Efficacies of uterine artery embolization for symptomatic uterine fibroids using gelatin sponge: a single-center experience and literature review

Figures & data

Table 1 Baseline characteristics

Baseline characteristics	Total (n=60)	GSP (n=29)	PGP (n=31)
Age, years, median (range)	45 (34–53)	46 (34–50)	45 (39–53)
Follow-up period, days, median (range)	757 (44–3,491)	940 (219–3,491)	401 (44–1,345)
Presenting symptoms
Menorrhagia, n (%)	48 (80.0)	22 (75.9)	26 (83.9)
Dysmenorrhea, n (%)	11 (18.3)	4 (13.8)	7 (22.6)
Bulk-related symptoms, n (%)	41 (68.3)	21 (72.4)	20 (64.5)
Number of fibroids
1, n (%)	10 (16.6)	5 (17.2)	5 (16.1)
>1, n (%)	50 (83.3)	24 (6.2)	26 (83.9)
Dominant fibroid location
Intramural, n (%)	50 (83.3)	26 (89.7)	24 (77.4)
Submucosal, n (%)	7 (11.6)	2 (6.9)	5 (16.1)
Subserosal, n (%)	3 (5.0)	1 (3.4)	2 (6.5)
Dominant fibroid maximum diameter, mm, median (range)	88.5 (35–240)	89 (35–123)	88 (51–240)
Dominant fibroid volume, mL, median (range)	214.6 (10.6–5,026.6)	222 (10.6–974)	199 (51.7–5,026.6)
Previous treatment
Myomectomy, n (%)	11 (18.3)	5 (17.2)	6 (19.4)
UAE, n (%)	4 (6.7)	3 (10.3)	1 (3.2)
Hormonal therapy (OCs, GnRH agonists), n (%)	16 (26.7)	7 (24.1)	9 (29.0)
TCR, n (%)	1 (1.7)	0 (0)	1 (3.2)

Abbreviations: GSP, gelatin sponge particle; PGP, porous gelatin particle; UAE, uterine artery embolization; OCs, oral contraceptives; GnRH, gonadotropin-releasing hormone; TCR, transcervical resection.

Table 2 Clinical outcomes

Symptoms	3 months (N=58a), n (%)	12 months (N=56b), n (%)
Menorrhagia
Greatly improved	11 (19.0)	20 (35.7)
Moderately improved	20 (34.5)	21 (37.5)
Slightly improved	12 (20.7)	8 (14.3)
Unchanged	6 (10.3)	1 (1.8)
Worsened	1 (1.7)	0 (0.0)
Previously absent	5 (8.6)	4 (7.1)
NA	3 (5.2)	2 (3.6)
Bulk-related symptoms
Greatly improved	13 (22.4)	15 (26.8)
Moderately improved	17 (29.3)	25 (44.6)
Slightly improved	8 (13.8)	5 (8.9)
Unchanged	11 (19.0)	2 (3.6)
Worsened	0 (0.0)	0 (0.0)
Previously absent	6 (10.3)	8 (14.3)
NA	3 (5.2)	1 (1.8)
General conditions
Greatly improved	15 (25.9)	21 (37.5)
Moderately improved	24 (41.4)	22 (39.2)
Slightly improved	11 (19.0)	10 (17.9)
Unchanged	5 (8.6)	1 (1.8)
Worsened	0 (0.0)	0 (0.0)
NA	3 (5.2)	2 (3.6)
Satisfaction
Greatly satisfied	21 (36.2)	31 (55.4)
Moderately satisfied	25 (43.1)	19 (33.9)
Slightly satisfied	8 (13.8)	4 (7.1)
Not satisfied	1 (1.7)	0 (0.0)
Dissatisfied	0 (0.0)	1 (1.8)
NA	3 (5.2)	1 (1.8)
Recommend to friends
Yes	37 (63.8)	37 (66.1)
Neither	18 (31.0)	18 (32.1)
No	0 (0.0)	1 (1.8)
NA	3 (5.2)	0 (0.0)

Notes:

a One opted for hysterectomy (1 month), and one lost to follow-up (1 month).

b Two opted for hysterectomy (1 and 7 months), and two lost to follow-up (1 and 7 months).

