Comparison of clinical outcomes of tris-acryl microspheres versus polyvinyl alcohol microspheres for uterine artery embolization for leiomyomas: results of a randomized trial

True Costs of Uterine Artery Embolization: Time-Driven Activity-Based Costing in Interventional Radiology Over a 3-Year Period

PURPOSE

The aim of this study is to uncover potential areas for cost savings in uterine artery embolization (UAE) using time-driven activity-based costing, the most accurate costing methodology for direct health care system costs.

METHODS

One hundred twenty-three patients who underwent outpatient UAE for fibroids or adenomyosis between January 2020 and December 2022 were retrospectively reviewed. Utilization times were captured from electronic health record time stamps and staff interviews using validated techniques. Capacity cost rates were estimated using institutional data and manufacturer proxy prices. Costs were calculated using time-driven activity-based costing for personnel, equipment, and consumables. Differences in time utilization and costs between procedures by an interventional radiology attending physician only versus an interventional radiology attending physician and trainee were additionally performed.

RESULTS

The mean total cost of UAE was $4,267 ± $1,770, the greatest contributor being consumables (51%; $2,162 ± $811), followed by personnel (33%; $1,388 ± $340) and equipment (7%; $309 ± $96). Embolic agents accounted for the greatest proportion of consumable costs, accounting for 51% ($1,273 ± $789), followed by vascular devices (15%; $630 ± $143). The cost of embolic agents was highly variable, driven mainly by the number of vials (range 1-19) of tris-acryl gelatin particles used. Interventional radiology attending physician only cases had significantly lower personnel costs ($1,091 versus $1,425, P = .007) and equipment costs ($268 versus $317, P = .007) compared with interventional radiology attending physician and trainee cases, although there was no significant difference in mean overall costs ($3,640 versus $4,386; P = .061).

CONCLUSIONS

Consumables accounted for the majority of total cost of UAE, driven by the cost of embolic agents and vascular devices.

Current Trends in Gelatin-Based Drug Delivery Systems

Gelatin is a highly versatile natural polymer, which is widely used in healthcare-related sectors due to its advantageous properties, such as biocompatibility, biodegradability, low-cost, and the availability of exposed chemical groups. In the biomedical field, gelatin is used also as a biomaterial for the development of drug delivery systems (DDSs) due to its applicability to several synthesis techniques. In this review, after a brief overview of its chemical and physical properties, the focus is placed on the commonly used techniques for the development of gelatin-based micro- or nano-sized DDSs. We highlight the potential of gelatin as a carrier of many types of bioactive compounds and its ability to tune and control select drugs' release kinetics. The desolvation, nanoprecipitation, coacervation, emulsion, electrospray, and spray drying techniques are described from a methodological and mechanistic point of view, with a careful analysis of the effects of the main variable parameters on the DDSs' properties. Lastly, the outcomes of preclinical and clinical studies involving gelatin-based DDSs are thoroughly discussed.

Comparison of polyvinyl alcohol particles and tris-acryl gelatin microspheres embolic agents used in uterine artery embolization: A systematic review and meta-analysis

Objective

To identify the preferred agent by comparing the therapeutic efficacy, degree of infarction, and side effects of polyvinyl alcohol particles (PVA) and tris-acryl gelatin embolization (TAGM) agents in uterine artery embolization.

Materials and Methods

We included available articles comparing PVA with TAGM embolization agents in the management of fibroids. The primary outcomes included the decrease in uterine volume (%), decrease in dominant tumor volume (%), fibroid infarction rate, complete infarction fibroid, complications, pain score after 24 h, procedure time (minutes), duration of hospital stay, fluoroscopy time (minutes), and the change in symptom severity score.

Results

Eight articles that met our inclusion criteria were included in this study. Our analysis yielded an overall superiority of PVA compared to TAGM regarding complete fibroid infarction rate at the first 24 h. However, TAGM was better than PVA concerning <90% infarction rate outcome. While both embolization techniques showed similar effects regarding the change in symptom severity score, the percentage of decrease in uterine volume, percentage of decrease of dominant tumor volume, 90-99% infarction rate, complete infarction rate when assessed after the first 24 h, pain score after the first 24 h, procedure time, fluoroscopy time, minor, and major complications.

