To compare clinical and imaging outcomes after uterine fibroid embolization (UFE) with BeadBlock, Embospheres and polyvinyl alcohol (PVA) particles.
Materials & Methods
In a retrospective study of all our patients who underwent UFE from 08/2000 to 08/2008, we reviewed the electronic medical records, MRI and angiographic images (pre/post UFE), procedural parameters, and follow-up clinical data at 2 weeks, 3 months, 6 months, and 1 year. Symptoms were divided into pain/pressure, bleeding, or combined. Fibroids were classified as localized (submucosal, intramural, subserosal, or combined) vs diffuse. Fibroid volume was calculated by the largest diameter in 3 anatomic planes. Particle size ranged from 300-500 to 710-1000 microns. Angiographic endpoint was stasis or near-stasis.
Results
179 consecutive women had UFE with BeadBlock (n=31), Embospheres (n=78) or PVA (n=70). The PVA group was older (mean = 47 vs 43 vs 43 years, p=0.004) and presented more often with combined symptoms (p=0.025). Fibroid location (localized vs diffuse), side (right vs left), maximal uterine diameter, and side of larger uterine artery were similar (p>0.05). The largest fibroid in BeadBlock patients was significantly smaller (mean diameter = 6.0 cm) than in PVA (7.7 cm) or Embospheres patients (9.8 cm). Similar angiographic endpoints were observed across groups (86% near-stasis) and were reached after injecting 4 syringes or less in 61% of BeadBlock, 55% of Embospheres and 87% of PVA cases (p=0.008); cost difference of all agents in our institution fell within a $50 range. During follow-up, all but 2 patients experienced symptomatic improvement and normalization of menses. None had symptoms of infection or persistent facial flushing. On MRI, the largest uterine and fibroid diameters, percentage of fibroid infarction, and residual enhancement rate were similar in all groups, with no myometrial infarction. Despite baseline differences in largest fibroid diameter, the calculated mean volume reduction after UFE was similar in all groups (41% BeadBlock, 48% Embospheres, 40% PVA).
Conclusion
UFE with all 3 particle types yielded similarly good clinical and imaging outcomes. No single agent demonstrated greater treatment efficacy.
1Massachusetts General Hospital - Radiology, Boston, MA
2Massachusetts General Hospital - Obstetrics and Gynecology, Boston, MA
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