Abbreviation: NA, not applicable.

Table 3 Magnetic resonance imaging findings

Variable	Pre-UAE (n=60)	3 months (n=51)	12 months (n=57)
Dominant fibroid volume, mL, % (95% CI)	214.6 (28.3–5,026.5)	138.8 (2.6–696.6)	114.4 (0–742.7)
Reduction from baseline, % (95% CI)		33.4 (24.9–41.1)	47.8 (39.2–55.8)
P-value from pre-UAE		0.0476	0.0148

Abbreviations: CI, confidence interval; UAE, uterine artery embolization.

Table 4 Patients requiring further intervention due to complications or recurrence

Patient	Reason for intervention	Intervala	Intervention
1	Deep venous thrombosis	1	Anticoagulation
2	Fibroid regrowth	24	Myomectomy
3	Symptom recurrence	34	GnRH agonist
4	Fibroid passage	1	Transvaginal resection
5	Fibroid passage	1.5	Transvaginal resection
6	Infectious fibroid passage	1	Transvaginal resection, antibiotics
7	Infectious fibroid passage	7	Hysteroscopic resection, antibiotics
8	Endometritis	1	Hysterectomyb
9	Tubo-ovarian abscess and fibroid passage	6	Drainage, hysterectomyc
10	Tubo-ovarian abscess	4	Percutaneous drainage, antibiotics

Notes:

a Interval months from uterine artery embolization.

b Includes left salpingo-oophorectomy for firmly adhering the uterus.

c Includes right salpingo-oophorectomy for tubo-ovarian abscess.

Abbreviation: GnRH, gonadotropin-releasing hormone.

Table 5 Outcomes of uterine artery embolization using gelatin sponge as an embolic agent for symptomatic uterine fibroids

Study	Study design	Number of patients	Follow-up (months)	Symptom improvement (%)	Dominant fibroid volume reduction (%)
Katsumori et al^Citation8	Prospective	25	12	Menorrhagia, 70; bulk, 90; pain, 100 (at 12 months)	49.0 (at 4 months), 61.2 (at 12 months)
Katsumori et al^Citation13	Prospective	96	37.4	Symptom control, 96.9 (at 12 months), 89.5 (at 60 months)	NA
Sone et al^Citation14	Prospective Phase I/II	33	33.4	Menorrhagia, 90; bulk, 76; pain, 96 (at 12 months)	61.4 (at 12 months)
Huang et al^Citation16	Prospective	40	8.1	Menorrhagia, 83; pain, 77 (at 8 months)	54.9 (at 8 months)
Song et al^Citation15	Prospective	30	12.9	Menorrhagia, 100; bulk, 92 (at 12 months)	56.2 (at 3 months), 72.6 (at 12 months)
Present study	Retrospective	60	25.2	Menorrhagia, 98; bulk, 96 (at 12 months)	47.8 (at 12 months)

Abbreviation: NA, not applicable.

KatsumoriTKasaharaTOdaMKotaniTInitial experience of uterine fibroid embolization using porous gelatin sponge particlesCardiovasc Intervent Radiol201134351352120574795

 PubMed Web of Science ®Google Scholar

KatsumoriTKasaharaTAkazawaKLong-term outcomes of uterine artery embolization using gelatin sponge particles alone for symptomatic fibroidsAJR Am J Roentgenol2006186384885416498120

 PubMed Web of Science ®Google Scholar

SoneMAraiYShimizuTPhase I/II multiinstitutional study of uterine artery embolization with gelatin sponge for symptomatic uterine leiomyomata: Japan Interventional Radiology in Oncology Study Group studyJ Vasc Interv Radiol2010211665167120884240

 PubMed Web of Science ®Google Scholar

HuangLYChengYFChangHWQuantified short-term outcome of uterine artery embolization with gelatin sponge particles and lipiodol for symptomatic myomaFertil Steril20048151375138215136105

 PubMed Web of Science ®Google Scholar

SongYGWooYJKimCWUterine artery embolization using progressively larger calibrated gelatin sponge particlesMinim Invasive Ther Allied Technol2016251354226414280

 PubMed Web of Science ®Google Scholar