Conclusion

Both PVA and TAGM embolization agents are effective and safe modalities in treating patients with fibroids, with no significant variation of both agents in most outcomes.

Nononcologic Embolization

The scope of conditions managed by embolization, which was initially used for the treatment of hemorrhage and vascular malformations, is constantly expanding. Apart from oncologic indications, embolization is used to treat a wide range of benign pathology, including uterine fibroids and benign prostatic hyperplasia. While various particulate embolic agents are successfully used for benign embolization, there is growing evidence that unique properties of these may result in different outcomes. This article reviews available evidence comparing various particles used for uterine fibroid embolization and prostate artery embolization. In addition, we provide an overview of periprocedural pharmacology and protocols facilitating same-day discharge for these interventions.

Emerging Polymer Materials in Trackable Endovascular Embolization and Cell Delivery: From Hype to Hope

Minimally invasive endovascular embolization is a widely used clinical technique used for the occlusion of blood vessels to treat various diseases. Different occlusive agents ranging from gelatin foam to synthetic polymers such as poly(vinyl alcohol) (PVA) have been commercially used for embolization. However, these agents have some drawbacks, such as undesired toxicity and unintended and uncontrolled occlusion. To overcome these issues, several polymer-based embolic systems are under investigation including biocompatible and biodegradable microspheres, gelling liquid embolic with controlled occlusive features, and trackable microspheres with enhanced safety profiles. This review aims to summarize recent advances in current and emerging polymeric materials as embolization agents with varying material architectures. Furthermore, this review also explores the potential of combining injectable embolic agents and cell therapy to achieve more effective embolization with the promise of outstanding results in treating various devastating diseases. Finally, limitations and challenges in developing next-generation multifunctional embolic agents are discussed to promote advancement in this emerging field.

Particle Distribution in Embolotherapy, How Do They Get There? A Critical Review of the Factors Affecting Arterial Distribution of Embolic Particles

Embolization has tremendously evolved in recent years and has expanded to treatment of a variety of pathologic processes. There has been emerging evidence that the level of arterial occlusion and the distribution of embolic particles may play an important role in the clinical outcome. This is a comprehensive literature review to identify variables that play important role in determination of level of occlusion of blood vessels and distribution of embolic particles. The literature searches between 1996 to 2020 through PubMed and Ovid-MEDLINE yielded over 1030 articles of which 30 studies providing details on the level of occlusion are reviewed here. We divided the playing factors into characteristics of the particles, solution/injection and vascular bed. Accordingly, particle size, type and aggregation, compressibility/deformability, and biodegradability are categorized as the factors involving particles' behavioral nature. Infusion rate and concentration/dilution of the medium are related to the carrying solution. Hemodynamics and the arterial resistance are characteristics of the vascular bed that also play an important role in the distribution of embolic particles. Understanding and predicting the level of embolization is a complex multi-factor problem that requires more evidence, warranting further randomized controlled trials, and powered human and animal studies.

Randomised Controlled Trial of Particles Used in Uterine fibRoid Embolisation (PURE): Non-Spherical Polyvinyl Alcohol Versus Calibrated Microspheres

Purpose

The PURE study is a randomised controlled trial (RCT) comparing the clinical and MRI outcomes of patients treated with non-spherical polyvinyl alcohol, ns-PVA (Contour PVA–Boston Scientific–355–500 & 500–700 microns) versus calibrated hydrogel microspheres (Embozene–Varian Inc–700 & 900 microns) for symptomatic uterine fibroids.

Materials and Methods

Prospective, ethically approved non-sponsored RCT in 84 patients in a single UK tertiary IR unit, ISRCTN registry trial number ISRCTN18191539 in 2013 and 2014. All patients with symptomatic fibroid disease were eligible. UAE followed a standardised protocol with UFS-QOL and contrast-enhanced MRI before and 6 months post UAE. Outcome measures included: (1) Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL). (2) Percentage total and dominant fibroid infarction. (3) Uterine and dominant fibroid volume reduction. (4) Volume of embolics.

