Medical Student University of Illinois College of Medicine, United States
Purpose: Endometriosis (EM) is a common and highly morbid chronic disease associated with menorrhagia, dysmenorrhea, and anemia for which therapeutic options are limited. While originally indicated only for uterine fibroids (UF), Uterine Artery Embolization (UAE) has been shown to be an effective treatment for patients with adenomyosis (AM) {Maili et al, 2023}. AM often occurs jointly with EM {Vannuccini et al, 2019} which is currently considered a relative contraindication to UAE {Young et al, 2023}. The prevalence EM and dearth of data on its impact on clinical outcomes after UAE demands further exploration. This study was thus undertaken to investigate the impact of EM on the clinical outcome of patients with AM or UF undergoing UAE
Materials and Methods: This IRB-approved retrospective, observational, single-institution study over a 9-year period (2015-2024) included 116 women (age 25-55) who underwent UAE for menorrhagia or dysmenorrhea and had clinical/imaging follow-up. Patients were stratified into four groups: 1) EM, 2) AM, 3) EM + AM, and 4) UF alone. Pre- and post-procedure MRIs were reviewed for imaging response (loss of enhancement/viability of fibroids, change in junctional zone thickness) and change in uterine size. Clinical documentation was evaluated for changes in presenting symptoms, patient satisfaction, and need for further intervention. The primary study endpoints were clinical success (CS) and imaging response (IR)
Results: All UAE procedures were technically successful. Mean follow-up times were 6 months. Complete IR rates in the EM, AM, EM + AM, and UF groups were 100%, 84.4%, 40% and 81.8%. CS rates in the EM, AM, EM + AM, and UF groups were 92.3%, 93.8%, 80% and 77.3%. There was statistically significant association between diagnosis of EM and IR (p=0.027), but no statistical significance between EM and CS (p=0.141). Likelihood ratio for IR was 9.595 (p=0.022), while that of CS was 14.373 (p=0.026). Results indicate a positive correlation between EM and successful imaging outcomes for patients with AM or UF being treated with UAE
Conclusion: EM is a positive predictive factor of successful imaging outcomes for patients with AM or UF treated with UAE. There is not yet enough data to make recommendations for endovascular treatment of endometriosis alone or in conjunction with other pathology and further investigation with a prospective study is needed, but the initial data is encouraging
.jpg)