Uterine Artery Embolization for Mixed Adenomyosis and Fibroids: Outcomes According to Initial Particle Sizes.

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 was compiled of all patients with mixed adenomyosis/fibroids who underwent UAE with particles (Embosphere, Merit, USA; Embozene, Varian, UK) from September 2015 to May 2022 (n=76, mean age: 46.7 ± 5.7). Demographic, clinical, imaging, procedural, and follow-up data were collected. Intraprocedurally, initial particle size was chosen according to proceduralist judgment and subsequently upsized as needed until near-stasis was achieved. Initial particle size was categorized as either small (Embosphere 300-500μm, Embozene 500μm) or large (Embosphere 500-700μm, Embozene 700μm). The effect of initial particle size on patient-reported symptomatic improvement was assessed with logistic regression, with pre-procedural uterine volume, presence of focal adenomyoma, and total number of vials of embolic material as regression covariates.

Results: Pre-procedural symptoms included menorrhagia (89.5%), pelvic pain (53.9%), and bulk symptoms (60.5%). Baseline mean uterine volume was 748.5 ± 543.9 mL. Post-procedurally, 89.1%, 92.3%, and 97.4% reported improvement in menorrhagia, pelvic pain, and bulk symptoms, respectively. Initial embolic particle sizing was not significantly associated with patient-reported improvement in menorrhagia (p=0.134), pelvic pain (p=0.598), or bulk symptoms (p=0.151), when controlling for covariates.

Conclusion: When controlling for covariates, smaller calibrated microspheres had similar post-procedural pain outcomes as larger particles, with similar target outcomes in UAE for mixed adenomyosis/fibroids.