Results

Sixty-three patients completed the QOL follow-up (33 ns-PVA vs 30 Embozenes), the groups were equivalent at baseline. Patients were followed up for 6 months following UAE. There was no significant difference in symptom scores or HR-QOL between ns-PVA and Embozenes, p = 0.67 and 0.21, respectively. 92.7% of patients treated with ns-PVA achieved > 90% dominant fibroid infarction versus 61.8% treated with Embozenes (p = 0.0016). 66% of patients treated with ns = PVA achieved > 90% total fibroid percentage infarction compared with 35% in the Embozene group (p = 0.011). The mean vials/syringes used were 5.2 with Embozenes versus 4.1 using PVA (p = 0.08).

Conclusion

The PURE study informs IRs regarding the efficacy of embolic agents in UAE, with superior fibroid infarction on MRI using ns-PVA versus Embozenes however no significant difference in clinical outcomes at 6 months after UAE.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00270-021-02977-0.

Identifying the Ideal Target Vessel Size for Bariatric Embolization: Histologic Analysis of Swine and Human Gastric Fundi

This study aimed to identify the ideal arteriole size to target in bariatric embolization, with the goal of maximizing weight loss efficacy while maintaining patient safety. Although all published clinical trials of bariatric embolization have used embolic microspheres that were at least 300 μm in diameter, optimal weight loss outcomes have been achieved safely in swine using 50-μm embolics. Human fundal remnants from bariatric surgery were compared with swine fundal sections after bariatric embolization with 50-μm embolic microspheres to assess the ideal fundal vessel size for bariatric embolization. In swine, the 50-μm embolic microspheres deposited in the luminal half of the submucosa with a mean arteriole size of 49 μm ± 30. The mean arteriole diameter in the corresponding submucosal layer of the human gastric fundi was 40 μm ± 30. These measurements may inform future clinical trials and direct the development of embolic agents for bariatric embolization.

Choice of primary and secondary outcomes in randomised controlled trials evaluating treatment for uterine fibroids: a systematic review

BACKGROUND

Core outcome sets aim to reduce research heterogeneity and standardise reporting, allowing meaningful comparisons between studies.

OBJECTIVES

To report on outcomes used in randomised controlled trials (RCTs) investigating uterine fibroid treatments, towards the development of a core outcome set for fibroid research.

SELECTION STRATEGY

Database search of MEDLINE, PubMed, EMBASE and CINAHL (inception to July 2021) for all English-language RCTs involving surgical or radiological fibroid treatments.

DATA COLLECTION AND ANALYSIS

A total of 1885 texts were screened for eligibility by two reviewers independently according to PRISMA methodology. JADAD and Management of Otitis Media with Effusion in Cleft Palate (MOMENT) scores were used to assess methodological and outcome reporting quality of studies, respectively. Outcomes were mapped to nine domains. Non-parametric tests for correlation and to compare group medians were undertaken.

MAIN RESULTS

There were 23 primary outcomes (23 outcome measures) and 173 secondary outcomes (95 outcome measures) reported in 60 RCTs (5699 participants). The domains with highest frequency of primary outcomes reported were bleeding and quality of life (QoL). The most frequent primary outcomes were postoperative pain, QoL and menstrual bleeding. No primary outcomes were mapped to fertility domains. Median MOMENT outcome score was 5 (interquartile range 3). There was correlation between MOMENT outcome score and JADAD scores (r = 0.491, P = 0.0001), publishing journal impact factor (r = 0.419, P = 0.008) and publication year (r = 0.332, P = 0.01).

CONCLUSION

There is substantial variation in the outcomes reported in fibroid RCTs. There is a need for a core outcome set for fibroid research, to allow improved understanding regarding the effects of different treatments.

Biodegradable Polydioxanone Microspheres for Transcatheter Arterial Embolization: Proof of Principle

PURPOSE

To evaluate feasibility, embolization success, biodegradability, reperfusion, and biocompatibility of biodegradable microspheres (MS) made from polydioxanone (PDO) for transcatheter arterial embolization.

