Acrylamido Polyvinyl Alcohol Microspheres for Uterine Artery Embolization: 12-month Clinical and MR Imaging Results

Kroencke, Thomas J.; Scheurig, Christian; Lampmann, Leo E.H.; Boekkooi, Peter F.; Kissner, Lutz; Kluner, Claudia; Weichert, Wilko; Hamm, Bernd; Lohle, Paul N.M.

doi:10.1016/j.jvir.2007.08.019

« Previous Next »Journal of Vascular and Interventional Radiology
Volume 19, Issue 1 , Pages 47-57, January 2008

Acrylamido Polyvinyl Alcohol Microspheres for Uterine Artery Embolization: 12-month Clinical and MR Imaging Results

Thomas J. Kroencke, MD
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- T.J.K. has served as an advisor to Biocompatibles and is currently an advisor to Terumo, and has received honoraria for presentations relating to the use of BeadBlock. None of the other authors have identified a conflict of interest.
- Address correspondence to T.J.K.
Christian Scheurig, MD
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
Leo E.H. Lampmann, MD, PhD
- Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, The Netherlands.
Peter F. Boekkooi, MD, PhD
- Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, The Netherlands.
Lutz Kissner, MD
- Department of Gynecology and Obstetrics, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
Claudia Kluner, MD
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
Wilko Weichert, MD
- Department of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
Bernd Hamm, MD
- Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
Paul N.M. Lohle, MD, PhD
- Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, The Netherlands.

Received 26 February 2007; received in revised form 13 August 2007; accepted 14 August 2007.

Purpose

To report the 12-month clinical and magnetic resonance (MR) imaging results of an ongoing two-center registry involving acrylamido polyvinyl alcohol (PVA) microspheres for uterine artery embolization (UAE) for leiomyomas.

Materials and Methods

A total of 69 patients underwent UAE with 500–700-μm, 700–900-μm, and 900–1,200-μm acrylamido PVA microspheres (BeadBlock). Thirty-three patients underwent UAE with a limited embolization (protocol A) and 36 patients underwent UAE with stasis as the angiographic endpoint (protocol B). Primary objectives were clinical efficacy measured by a leiomyoma-specific quality of life (QOL) questionnaire and infarction rate of leiomyomas on early contrast agent–enhanced MR imaging. Secondary objectives were in-hospital complications, patient satisfaction, and frequency of clinical failure.

Results

Bilateral embolization was technically successful in 68 of 69 patients. A significant decrease (P < .001) in symptom severity and increase in health-related QOL was observed at 3 and 12 months with no significant differences between embolization protocols. However, contrast agent–enhanced MR imaging showed a significantly lower rate of completely infarcted leiomyomas in protocol A compared with protocol B (P < .05). Early clinical failures in patients treated according to protocol A were caused by incomplete tumor infarction. Minor complications occurred in five of 69 patients. Patient satisfaction was similar between protocols.

Conclusions

Acrylamido PVA microspheres are a clinically effective and safe embolic agent for UAE. The use of 500–700-μm spheres and a limited embolization results in an unacceptably high rate of failed tumor infarction. Superior imaging results and fewer repeat interventions can be achieved with use of 700–900-μm spheres and stasis as the angiographic endpoint.

Abbreviations: PVA, polyvinyl alcohol, QOL, quality of life, UAE, uterine artery embolization