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Ito H, Nakai M, Yunaiyama D, Shirota N, Kobayashi T, Yasutomi M, Kikuchi T, Kinoshita Y, Takara Y, Tanaka T, Saguchi T, Saito K. Efficacy of uterine artery embolization (UAE) for uterine fibroids according to FIGO classification: a single-center experience. Jpn J Radiol 2024; 42:174-181. [PMID: 37815695 DOI: 10.1007/s11604-023-01492-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/13/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE This study aims to retrospectively evaluate the outcomes of uterine artery embolization (UAE) for uterine fibroids (UFs), specifically submucosal UFs, according to the International Federation of Gynecology and Obstetrics (FIGO) classification of UFs. MATERIALS AND METHODS Forty-two patients with symptomatic UFs underwent UAE with Embosphere® between July 2016 and November 2021. MRI was performed before, at 3 and 6 months after the UAE. At each examination, the volume of UF was measured, and the percentage volume reduction rate (VRR) was calculated. The technical success rate (TSR), symptom improvement rate (SIR), regrowth rate (RR) after 6 months, and adverse events (AEs) were examined; VRR was compared between patients with submucosal UFs (FIGO types 0-2, group A), those with submucosal contacts (FIGO type 3, group B), and those without submucosal UFs (FIGO types 4-7, group C). Statistical analysis was performed on the difference in VRR between groups A, B, and C at 3 and 6 months after UAE. The relationship with hormone levels before UAE and VRR was evaluated. RESULTS Thirty-seven of the 42 patients were evaluated. Overall, VRR was 37.0% at 3 months and 52.1% at 6 months; TSR, SIR, and RR were 100%, 95.2%, and 5.4%, respectively; VRR at 6 months was 80.7% for group A (n = 7), 57.8% for group B (n = 13), and 37.1% for group C (n = 17). Significant differences were found between A and C (p < 0.001) and B and C (p = 0.023). Hormone levels before UAE had no effect on VRR. There was no significant AEs other than grade 3 pulmonary embolism in one patient. CONCLUSION UAE was effective for submucosal FIGO types 0-3. UAE was especially useful as an option for FIGO type 3 with a low protrusion rate that is difficult to treat with transcervical resection.
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Affiliation(s)
- Hiroe Ito
- Department of Obstetrics and Gynecology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Motoki Nakai
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan.
| | - Daisuke Yunaiyama
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Natsuhiko Shirota
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Takehiro Kobayashi
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Mika Yasutomi
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Takayuki Kikuchi
- Department of Obstetrics and Gynecology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Yuta Kinoshita
- Department of Obstetrics and Gynecology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Yuki Takara
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Taro Tanaka
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Toru Saguchi
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-Ku, Tokyo, Japan
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Tsikouras P, Oikonomou E, Tsatsaris G, Bothou A, Kyriakou D, Nikolettos K, Nalmbanti T, Peitsidis P, Trypsanis G, Iatrakis G, Nikolettos N, Souftas V. Our Experience with Hydrogel-Coated Trisacryl Microspheres in Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids and Adenomyosis: A Follow-Up of 11 Years. J Pers Med 2023; 13:1385. [PMID: 37763151 PMCID: PMC10532514 DOI: 10.3390/jpm13091385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Uterine artery embolization (UAE) for the treatment of symptomatic uterine fibroids and non-controllable adenomyosis symptoms is a relatively new procedure for organ-preserving therapy. These benign conditions can become symptomatic in about 30% of women between the ages of 35 and 50. The purpose of the UAE either for fibroids or adenomyosis is the elimination of blood loss, the reduction in pain, and bulky or rectal pressure symptoms. The purpose of this study is to present our experience in UAE with the use of hydrogel-coated tris acryl microspheres for the treatment of symptomatic uterine fibroids and adenomyosis.
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Affiliation(s)
- Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Efthymios Oikonomou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - George Tsatsaris
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Anastasia Bothou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Dimitrios Kyriakou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Konstantinos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Theopi Nalmbanti
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Panagiotis Peitsidis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Grigorios Trypsanis
- Department of Medical Statistics, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - George Iatrakis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Nikolaos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (G.T.); (A.B.); (D.K.); (K.N.); (T.N.); (P.P.); (G.I.); (N.N.)
| | - Vasileios Souftas
- Department of Interventional Radiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
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Dong Z, Meng X, Yang W, Zhang J, Sun P, Zhang H, Fang X, Wang DA, Fan C. Progress of gelatin-based microspheres (GMSs) as delivery vehicles of drug and cell. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 122:111949. [PMID: 33641932 DOI: 10.1016/j.msec.2021.111949] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022]
Abstract
Gelatin has various attractive features as biomedical materials, for instance, biocompatibility, low immunogenicity, biodegradability, and ease of manipulation. In recent years, various gelatin-based microspheres (GMSs) have been fabricated with innovative technologies to serve as sustained delivery vehicles of drugs and genetic materials as well as beneficial bacteria. Moreover, GMSs have exhibited promising potentials to act as both cell carriers and 3D scaffold components in tissue engineering and regenerative medicine, which not only exhibit excellent injectability but also could be integrated into a macroscale construct with the laden cells. Herein, we aim to thoroughly summarize the recent progress in the preparations and biomedical applications of GMSs and then to point out the research direction in future. First, various methods for the fabrication of GMSs will be described. Second, the recent use of GMSs in tumor embolization and in the delivery of cells, drugs, and genetic material as well as bacteria will be presented. Finally, several key factors that may enhance the improvement of GMSs were suggested as delivery vehicles.
