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

PURPOSE: To characterize the effect of embolic particle size on outcomes of uterine artery embolization (UAE) for mixed adenomyosis/fibroids. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.