Long-Term Results of Uterine Artery Embolization for Symptomatic Adenomyosis

Man Deuk Kim, Kim MD, Kim S, Sehuyn Kim, Nahk Keun Kim, Kim NK, Mee Hwa Lee, Lee MH, Ahn EH, Eun Hee Ahn, Han Jo Kim, Kim HJ, Hee Jin Kim, Cho JH, Jin Ho Cho, Cha SH, Sun Hee, Sun Hee Cha
AJR. American journal of roentgenology · 2006 · vol. 188(1) , pp. 176–181 · doi:10.2214/ajr.05.1613 · PMID:17179361 · W1981029443
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Uterine artery embolization (UAE) provided long-term symptom relief for adenomyosis in over half of patients, with significant reduction in menorrhagia and dysmenorrhea and uterine volume.

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Abstract

OBJECTIVE: Controversy exists regarding the effectiveness of uterine artery embolization (UAE) in the management of symptomatic adenomyosis. The aim our study was to determine the long-term clinical efficacy of UAE in the management of symptomatic adenomyosis without fibroids. MATERIALS AND METHODS: The cases of all patients who underwent UAE for adenomyosis without fibroids between 1998 and 2000 were analyzed. This study was a retrospective review of a prospectively collected database. Of the 66 patients, 54 patients with a follow-up period of 3 years or longer were enrolled in the study. Twelve patients were lost to follow-up. The patients' ages ranged from 29 to 49 years (mean, 40.2 years). The mean follow-up period was 4.9 years (range, 3.5-5.8 years). The primary embolic agent was polyvinyl alcohol particles (250-710 microm). All patients underwent MRI before UAE. Long-term follow-up MRI was performed on 29 patients; 22 of these patients had undergone short-term (3.5 months) follow-up MRI. Uterine volume was calculated with MR images. Symptom status in terms of menorrhagia and dysmenorrhea was scored on a scale of 0-10, 0 being no symptoms and 10 being the baseline, or initial symptoms. RESULTS: Thirty-one (57.4%) of the 54 women who underwent follow-up had long-term success. Four had immediate treatment failure, and 19 had relapses. Changes in mean menorrhagia and dysmenorrhea scores at long-term follow-up were -5.3 and -5.1, respectively (p < 0.001), representing significant relief of symptoms. The time between UAE and recurrence of symptoms ranged from 4 to 48 months (mean, 17.3 months). Five patients underwent hysterectomy because of symptom recurrence. Mean reduction in volume of the uterus was 26.3% at short-term follow-up and 27.4% at long-term follow-up. CONCLUSION: We found that UAE is effective in the management of symptomatic adenomyosis and has an acceptable long-term success rate. UAE should be considered a primary treatment method for patients with symptomatic adenomyosis. However, all patients should be given an explanation of the possibility of treatment failure, recurrence, and the need for hysterectomy.

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Condition tags

endometriosisadenomyosisdysmenorrhea

MeSH descriptors

Embolization, Therapeutic Endometriosis Uterine Neoplasms Uterus Uterus Adult Embolization, Therapeutic Endometriosis Endometriosis Female Humans Longitudinal Studies Magnetic Resonance Imaging Male Middle Aged Retrospective Studies Treatment Outcome Uterine Neoplasms Uterine Neoplasms Uterus

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