Characteristics of vascular supply to uterine leiomyoma: an analysis of digital subtraction angiography imaging in 518 cases.

Objectives: To investigate the characteristics of the vascular supply to uterine leiomyomas based on digital subtraction angiography.

Methods: The feeding artery, vascularity of uterine leiomyoma and visualisation of the ovarian vessel network were studied in 518 patients undergoing uterine artery embolisation (UAE). Mean patient age was 38.97 ± 6.09 years (range, 22-54 years). The types of vascular supply were analysed by the vascular supply to the leimyoma and grades of vascularity by the degree of enhancement of the leimyoma compared with the myometrium.

Results: The blood supply of leiomyomas could not be classified in 3.28 % of patients. Blood was supplied solely by the uterine artery in 88.61 % of leiomyomas, 8.11 % of leiomyomas were partially fed by an ovarian artery, and 0.39 % by it exclusively. Leiomyoma blood supply was classified as unilateral predominant, bilateral balanced, single unilateral uterine artery and single ovarian artery in 36.48, 49.23, 10.62 and 0.39 % of cases respectively. Leiomyoma vascularity was classified as extremely hypervascular (8.69 %), hypervascular (46.14 %), isovascular (33.39 %) and hypovascular (11.78 %).

Conclusions: Uterine leiomyomas supplied by both uterine arteries and with rich blood flow were seen in approximately 50 % of patients. However, close attention also should be given to the collateral circulation during UAE.