MATERIALS AND METHODS

Unilateral selective renal embolization of a segmental artery was performed in 16 New Zealand White rabbits with PDO-MS (100-150 μm and 90-315 μm). Animals were randomly assigned to different observation periods and underwent control digital subtraction angiography (DSA) and MR imaging immediately (n = 3), 1 week (n = 2), 4 weeks (n = 2), 8 weeks (n = 2), 12 weeks (n = 5), and 16 weeks (n = 2) after embolization. Kidneys were harvested for macroscopic and histologic analysis of embolization success, biodegradability, and biocompatibility.

RESULTS

Embolization was technically successful in 15 of 16 animals. One animal died of anesthesia-related circulatory failure. The 100-150 μm MS were injected easily through 3-F catheters; the 90-315 μm MS tended to clog with intermittent catheter obstruction. DSA and MR imaging showed successful target embolization in 13 of 15 animals. In 2 animals, the entire kidney was affected owing to catheter clogging, including a reflux of MS while flushing. Control DSA and MR imaging showed increasing vascular reperfusion with time. Macroscopic and histologic analysis revealed necrosis/infarction in areas in which embolization was achieved. MS were extensively degraded after 16 weeks, and overall inflammatory reaction was mild.

CONCLUSIONS

Biodegradable PDO-MS induced effective embolization of target vessels while demonstrating good biocompatibility. MS increasingly dissolved at 16 weeks, partial reperfusion started at week 1, and complete reperfusion started at week 8, thus offering possible advantages as a temporary embolic agent.

Comparison of outcomes and cost-effectiveness of trisacryl gelatin microspheres alone versus combined trisacryl gelatin microspheres and gelatin sponge embolization in uterine fibroid embolization

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%.

Novel MR-Visible, Biodegradable Microspheres for Transcatheter Arterial Embolization: Experimental Study in a Rabbit Renal Model

PURPOSE

To assess feasibility, embolization success, biodegradability, reperfusion, biocompatibility and in vivo visibility of novel temporary microspheres (MS) for transcatheter arterial embolization.

MATERIAL AND METHODS

In 9 New Zealand white rabbits unilateral superselective embolization of the lower kidney pole was performed with biodegradable MS made of polydioxanone (PDO) (size range 90-300 and 200-500 µm) impregnated with super-paramagnetic iron oxide (SPIO). Magnetic resonance imaging (MRI) was performed post-interventionally to assess in vivo visibility. Embolization success was assessed on digital subtraction angiography, MRI and gross pathology. One animal was killed immediately after embolization to assess original particle appearance. 8 animals were randomly assigned to different observation periods (1, 4, 8, 12 and 16 weeks), after which control angiography and MRI were obtained to determine recanalization. Histopathological analysis was performed to determine biodegradability and biocompatibility by using dedicated quantitative assessment analysis.

RESULTS

Ease of injection was moderate. Embolization was technically successful in 7 of 8 animals, one rabbit received non-selective embolization of the whole kidney and abdominal off-target embolization. Arterial occlusion was achieved in all kidneys, infarct areas in macro- and microscopic analysis confirmed embolization success. Control angiograms showed evidence of partial reperfusion. The microspheres showed extensive degradation over the course of time along with increasing inflammatory response and giant cell formation. SPIO-loaded MS were visible on MRI at all time points.

CONCLUSIONS

SPIO-impregnated biodegradable PDO-MS achieved effective embolization with in vivo visibility on MRI and increasing biodegradation over time while demonstrating good biocompatibility, i.e., a physiologically immune response without transformation into chronic inflammation. Further studies are needed to provide clinical applicability.

Randomised trial of two embolic agents for uterine artery embolisation for fibroids: Gelfoam versus Embospheres (RAGE trial)

Background

Uterine artery embolisation (UAE) is an established treatment option for women with symptomatic uterine fibroids who wish to avoid surgery. However the most efficacious embolic agent remains uncertain.

