Re-intervention after uterine leiomyoma embolisation is related to incomplete infarction and presence of submucous leiomyomas
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved..
OBJECTIVE: To evaluate outcome of invasive gynecological re-interventions after uterine artery embolisation (UAE) in relation to leiomyoma characteristics.
DESIGN: A cohort of 114 women with symptomatic myomas underwent UAE. Myoma characteristics were determined by contrast-enhanced magnetic resonance imaging (MRI) before and 6 months after treatment. The median follow-up time after UAE was 55.9 months; (range 20-116). Data on gynecological re-interventions were obtained for all patients and were analysed using the Kaplan-Meier method. Data were obtained on frequency of invasive re-interventions: major myoma procedures (hysterectomy, re-embolisation, laparoscopic or abdominal myomectomy) and outpatient hysteroscopic myoma procedures. Myoma characteristics with impact on outcome of re-interventions were determined by statistical analysis.
RESULTS: Total re-intervention rate was 35.1%. Hysterectomy was performed due to myoma related symptoms in 6.1% of patients, but 23.7% of patients underwent additional uterine procedures, mainly outpatient hysteroscopy (15%). Major myoma re-intervention correlated with the extent of the infarct at follow-up MRI (n=107). Patients had undergone major re-intervention (3 years) as follows: infarct group C (<80%, n=16) 44%, infarct group B (80-99%, n=16) 19%, and infarct group A (100%, n=75) 10.1% ((p<0.01) for both A vs B+C and A+B vs C). Major re-interventions were not associated with the presence of submucous myomas; but the hazard ratio (CI 95%) for undergoing hysteroscopic re-intervention was 8.4 (2-29) (p=0.001) in patients with submucous myomas, but 12.7 (5-35) (p<0.0001) in patients with more than one submucous myomas.
CONCLUSIONS: Complete infarction after UAE reduces the need for major re-interventions. Assessment of complete infarction may be considered to improve quality in UAE procedures. Patients with more than one submucous myoma at UAE may often have hysteroscopic removal of residual myomas.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2014 |
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| Erschienen: |
2014 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:178 |
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| Enthalten in: |
European journal of obstetrics, gynecology, and reproductive biology - 178(2014) vom: 09. Juli, Seite 100-6 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Dueholm, Margit [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 09.02.2015 Date Revised 20.06.2014 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ejogrb.2014.04.022 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM238106586 |
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| 100 | 1 | |a Dueholm, Margit |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Re-intervention after uterine leiomyoma embolisation is related to incomplete infarction and presence of submucous leiomyomas |
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| 500 | |a Date Revised 20.06.2014 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2014 Elsevier Ireland Ltd. All rights reserved. | ||
| 520 | |a OBJECTIVE: To evaluate outcome of invasive gynecological re-interventions after uterine artery embolisation (UAE) in relation to leiomyoma characteristics | ||
| 520 | |a DESIGN: A cohort of 114 women with symptomatic myomas underwent UAE. Myoma characteristics were determined by contrast-enhanced magnetic resonance imaging (MRI) before and 6 months after treatment. The median follow-up time after UAE was 55.9 months; (range 20-116). Data on gynecological re-interventions were obtained for all patients and were analysed using the Kaplan-Meier method. Data were obtained on frequency of invasive re-interventions: major myoma procedures (hysterectomy, re-embolisation, laparoscopic or abdominal myomectomy) and outpatient hysteroscopic myoma procedures. Myoma characteristics with impact on outcome of re-interventions were determined by statistical analysis | ||
| 520 | |a RESULTS: Total re-intervention rate was 35.1%. Hysterectomy was performed due to myoma related symptoms in 6.1% of patients, but 23.7% of patients underwent additional uterine procedures, mainly outpatient hysteroscopy (15%). Major myoma re-intervention correlated with the extent of the infarct at follow-up MRI (n=107). Patients had undergone major re-intervention (3 years) as follows: infarct group C (<80%, n=16) 44%, infarct group B (80-99%, n=16) 19%, and infarct group A (100%, n=75) 10.1% ((p<0.01) for both A vs B+C and A+B vs C). Major re-interventions were not associated with the presence of submucous myomas; but the hazard ratio (CI 95%) for undergoing hysteroscopic re-intervention was 8.4 (2-29) (p=0.001) in patients with submucous myomas, but 12.7 (5-35) (p<0.0001) in patients with more than one submucous myomas | ||
| 520 | |a CONCLUSIONS: Complete infarction after UAE reduces the need for major re-interventions. Assessment of complete infarction may be considered to improve quality in UAE procedures. Patients with more than one submucous myoma at UAE may often have hysteroscopic removal of residual myomas | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Leiomyoma | |
| 650 | 4 | |a Outcome | |
| 650 | 4 | |a Re-interventions | |
| 650 | 4 | |a Uterine artery embolisation | |
| 700 | 1 | |a Langfeldt, Sten |e verfasserin |4 aut | |
| 700 | 1 | |a Mafi, Hossain M |e verfasserin |4 aut | |
| 700 | 1 | |a Eriksen, Gitte |e verfasserin |4 aut | |
| 700 | 1 | |a Marinovskij, Edvard |e verfasserin |4 aut | |
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