The Incidence and Risk Factors for the Presence of Type 1B or Type 3 Utero-ovarian Anastomoses During Uterine Artery Embolization
Abstract
Background/Aims: Demonstration of possible utero-ovarian anastomoses (UOA) before or during uterine artery embolization (UAE) is important to preserve ovarian reserve. This study aimed to evaluate the incidence and risk factors for the presence of type 1b or type 3 UOA in patients undergoing UAE for the treatment of uterine myomas.
Methods: Procedural angiographies of patients who underwent UAE were evaluated in a single academic center. Patients’ demographics, indication for UAE, presence and type of UOA, presence of adnexal pathology at preprocedural MRI, history of pelvic surgery, and total uterine volume at preprocedural MRI were retrospectively evaluated. Analysis of the aforementioned variables between patients with and without UOA was performed.
Results: This study included 30 patients with a mean age of 41.97±5.72 years (range 32 - 56). UOA was found in 17 (56.6%) patients, 10 (33.3%) of them were type 1b, and 7 (23.3%) of them were type 3. Five patients (17.2%) had adnexal pathology at pre-procedural MRI and 12 patients (40%) had a history of pelvic surgery. The mean total uterine volume was 607.1 cm3. In the analysis of variables between patients with and without UOA, UOA presence was significantly higher in patients with a history of pelvic surgery (p=0.005). All of the patients with a history of myomectomy were found to have type 1b or type 3 UOA. No significant relation between UOA and age, the presence of adnexal pathology, and uterine volume were detected.
Conclusion: Utero-ovarian anastomoses are commonly encountered during UAE. A history of pelvic surgery was found to be a risk factor for the presence of type 1b and type 3 UOA.
Keywords
Uterine artery embolization utero-ovarian anastomoses arterial angiography pelvic surgery ovarian reserve risk factors premature menopause
References
- Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M. Burden, Prevalence, and Treatment of Uterine Fibroids: A Survey of U.S. Women. J Womens Health (Larchmt). 2018; 27(11): 1359-1367.
- Wallach EE, Vlahos NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol. 2004; 104(2): 393-406.
- Stewart JK. Uterine artery embolization for uterine fibroids: a closer look at misperceptions and challenges. Tech Vasc Interv Radiol. 2021; 24(1): 100725.
- El Shamy T, Amer SAK, Mohamed AA, James C, Jayaprakasan K. The impact of uterine artery embolization on ovarian reserve: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2020; 99(1): 16-23.
- Sheikh GT, Najafi A, Cunier M, Hess TH, Binkert CA. Angiographic detection of utero-ovarian anastomosis and influence on ovarian function after uterine artery embolization. Cardiovasc Intervent Radiol. 2020; 43(2): 231-237.
- Kim HS, Tsai J, Lee JM, Vang R, Griffith JG, Wallach EE. Effects of utero-ovarian anastomoses on basal follicle-stimulating hormone level change after uterine artery embolization with tris-acryl gelatin microspheres. J Vasc Interv Radiol. 2006; 17(6): 965-971.
- Razavi MK, Wolanske KA, Hwang GL, Sze DY, Kee ST, Dake MD. Angiographic classification of ovarian artery–to–uterine artery anastomoses: initial observations in uterine fibroid embolization. Radiology. 2002; 224(3): 707-712.
- Pelage JP, Walker WJ, Le Dref O, Rymer R. Ovarian artery: angiographic appearance, embolization and relevance to uterine fibroid embolization. Cardiovasc Intervent Radiol. 2003; 26(3): 227-233.
- Langer JE, Oliver ER, Lev-Toaff AS, Coleman BG. Imaging of the female pelvis through the life cycle. Radiographics. 2012; 32(6): 1575-1597.
- Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database of Syst Rev. 2014; 12: CD005073
- de Bruijn AM, Ankum WM, Reekers JA, Birnie E, van der Kooij SM, Volkers NA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol. 2016; 215(6): 745. e1-12.
- Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol. 2008; 31: 73-85.
- Salazar GM, Walker TG, Conway RF, Yeddula K, Wicky S, Waltman AC, et al. Embolization of angiographically visible type I and II utero-ovarian anastomoses during uterine artery embolization for fibroid tumors: impact on symptom recurrence and permanent amenorrhea. J Vasc Interv Radiol. 2013; 24(9): 1347-1352.
- Kim HS, Tsai J, Patra A, Lee JM, Griffith JG, Wallach EE. Effects of utero-ovarian anastomoses on clinical outcomes and repeat intervention rates after uterine artery embolization. J Vasc Interv Radiol. 2006; 17(5): 783-789.