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Affiliation(s)
- Zuoxiang Dong
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao 266000, Shandong, China; Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Xinyue Meng
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao 266000, Shandong, China
| | - Wei Yang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao 266000, Shandong, China
| | - Jinfeng Zhang
- Department of Surgery, Songshan Hospital of Qingdao University, Qingdao 266021, Shandong, China
| | - Peng Sun
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Huawei Zhang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Xing Fang
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Dong-An Wang
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong Special Administrative Region; Shenzhen Research Institute, City University of Hong Kong, Shenzhen Hi-tech Industrial Park, Shenzhen, Guangdong 518057, China; Karolinska Institute Ming Wai Lau Centre for Reparative Medicine, HKSTP, Sha Tin, Hong Kong Special Administrative Region.
| | - Changjiang Fan
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao 266000, Shandong, China.
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Liu S, Li W. Intra-arterial lidocaine for pain control after uterine artery embolization: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 2020; 35:4162-4167. [PMID: 33172315 DOI: 10.1080/14767058.2020.1847079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The efficacy of intra-arterial lidocaine for pain control of uterine artery embolization remains controversial. We conduct a systematic review and meta-analysis to explore the influence of intra-arterial lidocaine versus placebo on the postoperative pain intensity of uterine artery embolization. METHODS We searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through April 2020 for randomized controlled trials (RCTs) assessing the effect of intra-arterial lidocaine versus placebo on pain control of uterine artery embolization. This meta-analysis is performed using the random-effect model. RESULTS Three RCTs were included in the meta-analysis. Overall, compared with control group for uterine artery embolization, intra-arterial lidocaine was associated with substantially reduced pain scores at 4 h (SMD = -0.85; 95% CI = -1.31 to -0.38; p = .0003) and analgesic consumption (SMD = -0.84; 95% CI = -1.26 to -0.42; p < .0001), but has no obvious influence on pain scores at 7 h (SMD = -0.19; 95% CI = -0.63 to 0.25; p = .40) or pain scores at 24 h (SMD = -0.55; 95% CI = -1.25 to 0.16; p = .13). CONCLUSIONS Intra-arterial lidocaine is effective for pain control after uterine artery embolization.
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Affiliation(s)
- Shudong Liu
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Wenyan Li
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Farrell TP, Garvey C, Adams NC, Mulholland D, Ryan JM, Guiney M, McEniff N. Comparison of outcomes and cost-effectiveness of trisacryl gelatin microspheres alone versus combined trisacryl gelatin microspheres and gelatin sponge embolization in uterine fibroid embolization. Acta Radiol 2020; 61:1287-1296. [PMID: 31955609 DOI: 10.1177/0284185119898660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Uterine fibroid embolization (UFE) is an effective treatment for uterine leiomyomata. Optimizing the choice of embolic agents is imperative to achieve better patient outcomes with maximum resource utilization. PURPOSE To evaluate the efficacy and cost-effectiveness of trisacryl gelatin microspheres (TAGM) versus combined TAGM and gelatin sponge (GS) embolization in the treatment of symptomatic uterine leiomyomata. MATERIAL AND METHODS Between July 2007 and December 2010, 106 consecutive patients underwent UFE with TAGM. Between January 2011 and December 2016, 123 consecutive patients underwent UFE with a combination of TAGM/GS. The primary outcomes were successful infarction rate (≥90% infarction) of the dominant leiomyoma and percentage reduction in uterine and dominant leiomyoma volume on MRI at six months. Secondary outcomes included adverse event rates, pain scores, and change in clinical symptoms at six months. The embolic agents utilized per procedure were recorded and a cost-effectiveness analysis was performed. RESULTS Baseline characteristics of both groups were similar. Successful infarction was achieved in 93.2% of the TAGM group and 94.6% of the TAGM/GS group (P = 0.52). Reduction in uterine volume (TAGM 40.7%, TAGM/GS 44.4%, P = 0.16) and dominant leiomyoma volume (TAGM 47.6%, TAGM/GS 50.1%, P = 0.29) at six months was similar. No significant difference was observed in symptom improvement at six months (P = 0.8). The mean number of TAGM vials utilized and cost per procedure was 6.3 and $1688.40 for TAGM embolization and 3.6 and $979.50 for TAGM/GS embolization, respectively. CONCLUSION Primary and secondary outcomes were comparable when performing UFE with TAGM versus combined TAGM/GS. The combined use of TAGM/GS reduced the mean cost of embolic agents by 42%.
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Affiliation(s)
| | - Chris Garvey
- Department of Radiology, St James’s Hospital, Dublin, Ireland
| | - Niamh C Adams
- Department of Radiology, St James’s Hospital, Dublin, Ireland
| | | | - J Mark Ryan
- Department of Radiology, St James’s Hospital, Dublin, Ireland
| | - Michael Guiney
- Department of Radiology, St James’s Hospital, Dublin, Ireland
| | - Niall McEniff
- Department of Radiology, St James’s Hospital, Dublin, Ireland
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Katsumori T, Miura H, Yoshikawa T, Seri S, Kotera Y, Asato A. Intra-Arterial Lidocaine Administration for Anesthesia after Uterine Artery Embolization with Trisacryl Gelatin Microspheres for Leiomyoma. J Vasc Interv Radiol 2020; 31:114-120. [DOI: 10.1016/j.jvir.2019.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/12/2019] [Accepted: 09/14/2019] [Indexed: 10/25/2022] Open
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Saibudeen A, Makris GC, Elzein A, Wigham A, Patel R, Husainy MA, Anthony S, Uberoi R. Pain Management Protocols During Uterine Fibroid Embolisation: A Systematic Review of the Evidence. Cardiovasc Intervent Radiol 2019; 42:1663-1677. [DOI: 10.1007/s00270-019-02327-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/24/2019] [Indexed: 11/30/2022]
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