Initial experience of uterine fibroid embolization using porous gelatin sponge particles.

Department of Radiology, Saiseikai Shiga Hospital, Ritto, Shiga, 520-3046, Japan.
CardioVascular and Interventional Radiology (Impact Factor: 2.09). 06/2011; 34(3):513-21. DOI: 10.1007/s00270-010-9919-6
Source: PubMed

ABSTRACT The purpose of this study was to prospectively assess the safety and effectiveness of uterine artery embolization (UAE) using porous gelatin particle (PGP; Gelpart; Asuterasu, Tokyo, Japan) for symptomatic uterine fibroids. Twenty-five consecutive premenopausal women underwent UAE with PGP. The angiographic end point of embolization was near stasis of the ascending uterine artery. Pelvic magnetic resonance imaging (MRI) was obtained before and after the procedure. Complications were assessed. The outcomes of technique, infarction rates of all fibroid tissue after UAE with contrast-enhanced MRI, change in symptoms and quality of life using serial Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaires, and additional interventions were evaluated. Bilateral UAE was successfully performed in all patients. Enhanced MRI 1 week after UAE showed that 100% infarction of all fibroid tissue was achieved in 65% (15 of 23) of patients; 90-99% infarction was achieved in 35% (8 of 23) of patients. Mean follow-up was 12 months (range 1-20). Symptom and QOL scores at baseline were 47.2 and 61.7, respectively. Both scores significantly improved to 26.3 (P<0.001) and 82.4 (P<0.001) at 4 months and to 20.4 (P<0.001) and 77.6 (P<0.001) at 1 year, respectively. No additional gynecologic interventions were performed in any patient. There were no major complications. Minor complications occurred in two patients. UAE using PGP is a safe and effective procedure and shows that outcomes after UAE, as measured with enhanced MRI and UFS-QOL questionnaires, seem comparable with those of UAE using other embolic agents. PGP is a promising embolic agent used for UAE to treat symptomatic uterine fibroids. Further comparative study between PGP and other established embolic agents is required.

  • [Show abstract] [Hide abstract]
    ABSTRACT: This study was designed to compare the effectiveness of systemic methotrexate (MTX) with uterine artery embolization (UAE) combined with local MTX for the treatment of cesarean scar pregnancy (CSP) with different ultrasonographic pattern, and to indicate the preferable therapy in CSP patients. The results of 21 CSP cases were reviewed. All subjects were initially administrated with systemic MTX (50 mg/m(2) body surface area). UAE combined with local MTX was added to the patients who had failed systemic MTX. The transvaginal ultrasonography data were retrospectively assessed, and two different ultrasonographic patterns were found: surface implantation and deep implantation of amniotic sac. The management and its effectiveness for patients with the two ultrasonographic patterns were studied retrospectively. Ultrasound scan and serum β-hCG were monitored during follow-up. Data were analyzed with the Student's t test. Nine patients were successfully treated with systemic MTX. The remaining 12 cases were successfully treated with additional UAE combined with local MTX. According to the classification by Vial et al. of CSP on ultrasonography, most surface implanted CSPs (8/11, 72.7%) could be successfully treated with systemic MTX, whereas most deeply implanted CSPs (9/10, 90%) had failed systemic MTX but still could be successfully treated with additional UAE combined with local MTX. All patients recovered without severe side effects. Most patients with a future desire for reproduction achieved subsequent pregnancy. For CSP patients suitable for nonsurgical treatment, UAE combined with local MTX would be the superior option compared with systemic MTX in the cases with deep implantation of amniotic sac.
    CardioVascular and Interventional Radiology 01/2011; 35(2):286-91. · 2.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: To introduce a newly developed double lumen microballoon catheter with a side hole for intraarterial infusion chemotherapy and/or embolization. METHODS AND MATERIALS: Seven patients with malignant tumors, for whom superselective catheterization was considered difficult or had failed, underwent intraarterial infusion chemotherapy and/or embolization with the 3.3-Fr microballoon catheter. The catheter has a double lumen and a side hole to facilitate infusion from the proximal end of the balloon. The balloon was placed on the distal side of the target artery branching site. Inflation of the balloon and occlusion of the main lumen with the tip of the occlusion device allowed for intraarterial infusion chemotherapy and/or embolization of the target artery via the side hole. RESULTS: Successful intraarterial infusion chemotherapy and/or embolization with the microballoon catheter was performed in all patients with no complications. CONCLUSIONS: The newly developed microballoon catheter achieves intraarterial infusion chemotherapy and/or embolization without the need for superselective catheterization.
    Japanese journal of radiology 09/2012; · 0.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Purpose: To compare clinical and magnetic resonance imaging (MRI) outcomes after uterine artery embolization (UAE) with non spherical polyvinyl alcohol (nPVA) versus gelatin sponge particles. Material and methods: During ten months, from Jan 2011 to Oct 2011, 60 patients underwent UAE in a standardized manner. nPVA (n = 30) or gelatin sponge particles (n = 30) were used in all patients. Pelvic MRI and clinical symptoms were reviewed before and after the procedure. Changes in tumor, uterine volume and infarction rate of dominant tumor were assessed using MRI. Result: At three months after embolization, the outcome data were collected. The improvement of the mean bleeding score was more pronounced with gelatin sponge particles than with nPVA particles (p = 0.035). The mean volume reduction rate and infarction rate of dominant fibroid were 47.9 ± 20.8%, 97.7 ± 5.2% and 60.2 ± 18.1, 96 ± 7.0% after UAE with nPVA compared to gelatin sponge particles, respectively. Conclusion: This study showed the superiority of gelatin sponge particles over nPVA in terms of improvement of mean bleeding score and volume reduction rate of dominant fibroid at three months follow-up after UAE, although the infarction rate of dominant fibroid was similar across groups at three months.
    Minimally invasive therapy & allied technologies: MITAT: official journal of the Society for Minimally Invasive Therapy 09/2013; · 1.33 Impact Factor