Effect of Embolic Particle Size on Outcomes of Uterine Artery Embolization for Mixed Adenomyosis/Fibroids: Are Smaller Particles Needed?

Monday, March 6, 2023

3:36 PM – 3:45 PM

Location: Phoenix Convention Center, 226ABC

Presenting Author(s)

Sophia Manduca (she/her/hers)

Medical Student
New York University Grossman School of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Tarub S. Mabud, MD

Resident Physician
New York University Grossman School of Medicine
Shu Liu, MD

Clinical Assistant Professor
NYU Grossman School of Medicine
Bedros Taslakian, MD, EBIR

Director of VIR Research Program; Director of Clinical Research Integration
NYU Grossman School of Medicine Program
EM

Elizabeth Morris, MD

Clinical Assistant Professor
Department of Radiology at NYU Grossman School of Medicine
KK

Kopal Kulkarni, MD

Clinical Assistant Professor
Department of Radiology at New York University Grossman School of Medicine

Disclosure(s):

Sophia Manduca: No financial relationships to disclose

Bedros Taslakian, MD, EBIR: Advarra: Consultant (Ongoing), Independent Contractor (Ongoing); Atheneum: Consultant (Ongoing); Elsevier: Royalties (Ongoing); Guidepoint: Consultant (Ongoing); Siemens: Contracted Research (Ongoing); Varian Medical Systems: Contracted Research (Ongoing)

Purpose: To characterize the effect of embolic particle size on outcomes of uterine artery embolization (UAE) for mixed adenomyosis/fibroids.

Materials and Methods: A single-center retrospective database of all patients who underwent UAE with particles (Embosphere, Merit, USA; Embozene, Varian, UK) for mixed adenomyosis/fibroids from September 2015 to May 2022 was compiled. Demographic, clinical, imaging, procedural, and follow-up data were documented via chart review. The effect of initial particle size (after which subsequent upsizing was performed until stasis) upon improvement in patient-reported symptoms was assessed with logistic regression; initial particle size was categorized as either small (Embosphere 300-500μm, Embozene 500μm) or large (Embosphere 500-700μm, Embozene 700μm). Preprocedural uterine volume, presence of focal adenomyoma, and total volume of embolic administered were included as regression covariates.

Results: UAE was performed in 76 patients with mixed adenomyosis/fibroids during the study period (mean age: 46.7 ± 5.7). Preprocedural symptoms included menorrhagia (89.5%), pelvic pain (65.1%), and bulk symptoms (62.2%). Baseline mean uterine volume was 748.5 ± 543.9 mL. Postprocedurally, 89.1%, 92.3%, and 97.4% reported improvement in menorrhagia, pelvic pain, and bulk symptoms, respectively. Decrease in uterine volume was not significantly different between patients who received small (n=19) vs. large (n=57) embolic particles (p=0.82). Initial embolic particle sizing was not significantly associated with patient reported improvement in menorrhagia (p=0.15), pelvic pain (p=0.37), or bulk symptoms (p=0.26), when controlling for covariates.

Conclusion:

Initiation of UAE with smaller particles (<500μm) for mixed adenomyosis/fibroids (with subsequent upsizing until stasis) did not affect patient-reported outcomes relative to initiation of UAE with larger particles ( >500μm). For patients with mixed adenomyosis/fibroids, smaller particles may not be necessary to achieve satisfactory patient outcomes.