- Xiangying H, Lili H, Yifu S. The effect of hysterectomy on ovarian blood supply and endocrine function. Climacteric. 2006; 9(4): 283-289.
- Nahás EAP, Pontes A, Nahas-Neto J, Borges VTM, Dias R, Traiman P. Effect of total abdominal hysterectomy on ovarian blood supply in women of reproductive age. J Ultrasound Med. 2005; 24(2): 169-174.
- Mahesan A, Sadek S, Sabouni R, Stadtmauer L. Utero-ovarian arterial blood flow is impaired at 1 month follow-up after robotic-assisted laparoscopic myomectomy. Fertil Steril. 2018; 110(4): e134.
- Kozik W. Arterial vasculature of ovaries in women of various ages in light of anatomic, radiologic and microangiographic examinations. Ann Acad Med Stetin. 2000; 46: 25-34.
- Ouyang Z, Liu P, Yu Y, Chen C, Song X, Liang B, et al. Role of ovarian artery-to-uterine artery anastomoses in uterine artery embolization: initial anatomic and radiologic studies. Surg Radiol Anat. 2012; 34: 737-741.
- Lanciego C, Diaz-Plaza I, Ciampi J-J, Cuena-Boy R, Rodríguez-Martín N, Maldonado M-D, et al. Utero-ovarian anastomoses and their influence on uterine fibroid embolization. J Vasc Interv Radiol. 2012; 23(5): 595-601.
- Kim HS, Thonse VR, Judson K, Vang R. Utero-ovarian anastomosis: histopathologic correlation after uterine artery embolization with or without ovarian artery embolization. J Vasc Interv Radiol. 2007; 18(1): 31-39.
Uterin Arter Embolizasyonu Sırasında Tip 1B veya Tip 3 Utero-ovaryan Anastomoz Varlığının Sıklığı ve Risk Faktörleri
Abstract
Giriş/amaç: Uterin arter embolizasyonu (UAE) öncesinde veya sırasında olası utero-ovaryan anastomozların (UOA) gösterilmesi over rezervinin korunması açısından önemlidir. Bu çalışma, uterus miyomu tedavisi için UAE uygulanan hastalarda tip 1b veya tip 3 UOA varlığına ilişkin insidansı ve risk faktörlerini değerlendirmeyi amaçlamıştır.
Yöntem: UAE yapılan hastaların işlem anjiyografileri tek akademik merkezde değerlendirildi. Hastaların demografik özellikleri, UAE endikasyonu, UOA varlığı ve tipi, işlem öncesi MRG'de adneksiyal patoloji varlığı, pelvik cerrahi öyküsü ve işlem öncesi MRG' de toplam uterus hacmi retrospektif dosya incelemesi ile değerlendirildi. Yukarıda belirtilen değişkenlerin UOA’sı olan ve olmayan hastalar arasında analizi yapıldı.
Bulgular: Bu çalışmaya yaş ortalaması 41.97±5.72 yıl (32 – 56 yıl arası) olan 30 hasta dahil edildi. Hastaların 17'sinde (%56.6) UOA saptandı, bunların 10'u (%33.3) tip 1b, 7'si (%23.3) tip 3 idi. İşlem öncesi MRG'de 5 hastada (%17.2) adneksiyal patoloji vardı. On iki hastada (%40) pelvik cerrahi öyküsü vardı. Ortalama toplam uterus hacmi 607.1 cm3 idi. UOA olan ve olmayan hastalar arasındaki değişkenlerin analizinde, pelvik cerrahi öyküsü olan hastalarda UOA varlığı anlamlı derecede yüksekti (p=0.005). Miyomektomi öyküsü olan hastaların tamamında tip 1b veya tip 3 UOA mevcuttu. UOA ile yaş, adneksiyal patoloji varlığı ve uterus hacmi arasında anlamlı bir ilişki saptanmadı.
Sonuç: Utero-ovaryan anastomozlara UAE sırasında sıklıkla rastlanır. Bu çalışmada pelvik cerrahi öyküsü tip 1b ve tip 3 UOA varlığı için bir risk faktörü olarak bulunmuştur.
Keywords
Uterin arter embolizasyonu utero-ovaryan anastomozlar arteriyel anjiyografi pelvik cerrahi over rezervi risk faktörleri erken menopoz
References
- Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M. Burden, Prevalence, and Treatment of Uterine Fibroids: A Survey of U.S. Women. J Womens Health (Larchmt). 2018; 27(11): 1359-1367.
- Wallach EE, Vlahos NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol. 2004; 104(2): 393-406.
