Treatment failure after uterine artery embolization: Prospective cohort study with multifactorial analysis of possible predictors of long-term outcome

被引:11
|
作者
Scheurig-Muenkler, Christian [1 ]
Koesters, Clemens [1 ]
Grieser, Christian [1 ]
Hamm, Bernd [1 ]
Kroencke, Thomas J. [1 ]
机构
[1] Charite, Dept Radiol, D-13359 Berlin, Germany
关键词
Uterine artery embolization; Magnetic resonance imaging; Leiomyoma; Regression analysis; Women's health; FIBROID EMBOLIZATION; LEIOMYOMATA; SUCCESS;
D O I
10.1016/j.ejrad.2012.01.031
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose: To evaluate the impact of baseline characteristics and residual leiomyoma perfusion after uterine artery embolization (UAE) on clinical long-term outcome. Materials and methods: One hundred fifteen patients underwent UAE. All patients were divided into three groups according to achieved infarction rate determined on contrast-enhanced magnetic resonance imaging within 48-72 h after UAE (I: 100%, n = 60; II: 90-99%, n = 32; and III: 0-89%, n = 23). Treatment failure and subsequent re-interventions (surgery, repeat UAE) were assessed for each group and compared using Cox regression analysis (CRA) with respect to the following baseline variables: age, uterine and dominant fibroid volume, number of fibroids, location of largest fibroid, and clinical symptoms. Results: Long-term follow-up was completed after a median of 7.2 years (range 5.1-9.6) with a response rate of 84%. CRA revealed that patients in group III had a 22.2-fold higher risk (p < 0.001) of treatment failure than patients in group I, whereas groups I and II did not differ significantly (p = 0.578). For patients with bleeding-related symptoms only, CRA showed a 5.1-fold higher risk (p = 0.025) of treatment failure than for patients with equally dominant bleeding-and bulk-related symptoms. A 40.5-fold higher likelihood (p < 0.001) of treatment failure was observed for patients in group III with bleeding-related symptoms only compared to those in group I with combined bleeding-and bulk-related symptoms. Conclusion: Incomplete fibroid infarction after UAE is strongly associated with the risk of experiencing treatment failure. Patients with bleeding-related complaints only face the highest likelihood of treatment failure if UAE results in less than 90% fibroid devascularization. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:E727 / E731
页数:5
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