Methods

We conducted a pilot double blind randomized controlled trial comparing Gelfoam with Embospheres in women undergoing UAE. Outcomes recorded at baseline, 24-h, 1 and 6 months included complications, inflammatory, haematological markers and ovarian function. Contrast enhanced MRI (CEMRI) was acquired at baseline, 24-h and 6 months. Pain score (visual analogue) was measured at 24-h, quality of life (UFS-Qol) at baseline, 1 and 6 months. All patients were followed to 6 months.

Results

Twenty patients were randomized 1:1 to receive either Gelfoam (G) or Embospheres (E). The UFS-Qol symptom score improved in both groups at 6 months mean of 64 ± 18 to 23 ± 16 and 54 ± 15 to 32 ± 26 in the E and G groups respectively. UFS-Qol HRQL also improved in both groups at 6 months, mean 41 ± 28 to 79 ± 20 and 53 ± 19 to 78 ± 21 in the E and G groups respectively.

Uterine volume at 6 months reduced from 1018 ± 666mls to 622 ± 436 (p = 0.001) and from 1026 ± 756 to 908 ± 720 (p = 0.15) in the E and G groups respectively. There was a significant difference between groups for this parameter p = 0.01. All uterine arteries were patent at 24-h and 6 months. Complete (100%) fibroid infarction rates were 5(50%) and 2(20%) in the E and G groups respectively. None of the other outcome measures showed any between group differences. There were no re-interventions in either group.

Conclusion

The only significant between group differences was for a greater reduction in uterine volume at 6 months in the E group. A larger trial (estimate 172 subjects) is required to determine whether other apparent differences are clinically and statistically significant.

Trial registration

ISRCTN67347987

Uterine artery embolization in a sheep model: biodegradable versus non-degradable microspheres

Background Transarterial embolization with particles is a relatively common treatment method in both malignant and benign disorders. Permanent occlusion of the uterine arteries may sometimes be disadvantageous. Purpose To compare the local tissue effects, possible side effects, and extent of recanalization following uterine artery embolization, using either degradable or non-degradable microspheres in a sheep model. Material and Methods In 22 female sheep, the uterine artery (UA) was unilaterally, superselectively embolized, with either degradable starch microspheres-DSM (group A) or calibrated gelatin coated spherical shape tris-acryl microspheres-TGMS (group B). The completion of embolization was confirmed by angiography. The animals were kept in the animal research facilities for 14 days and sacrificed following new angiographic evaluation. Gross and histological examination of the uterus and other organs was performed. Results The procedure was successful in all animals. At final angiographic evaluation recanalization was found in 82% of the ewes in group A and in 18% in group B. At histopathological examination, tissue impairment was similar in both groups, whereas vascular changes were more pronounced in the TGMS-group. Conclusion Embolization with DSM was associated with significantly higher degree of recanalization, than after embolization with TGMS.

Management of Uterine Fibroids: A Focus on Uterine-sparing Interventional Techniques

Uterine fibroids occur in approximately 50% of women over the age of 40 years, and an estimated 50% of those are symptomatic. Menorrhagia is the most common symptom and the primary indication for treatment, although bulk symptoms often occur and can be treated. Pharmacotherapy is typically inadequate unless it can be expected to successfully bridge to menopause or allow for a less-invasive intervention. However, hormonal therapies have risks. Hysterectomy is still the most commonly performed procedure for symptomatic fibroids and has the lowest rate of reintervention (compared with myomectomy or uterine artery embolization [UAE]), but rates of more serious complications are higher and patient satisfaction and ability to return to normal activities may also be less favorable. Myomectomy is not necessarily less morbid than hysterectomy and may have a greater failure rate than UAE. Techniques and devices vary with little standardization, and operator experience is crucial to success. The largest studies of UAE show very low rates of serious complications and rapid recovery. UAE significantly improves symptoms related to uterine fibroids in 85%-90% of patients. Herein, this article will discuss the nature of fibroids and their diagnosis, pharmacotherapy, surgical treatment, and nonsurgical interventional treatment, including UAE and magnetic resonance-guided focused ultrasound. (©) RSNA, 2016.

