Initial experience with HydroPearl microspheres for uterine artery embolization for the treatment of symptomatic uterine fibroids

CVIR Endovascular - Tập 4 - Trang 1-7 - 2021
Matthew A. Patetta1, Ari J. Isaacson1, Jessica K. Stewart1
1Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, USA

Tóm tắt

Uterine Artery Embolization (UAE) is a minimally invasive procedure used to treat symptomatic uterine fibroids. The HydroPearl Microsphere (Terumo Interventional Systems) is an embolic agent approved for UAE and other embolization procedures. The purpose of this article is to describe our initial experience with HydroPearl for UAE in patients with symptomatic uterine fibroids. Twenty-one patients who underwent UAE using HydroPearl Microspheres at a single institution from May 1, 2018 to December 31, 2019 were included in the study. The electronic medical record (EMR) was reviewed for documentation of short- and long-term complications, as well as improvements in menorrhagia and bulk-type symptoms. We also describe unique attributes of the HydroPearl Microsphere that should be considered when utilizing this embolization particle for UAE. Of the 21 patients, 18 had a 3-month or later post-procedure follow-up documented in the EMR and were included in the analysis. The average time between the UAE procedure and the most recent clinical note was 145 days. Sixteen patients reported symptoms of menorrhagia and 13 reported bulk symptoms prior to the UAE procedure. On follow-up, 13/16 patients (81%) and 12/13 patients (92%) experienced improvement in menorrhagia and bulk symptoms, respectively. The only recorded complication was amenorrhea in 4 patients (22%) who had an average age of 51 years. Several characteristics of HydroPearl Microsphere may prove helpful when considering these embolic particles for use in UAE. Our initial experience with this embolic agent suggest that the reatment response for menorrhagia and bulk symptoms are largely similar to success rates reported in the literature for other embolic agents. Larger studies are needed to evaluate the safety and efficacy of this embolic particle for this indication.

Tài liệu tham khảo

Bagla S, Piechowiak R, Nagda S, Orlando J, Xavier C, Sajan A et al (2020) Arterial embolization of the shoulder for pain secondary to adhesive capsulitis: interim results from an investigational device exemption US trial. J Vasc Interv Radiol 31(3):S6–S7 Bain J, Bragg S, Ramsetty A, Bradford S (2018) Endocrine conditions in older adults: menopause. FP Essent 474:20–27 Dariushnia SR, Nikolic B, Stokes LS, Spies JB (2014) Society of Interventional Radiology Standards of practice C. quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol 25(11):1737–1747. https://doi.org/10.1016/j.jvir.2014.08.029 Dasnurkar A (2015) Chronic Evaluation of HydroPearl in Porcine Model 30 Day End Point. Internal MicroVention report unpublished Goodwin SC, Spies JB, Worthington-Kirsch R, Peterson E, Pron G, Li S et al (2008) Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID registry. Obstet Gynecol 111(1):22–33. https://doi.org/10.1097/01.AOG.0000296526.71749.c9 Hamoda H, Pepas L, Tasker F, Reidy J, Khalaf Y (2015) Intermediate and long-term outcomes following uterine artery fibroid embolization. Eur J Obstet Gynecol Reprod Biol 191:33–38. https://doi.org/10.1016/j.ejogrb.2015.05.016 Joffre F, Tubiana JM, Pelage JP, Groupe F (2004) FEMIC (Fibromes Embolises aux MICrospheres calibrees): uterine fibroid embolization using tris-acryl microspheres. A French multicenter study. Cardiovasc Intervent Radiol 27(6):600–606. https://doi.org/10.1007/s00270-004-0078-5 Jun F, Yamin L, Xinli X, Zhe L, Min Z, Bo Z, Wenli G (2012) Uterine artery embolization versus surgery for symptomatic uterine fibroids: a randomized controlled trial and a meta-analysis of the literature. Arch Gynecol Obstet 285(5):1407–1413. https://doi.org/10.1007/s00404-011-2065-9 Khalilzadeh O, Baerlocher MO, Shyn PB, Connolly BL, Devane AM, Morris CS, Cohen AM, Midia M, Thornton RH, Gross K, Caplin DM, Aeron G, Misra S, Patel NH, Walker TG, Martinez-Salazar G, Silberzweig JE, Nikolic B (2017) Proposal of a new adverse event classification by the Society of Interventional Radiology Standards of practice committee. J Vasc Interv Radiol 28(10):1432–7 e3. https://doi.org/10.1016/j.jvir.2017.06.019 Lohle PN, Boekkooi FP, Smeets AJ, Pieters JJ, Vervest HA, Lampmann LE et al (2006) Limited uterine artery embolization for leiomyomas with tris-acryl gelatin microspheres: 1-year follow-up. J Vasc Interv Radiol 17(2 Pt 1):283–287. https://doi.org/10.1097/01.RVI.0000195148.89573.9F Salehi M, Jalilian N, Salehi A, Ayazi M (2015) Clinical efficacy and complications of uterine artery embolization in symptomatic uterine fibroids. Glob J Health Sci 8(7):245–250. https://doi.org/10.5539/gjhs.v8n7p245 Sandberg EM, Tummers F, Cohen SL, van den Haak L, Dekkers OM, Jansen FW (2018) Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids: a systematic review and meta-analysis. Fertil Steril 109(4):698–707 e1. https://doi.org/10.1016/j.fertnstert.2017.11.033 Spencer EB, Stratil P, Mizones H (2013) Clinical and periprocedural pain management for uterine artery embolization. Semin Intervent Radiol 30(4):354–363. https://doi.org/10.1055/s-0033-1359729 Stampfl U, Radeleff B, Sommer C, Stampfl S, Dahlke A, Bellemann N, Kauczor HU, Richter GM (2011) Midterm results of uterine artery embolization using narrow-size calibrated embozene microspheres. Cardiovasc Intervent Radiol 34(2):295–305. https://doi.org/10.1007/s00270-010-9986-8 Toda A, Sawada K, Osuga K, Maeda N, Higashihara H, Sasano T, Tomiyama N, Kimura T (2016) Efficacies of uterine artery embolization for symptomatic uterine fibroids using gelatin sponge: a single-center experience and literature review. Int J Womens Health 8:397–404. https://doi.org/10.2147/IJWH.S107367 van der Kooij SM, Bipat S, Hehenkamp WJ, Ankum WM, Reekers JA (2011) Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol 205(4):317 e1–317 18 Wozniakowska E, Milart P, Paszkowski T, Palacz T, Wozniak S, Wrona W et al (2013) Uterine artery embolization--clinical problems. Ginekol Pol 84(12):1051–1054. https://doi.org/10.17772/gp/1679 Yoon J, Valenti D, Muchantef K, Cabrera T, Toonsi F, Torres C, Bessissow A, Bandegi P, Boucher LM (2018) Superior Hypogastric nerve block as post-uterine artery embolization analgesia: a randomized and double-blind clinical trial. Radiology. 289(1):248–254. https://doi.org/10.1148/radiol.2018172714