Intra-Arterial Lidocaine Administration for Anesthesia after Uterine Artery Embolization with Trisacryl Gelatin Microspheres for Leiomyoma

PurposeTo evaluate whether administration of lidocaine into the uterine artery for anesthesia immediately after uterine artery embolization (UAE) with trisacryl gelatin microspheres (TAGM) for leiomyoma is safe and effective.Materials and MethodsIn a single-institution retrospective study, 100 patients underwent UAE using TAGM with a pruned tree endpoint between June 2014 and April 2019. The first 50 patients (control group) underwent UAE without lidocaine; in the second 50 patients (study group), lidocaine was administered into the uterine artery immediately after UAE. Baseline characteristics and technical and periprocedural outcomes were compared. Visual analog scale (VAS) scores 0, 3, 6, 9, 12, and 18 hours after UAE were compared between the groups with repeated measures analysis of variance. Each multivariate-adjusted VAS score < 24 hours was compared with analysis of covariance.ResultsNo significant differences were observed in baseline characteristics or technical and periprocedural outcomes, including the volume of morphine used (P = .415), between the groups. No significant differences were found in crude or multivariate-adjusted VAS scores at each time point < 24 hours. Only the multivariate-adjusted VAS score 3 hours after UAE was 0.7 lower in the study group (mean ± SE, 2.2 ± 0.3 vs 2.9 ± 0.3); however, no significant difference was noted (P = .070). No adverse events associated with lidocaine were detected.ConclusionsIntra-arterial lidocaine administration immediately after UAE with TAGM for leiomyoma was safe, but did not contribute to significant reductions in pain or volume of narcotic agent administered.     

Pain after uterine artery embolization for leiomyomata: can its severity be predicted and does severity predict outcome?

PURPOSE: To determine whether the severity of postprocedure pain associated with uterine artery embolization (UAE) for leiomyomata can be predicted and if its severity can predict outcome. MATERIALS AND METHODS: Eighty-one patients underwent UAE and had postprocedure pain managed with use of patient-controlled analgesia (PCA) in the form of an intravenous morphine pump. Baseline uterine and dominant fibroid volumes were calculated for each patient. Attempted doses, doses given, total morphine dose, and maximum numerical rating scale (NRS) score during postprocedure hospitalization were recorded. At 3 months postprocedure, repeat imaging was used to determine uterine and dominant fibroid volume reduction. Each patient also completed a questionnaire assessing change in menstrual bleeding, pelvic pain and pressure symptoms, and satisfaction with symptomatic outcome. Simple regression analysis was used to determine if baseline volumes predicted postprocedure pain and if the pain-related variables could be used to predict outcome. RESULTS: Neither baseline uterine volume nor dominant fibroid volume predicted the severity of postprocedure pain. Similarly, none of the pain-related variables predicted uterine or fibroid volume reduction, symptomatic improvement, or satisfaction with outcome. CONCLUSIONS: Postprocedural pain cannot be predicted based on baseline uterine or fibroid volume and the severity of pain experienced cannot be used to predict outcome.     

Intraarterial Lidocaine for Pain Control in Uterine Artery Embolization: A Prospective,Randomized Study

Purpose

To assess efficacy of two different techniques of lidocaine injection in the uterine arteries to reduce pain following uterine artery embolization (UAE) for leiomyomas.

Intraarterial administration of lidocaine for analgesia in hepatic chemoembolization

Hepatic chemoembolization (HCE) routinely results in severe pain requiring massive doses of intravenously administered narcotics. This study examines the efficacy and safety of lidocaine administered intraarterially for analgesia in HCE. In 45 HCE procedures, lidocaine was injected into hepatic arterial branches just prior to and during chemoembolization. Adjunctive analgesic doses given during the procedure and the need for a morphine sulfate drip infusion for postprocedural pain control were recorded and compared with those in 20 procedures performed previously without lidocaine. In procedures with lidocaine, an average of 0.13 mg of morphine sulfate and 1.3 mg of midazolam were required. This is significantly lower than the 11.7 mg of morphine sulfate and 3.7 mg of midazolam used during procedures without lidocaine. A postprocedural morphine drip infusion was required for control of severe pain in 16 of 20 (80%) procedures performed without lidocaine compared with nine of 45 (20%) of those performed with lidocaine. Peripheral blood levels of lidocaine were well below the toxic level, and no complications referable to lidocaine toxicity occurred. Marked reductions in the amount of narcotic analgesia in HCE procedures may be safely achieved with the administration of intraarterial lidocaine.     

