UAE for the treatment of symptomatic adenomyosis

Vasileios Souftas
2010 · doi:10.1594/ecr2010/c-2074 · W2525623702
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This paper presents uterine artery embolization (UAE) as a treatment for symptomatic adenomyosis, detailing its application and outcomes.

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This study evaluated bilateral uterine artery embolization (UAE) as a conservative, non-amputating intervention for 15 consecutive symptomatic premenopausal women with imaging-diagnosed diffuse and/or focal adenomyosis, who wished to keep the uterus and were reluctant to hysterectomy. UAE was technically successful in all cases, with severe post-procedural pain for 24 hours managed with analgesics and no immediate complications; however, one major complication occurred 45 days after embolization, involving partial vaginal expulsion of necrosed focal adenomyosis tissue with sepsis that required surgical resection while preserving the uterus. At 6-month follow-up, the authors report a significant decrease in symptoms, while acknowledging that long-term outcomes and the need for re-embolization were still under evaluation, with the small sample and short follow-up as key limitations. This paper is centrally about endometriosis and adenomyosis—specifically, it evaluates UAE for symptomatic adenomyosis.

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Abstract

Poster: ECR 2010 / C-2074 / UAE for the treatment of symptomatic adenomyosis by: V. D. Souftas , P. Tsikouras, M. Mantatzis, E. Astrinakis, S. Foutzitzi, V. Liberis, P. Prassopoulos; Alexandroupolis/GR
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Keywords

Interventional vascular, Vascular, Percutaneous Authors: V. D. Souftas, P. Tsikouras, M. Mantatzis, E. Astrinakis, S. Foutzitzi, V. Liberis, P. Prassopoulos; Alexandroupolis/GR DOI: 10.1594/ecr2010/C-2074 Purpose Adenomyosis is a common disease with an incidence of 5-7% in surgical series, affecting primarily premenopausal women. It is characterized by the presence of heterotopic endometrial glands and stroma in the myometrium, associated with adjacent myometrial hyperplasia. Epithelial and stromal elements are situated at least 2.5mm beyond the endometrial-myometrial junction [1]. Adenomyosis may be either diffuse or focal (adenomyoma). Coexisting myomas and asymmetric wall involvement are common with the posterior uteral wall being mostly affected [2]. Menorrhagia and dysmenorrhea are the major symptoms of adenomyosis,...

Methods

and Materials The study comprises fifteen consecutive symptomatic women (age 37-55y.o., mean 46.3y) that were presented with dysmenorrhea, dyspareunea, pelvic discomfort, menorrhagia-metrorrhagia and anemia. Diffuse adenomyosis (n=5), focal adenomyosis (n=2), coexisting diffuse and focal adenomyosis (n=8) were diagnosed based on imaging findings (US, MRI) and clinical evaluation. Three patients had also myomatosis (Figure 1). Inclusion criteria were also based on the fact that all the patients desired to keep the uterus and were reluctant to a more invasive and amputating treatment such as hysterectomy (Figure 2). Patients...

Results

Technically successful embolization of both uterine arteries was achieved in all cases. All patients suffered from severe post-procedural pain lasting 24h, which was treated with analgesics. No other immediate complication was noted.A major complication occurred in one case (6%), 45 days post-embolization. This complication consisted of partial vaginal expulsion of necrosed portions of focal adenomyosis and sepsis. The necrosed tissues were surgically resected, while the uterus was preserved (Figure 1, Figure 2). On the follow up 6 months post-UAE, a significant decrease of the uterine...

Conclusion

The short-term and mid-term results of our study are encouraging. Thus, UAE seems to be a technically efficient, non-amputating treatment option for adenomyosis, offering a significant regression of the patients’ symptoms. The procedure is well tolerated by using analgesics, while the risk of significant complications is low. Long-term results as well as the need for re-embolization are currently under evaluation.Treatment of symptomatic adenomyosis with bilateral transcatheter embolization of the uterine arteries may offer an effective treatment option when conservative treatment fails.

References

Wang PH, Su WH, Sheu BC, Liu WM. Adenomyosis and its variance: adenomyoma and female fertility. Taiwan J Obstet Gynecol. 2009;48:232-8Levgur M. Diagnosis of adenomyosis. J Reprod Med 2007;52:177–93McElin TW, Bird CC. Adenomyosis of the uterus. Obstet Gynecol Annu. 1974;3:425-41Levgur M. Diagnosis of adenomyosis: a review. J Reprod Med. 2007;52:177-93Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T. MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics 2005;25:21–40Jha RC, Takahama J, Imaoka I, Korangy SJ, Spies JB, Cooper...

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