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Psilopatis I, Fleckenstein FN, Gebauer B, David M. Medical historical notes on myoma treatment by uterine artery embolization on the occasion of its introduction 30 years ago. ROFO-FORTSCHR RONTG 2023; 195:890-895. [PMID: 37467778 DOI: 10.1055/a-2077-1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Since its development, uterine artery embolization (UAE) for the treatment of symptomatic fibroids has become an established minimally invasive alternative to surgical myoma treatment. Currently, more than 25,000 myoma patients worldwide are likely to be treated with UAE annually. METHOD Thirty years ago, Jacques-Henri Ravina (b. 1930) and his Paris team first performed this therapy as a "substitute" for gynecologic surgery. We contacted him as part of the preparation of the present review. In addition, we performed a literature search with the aim of summarizing the current literature and data in addition to a historical account of the development of UAE. RESULTS AND CONCLUSION On the occasion of this anniversary, we would like to recall the interdisciplinary roots and some facets of the history of the development of this relatively young myoma treatment method. KEY POINTS · UAE is an established minimally invasive alternative to surgical myoma treatment.. · UAE was first developed 30 years ago.. · UAE has continuously increased in importance in recent years.. CITATION FORMAT · Psilopatis I, Fleckenstein FN, Gebauer B et al. Medical historical notes on myoma treatment by uterine artery embolization on the occasion of its introduction 30 years ago. Fortschr Röntgenstr 2023; 195: 890 - 895.
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Affiliation(s)
| | - Florian Nima Fleckenstein
- Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Germany
- BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charite, Berlin, Germany
| | - Bernhard Gebauer
- Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Germany
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Tsikouras P, Gkaitatzi F, Gerede A, Anthoulaki X, Bothou A, Chalkidou A, Michalopoulos S, Tsirkas I, Gyroglou S, Peitsidis P, Nikolettos K, Alexiou A, Dragoutsos G, Sachnova N, Chloropoulou P, Zervoudis S, Iatrakis G, Rath W, Trypsiannis G, Nikolettos N, Souftas V. Life Quality in Premenopausal Women after Embolization of Uterine Myomas. J Pers Med 2022; 12:jpm12121990. [PMID: 36556210 PMCID: PMC9786225 DOI: 10.3390/jpm12121990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/01/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: Fibroids cause significant morbidity and are the most common indication for hysterectomies worldwide, delimiting a major public health problem. Uterine artery embolization (UAE) is an alternative therapy to surgical treatment of symptomatic fibroids; it has satisfactory long-time results and is no longer considered investigational for the treatment of symptomatic fibroids. This study was undertaken to evaluate changes in fibroid specific symptom severity and health-related quality of life (HRQOL) after UAE and to optimize the assessment of safety and outcomes measures for participants who receive UAE to objective compare UAE and surgical alternatives for therapy of symptomatic fibroids. Study design: The analysis was based on questionnaires completed by 270 pre-menopausal females with a mean age of 42 years (range, 38-50 years) who underwent UAE for uterine leiomyomas and/or adenomyosis from November 2013 through December 2019. Only symptomatic women were selected whose symptoms were not improving with medication and who did not wish to have children. The primary outcome measure was a change in fibroid symptoms and HRQOL (health related quality of life) after UAE. Secondary outcomes included the decrease in uterine volume after UAE. Results: Questionnaires were completed by 270 women (100%) at a mean of 12.1 months from UAE. The median follow-up period was two years. Uterine fibroid embolization led to a shrinkage at three months for the 90% of the participants. A reduction of bleeding symptoms, pain and bulk-related symptoms was observed in 89.7%, 88.9%, and 89.5% of the patients, respectively. In the long term, there was no significant difference in parameters assessed compared with the midterm follow-up findings. A total of 6 patients (2.3%) underwent fractional curettage an average of 32.1 months after intervention due to necrotic changes in submucosal fibroids. All participants continued to be satisfied with the intervention, and 240 patients (88.9%) answered that they would recommend uterine fibroid embolization to other patients. Conclusions: Women who undergo UAE have a significant decrease in symptom severity and increase in HRQOL which is associated with high levels of satisfaction with the procedure (even when subsequent therapies are pursued).
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Affiliation(s)
- Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
- Correspondence:
| | - Foteini Gkaitatzi
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Aggeliki Gerede
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Xanthoula Anthoulaki
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Anastasia Bothou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Anna Chalkidou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Spyridon Michalopoulos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Ioannis Tsirkas
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Selma Gyroglou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | | | - Konstantinos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Alexios Alexiou
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - George Dragoutsos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Natalia Sachnova
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Pelagia Chloropoulou
- Department of Anaesthesiology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - George Iatrakis
- Rea Maternity Hospital, University of West Attica, 17564 Athens, Greece
| | - Werner Rath
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Grigorios Trypsiannis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Nikolaos Nikolettos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandropoulis, Greece
| | - Vasileios Souftas
- Department of Interventional Radiology, Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece
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Psilopatis I, Fleckenstein FN, Collettini F, Can E, Frisch A, Gebauer B, Fehrenbach U, Torsello GF, Schnapauff D, David M, Wieners G. Short- and long-term evaluation of disease-specific symptoms and quality of life following uterine artery embolization of fibroids. Insights Imaging 2022; 13:106. [PMID: 35727408 PMCID: PMC9213618 DOI: 10.1186/s13244-022-01244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study is to evaluate uterine artery embolization (UAE) for the management of symptomatic uterine leiomyomas regarding changes in quality of life after treatment in a large patient collective. This study retrospectively analyzed prospectively acquired standardized questionnaires of patients treated with UAE. Clinical success was evaluated before and after embolization. Patients were stratified into short- (≤ 7 months) and long-term (> 7 months) follow-up groups depending on the time of completion of the post-interventional questionnaire. Uterine leiomyomas were furthermore divided into small (< 10 cm) and large (≥ 10 cm) tumors based on the diameter of the dominant fibroid.
Results A total of 245 patients were included into the final data analysis. The Kaplan–Meier analysis showed a cumulative clinical success rate of 75.8% after 70 months until the end of follow-up (9.9 years). All questionnaire subscales showed a highly significant clinical improvement from baseline to short- and long-term follow-up (p < 0.001). Patients with small fibroids showed a significantly better response to UAE in multiple subcategories of the questionnaire than patients with fibroids ≥ 10 cm who had a twofold higher probability of re-intervention in the Cox-regression model. Conclusions UAE is an effective treatment method for symptomatic fibroids that leads to quick relief of fibroid-related symptoms with marked improvement of quality of life and is associated with a low risk for re-interventions. Patients with small fibroids tend to show a better response to UAE compared to patients with large fibroids. Trial registration Charité institutional review board, EA4/167/20. Registered 27 November 2020—Retrospectively registered. https://ethikkommission.charite.de/ Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01244-1.
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Affiliation(s)
- Iason Psilopatis
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Gynecology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Florian Nima Fleckenstein
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany.
| | - Federico Collettini
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Elif Can
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anne Frisch
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernhard Gebauer
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Uli Fehrenbach
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Giovanni Federico Torsello
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Matthias David
- Department of Gynecology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Gero Wieners
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Knapman BL, Abbott J, Vyas MA. The Advantages and Disadvantages of Uterine Artery Embolization in Women with Adenomyosis: What’s New? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2021. [DOI: 10.1007/s13669-021-00309-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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