Polyvinyl alcohol particles and tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a randomized comparative study

PURPOSE: To determine if the type of embolic material used for uterine artery embolization (UAE) for leiomyomas has an impact on short-term recovery or the effectiveness of embolization. MATERIALS AND METHODS: One hundred patients were randomly assigned to undergo UAE with polyvinyl alcohol (PVA) particles or tris-acryl gelatin microspheres. Short-term, in-hospital medication use and pain levels were recorded. After discharge, symptom severity, temperature, and medications used were recorded daily for 1 week and symptom levels were measured for weeks 2-4. Three months after embolization, contrast material-enhanced magnetic resonance imaging examinations were evaluated blindly to determine the extent of leiomyoma infarction. Symptom and quality of life (QOL) status was determined with use of questionnaires. Analysis was completed with use of chi(2) analysis, Fisher exact tests, Student t tests, and analysis of variance as appropriate. Regression analysis was used to analyze the impact on outcome of baseline factors (other than type of embolic agent). RESULTS: No significant differences were noted at baseline between the two treatment groups. On average, there were significantly higher volumes of tris-acryl microspheres used (9.0 mL vs 3.0 mL; P =.0001), whereas microcatheter occlusion was more common with PVA (28% vs 4%, P =.001). There were no differences in pain severity, other postprocedural symptoms, or medication use between the two treatment groups. There were also no differences in the frequency of incompletely infarcted leiomyomas, degree of improvement in symptom score, patient satisfaction, or QOL. CONCLUSION: No substantive differences were detected between outcomes of embolization with PVA particles or tris-acryl gelatin microspheres.     

子宫肌瘤栓塞术后产生疼痛的临床防治

目的 探讨子宫肌瘤栓塞术后产生疼痛的防治措施。方法 56例子宫肌瘤患者栓塞术后均出现疼痛，按对栓塞术后产生疼痛的处理方法不同分为对症组与预防组，分别为3l例和25例。通过观察2组患者术后疼痛的程度和持续时间，评价2种处理方法有无差异。结果 2组患者发生不同程度疼痛的比例无明显差异，但疼痛持续时间预防组显著较短。结论 积极地做好预防处理能有效地减轻子宫肌瘤栓塞术后产生疼痛的程度和持续时间，提高介入治疗的综合效果。     

Effectiveness of intra-arterial anesthesia for uterine fibroid embolization using dilute lidocaine

A modified protocol of uterine fibroid embolization (UFE) is proposed for alleviating the postinterventional pain. This randomized and double-blinded clinical trial is to evaluate the effectiveness of intra-arterial infusion of dilute lidocaine for postinterventional pain relief in UFE. Forty-six patients who underwent UFE were randomly grouped equally. In the test group, after the poly(vinyl alcohol) embolization was complete, a dilute lidocaine solution with 40 mg in 6.0 ml, 3.0 ml for each side or 4.0 and 2.0 ml for two sides, was given through the catheter. In the control group, the patients received 6.0 ml of saline solution as a placebo. A simple pain degree classification method for patient self-evaluation was developed. A questionnaire was completed by each patient to record the degree of pain during five periods; these were during the procedure, the first 12 h, the second 12 h, between 24 and 48 h, and between 48 and 72 h. The numbers of patients with the same degree of pain in the five time segments from the two groups were statistically compared. Compared with the control group, the patients in the test group experienced less pain within 48 h after the procedure (p<0.01). The results suggest that this improved UFE protocol is a simple approach to prevent the acute postinterventional pain of UFE.     