Polymeric materials for embolic and chemoembolic applications

Percutaneous transcatheter embolization procedures involve the selective occlusion of blood vessels. Occlusive agents, referred to as embolics, vary in material characteristics including chemical composition, mechanical properties, and the ability to concurrently deliver drugs. Commercially available polymeric embolics range from gelatin foam to synthetic polymers such as poly(vinyl alcohol). Current systems under investigation include tunable, bioresorbable microspheres composed of chitosan or poly(ethylene glycol) derivatives, in situ gelling liquid embolics with improved safety profiles, and radiopaque embolics that are trackable in vivo. This article reviews commercially available materials used for embolization as well as polymeric materials that are under investigation.

Unexpected complications with head and neck hydrogel microsphere particle embolization: A case series and a technical note

Endovascular particle embolization is a common procedure with a relatively safe profile. We report here four cases in which cranial nerves, skin and mucosal ischemic complications occurred with the use of hydrogel microspheres (250-500 µm in size). Given the compressibility and higher penetration potential of microsphere particles compared with polyvinyl alcohol particles of similar size, we suggest oversizing hydrogel microsphere particles for head and neck embolizations.

Preparation and evaluation of biocompatible long-term radiopaque microspheres based on polyvinyl alcohol and lipiodol for embolization

The aim of this work was to develop long-term radiopaque microspheres (LRMs) by entrapping lipiodol in biocompatible polyvinyl alcohol with multiple emulsions chemical crosslinking method. The high content of lipiodol (0.366 g/mL) was hardly released from LRMs in vitro and the radiopacity could maintain at least 3 months after subcutaneous injection in mice without weakening. A series of tests was performed to evaluate the feasibility of LRMs for embolization. LRMs were proved to be smooth, spherical, and well dispersed with diameter range of 100–1200 μm. Young's modulus of LRMs was 55.39 ± 9.10 kPa and LRMs could be easily delivered through catheter without aggregating or clogging. No toxicity of LRMs was found to mouse L929 fibroblasts cells and only moderate inflammatory in surrounding tissue of mice was found after subcutaneous injection of LRMs. After LRMs were embolized in renal artery of a rabbit, the distribution and radiopacity of LRMs in vivo were easily detectable by X-ray fluoroscopy and computed tomography (CT) imaging, respectively. More accurate distribution of LRMs in embolized kidney and vessels could be detected by high-revolution visualization of micro-CT ex vivo. In conclusion, the LRMs were proved to be biocompatible and provide long-term radiopacity with good physical and mechanical properties for embolization.

Comparison of polyvinyl alcohol microspheres and tris-acryl gelatin microspheres for uterine fibroid embolization: results of a single-center randomized study

PURPOSE

To assess the efficacy of two embolic agents in the treatment of symptomatic uterine leiomyomas.

MATERIALS AND METHODS

A randomized, prospective, single-center study enrolled 60 women with symptomatic uterine leiomyomas. Uterine artery embolization (UAE) with spherical polyvinyl alcohol (SPVA) microspheres (n = 30; 700-900 μm and 900-1,200 μm; near-stasis or stasis endpoint) and tris-acryl gelatin (TAG) microspheres (n = 30; 500-700 μm; "pruned-tree" endpoint) was performed. Infarction rates were calculated for the dominant tumor and for small (< 2 cm) and large (> 2 cm) nondominant tumors. The primary endpoint was tumor infarction at 24 hours measured by contrast-enhanced magnetic resonance imaging assessed by a blinded reviewer.

RESULTS

Baseline characteristics were similar between groups. The primary endpoint was similar in both treatments (≥ 91% dominant tumor infarction; SPVA. 86.2%; TAG, 93.3%, P = .35). Complete infarction (100%) was also similar between arms at 24 hours and 3 months. Symptom severity was reduced and quality of life improved equally at 3 and 12 months in each treatment group. Complications were minor in both groups.

CONCLUSIONS

Uterine leiomyoma infarction at 24 hours and 3 months after treatment with SPVA or TAG microspheres was comparable when using near-stasis as a procedural endpoint with SPVA microspheres. Symptom relief was maintained for as long as 12 months for both embolic agents.