- Stewart JK. Uterine artery embolization for uterine fibroids: a closer look at misperceptions and challenges. Tech Vasc Interv Radiol. 2021; 24(1): 100725.
- El Shamy T, Amer SAK, Mohamed AA, James C, Jayaprakasan K. The impact of uterine artery embolization on ovarian reserve: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2020; 99(1): 16-23.
- Sheikh GT, Najafi A, Cunier M, Hess TH, Binkert CA. Angiographic detection of utero-ovarian anastomosis and influence on ovarian function after uterine artery embolization. Cardiovasc Intervent Radiol. 2020; 43(2): 231-237.
- Kim HS, Tsai J, Lee JM, Vang R, Griffith JG, Wallach EE. Effects of utero-ovarian anastomoses on basal follicle-stimulating hormone level change after uterine artery embolization with tris-acryl gelatin microspheres. J Vasc Interv Radiol. 2006; 17(6): 965-971.
- Razavi MK, Wolanske KA, Hwang GL, Sze DY, Kee ST, Dake MD. Angiographic classification of ovarian artery–to–uterine artery anastomoses: initial observations in uterine fibroid embolization. Radiology. 2002; 224(3): 707-712.
- Pelage JP, Walker WJ, Le Dref O, Rymer R. Ovarian artery: angiographic appearance, embolization and relevance to uterine fibroid embolization. Cardiovasc Intervent Radiol. 2003; 26(3): 227-233.
- Langer JE, Oliver ER, Lev-Toaff AS, Coleman BG. Imaging of the female pelvis through the life cycle. Radiographics. 2012; 32(6): 1575-1597.
- Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database of Syst Rev. 2014; 12: CD005073
- de Bruijn AM, Ankum WM, Reekers JA, Birnie E, van der Kooij SM, Volkers NA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol. 2016; 215(6): 745. e1-12.
- Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol. 2008; 31: 73-85.
- Salazar GM, Walker TG, Conway RF, Yeddula K, Wicky S, Waltman AC, et al. Embolization of angiographically visible type I and II utero-ovarian anastomoses during uterine artery embolization for fibroid tumors: impact on symptom recurrence and permanent amenorrhea. J Vasc Interv Radiol. 2013; 24(9): 1347-1352.
- Kim HS, Tsai J, Patra A, Lee JM, Griffith JG, Wallach EE. Effects of utero-ovarian anastomoses on clinical outcomes and repeat intervention rates after uterine artery embolization. J Vasc Interv Radiol. 2006; 17(5): 783-789.
- Xiangying H, Lili H, Yifu S. The effect of hysterectomy on ovarian blood supply and endocrine function. Climacteric. 2006; 9(4): 283-289.
- Nahás EAP, Pontes A, Nahas-Neto J, Borges VTM, Dias R, Traiman P. Effect of total abdominal hysterectomy on ovarian blood supply in women of reproductive age. J Ultrasound Med. 2005; 24(2): 169-174.
- Mahesan A, Sadek S, Sabouni R, Stadtmauer L. Utero-ovarian arterial blood flow is impaired at 1 month follow-up after robotic-assisted laparoscopic myomectomy. Fertil Steril. 2018; 110(4): e134.
- Kozik W. Arterial vasculature of ovaries in women of various ages in light of anatomic, radiologic and microangiographic examinations. Ann Acad Med Stetin. 2000; 46: 25-34.
- Ouyang Z, Liu P, Yu Y, Chen C, Song X, Liang B, et al. Role of ovarian artery-to-uterine artery anastomoses in uterine artery embolization: initial anatomic and radiologic studies. Surg Radiol Anat. 2012; 34: 737-741.
- Lanciego C, Diaz-Plaza I, Ciampi J-J, Cuena-Boy R, Rodríguez-Martín N, Maldonado M-D, et al. Utero-ovarian anastomoses and their influence on uterine fibroid embolization. J Vasc Interv Radiol. 2012; 23(5): 595-601.
- Kim HS, Thonse VR, Judson K, Vang R. Utero-ovarian anastomosis: histopathologic correlation after uterine artery embolization with or without ovarian artery embolization. J Vasc Interv Radiol. 2007; 18(1): 31-39.
Details
| Primary Language | English |
|---|---|
| Subjects | Radiology and Organ Imaging |
| Journal Section | Original Article |
| Authors | |
| Early Pub Date | February 26, 2024 |
| Publication Date | February 29, 2024 |
| Submission Date | October 2, 2023 |
| Published in Issue | Year 2024 Volume: 34 Issue: 1 |
Journal of General Medicine is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY NC).