of recurrent symptoms had viable areas of adenomyosis and suggested that infarction of adenomyosis may lead to durable clinical improvement.…”

“…Previous studies suggested that necrosis on magnetic resonance (MR) imaging after the procedure is an important factor in long-term durability after UAE for adenomyosis (8,9). The purpose of this retrospective study was to determine whether the percentage of necrosis of adenomyosis is related to symptom recurrence on midterm follow-up.…”