子宫动脉栓塞术在剖宫产术后子宫瘢痕妊娠治疗中的应用

目的探讨子宫动脉栓塞术(UAE)在剖宫产术后子宫瘢痕妊娠(CSP)治疗中的应用价值。方法 2007年1月至2011年6月共收治CSP患者35例,根据是否行UAE分为栓塞组(21例)和非栓塞组(14例)。栓塞组中,16例在UAE后24～48 h行清宫术,5例在UAE后行开腹或阴式病灶切除术。非栓塞组中8例直接行清宫术,3例病灶局部注射甲氨蝶呤后行清宫术,3例直接开腹行病灶切除术。比较两组患者术中出血量、住院时间、β-人绒毛膜促性腺激素(β-HCG)值降至正常时间的差异。结果栓塞组21例患者UAE操作成功,全部患者保留子宫,平均住院时间为(11.5±3.6)d,β-HCG值降至正常的平均时间为(18.6±4.9)d,而非栓塞组则分别为(20.4±5.2)d和(28.7±5.6)d。非栓塞组中2例由于术中出血汹涌,被迫行子宫切除术。结论 UAE术是一种有效的治疗CSP的方法,创伤小、成功率高,保留了患者的生育功能,能起到明显的防止出血和止血的作用。     

Intraarterial Lidocaine Administration for Relief of Pain Resulting from Transarterial Chemoembolization of Hepatocellular Carcinoma: Its Effectiveness and Optimal Timing of Administration

PURPOSE: Patients undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) commonly have significant post-procedural abdominal pain necessitating narcotic administration. It is known that intraarterial administration of lidocaine is effective in controlling the pain during the procedure. However, optimum timing of the lidocaine administration is not precisely known. The purpose of this study was to assess the efficacy of intraarterial lidocaine administration for control of pain resulting from TACE and to evaluate the optimal timing of administration. METHODS: In a prospective trial, 113 consecutive patients with HCC who underwent TACE were classified into three groups: those who received a lidocaine bolus intraarterially immediately prior to TACE (group A, n = 30), those who received lidocaine immediately after TACE (group B, n = 46), and those who did not received lidocaine (group C, n = 37). Incidence and degree of post-procedural pain was assessed using a subjective method (visual analogue scales scored from 0 to 10) and an objective method (amount of post-procedural analgesics). RESULTS: The incidence of post-procedural pain in group A (16.7%) was significantly lower than that of group B (38.3%; p = 0.005). The mean pain score was 3.0 in group A and 4.8 and 3.1 in groups B and C, respectively. The mean dose of analgesic used after the procedure in group A (25.0 mg) was significantly lower than those in group B (52.9 mg) and group C (41.0 mg; p = 0.002). CONCLUSIONS: Pre-TACE intraarterial administration of lidocaine is much more effective than post-TACE administration in reducing the incidence and the severity of post-procedural pain. Furthermore, in order to reduce the incidence of post-procedural pain and dose of post-procedural analgesics, we recommend routine pre-TACE administration of lidocaine because post-procedural pain might developed even in patients who did not feel any pain during the TACE.     

Chemoembolization for hepatocellular carcinoma: effect of intraarterial lidocaine in peri- and post-procedural pain and hospitalization

PURPOSE: To assess the efficacy of intraarterial lidocaine on peri- and post-procedural pain and on length of hospital stay in hepatocellular carcinoma (HCC) patients undergoing chemoembolization. MATERIALS AND METHODS: Twenty-eight patients (19M, 9F, age range 49-76) who underwent hepatic chemoembolization at our Institution between March 2000 and February 2002 were included in the study. Group A consisted of 14 patients who received intraarterial lidocaine immediately before and during chemoembolization, while in the 14 patients of group B lidocaine was substituted with saline solution. The doses of centrally acting narcotics (tramadol) administered periprocedurally and in the three days following the procedure were compared, as were the hospitalization times. Subjective pain was measured using the visual analogue scale. Chemoembolizations were performed with an emulsion of lipiodol, cisplatin and epirubicin followed by embolizing material (gelfoam of Contour particles) in order to achieve complete blood flow stop in the proper hepatic artery. RESULTS: No side effects were noted that could be due to systemic administration of lidocaine. All patients experienced some degree of post-embolization syndrome. Periprocedural, day 1 and day 2 post chemoembolization dosages of tramadol were significantly lower in group A with respect to group B patients. No group A patient required analgesia on day 3. No statistical difference was observed in time persistence of nausea and vomiting, fever and hospitalization time between the two patient groups. CONCLUSIONS: Intraarterial administration of lidocaine before and during chemoembolization is a safe and effective method for preventing or reducing peri- and post-procedural pain and dosage of narcotic analgesics in patients with HCC. Hospitalization times did not differ significantly between the two groups, probably because of the other components of post-embolization syndrome, such as fever, nausea and vomiting.     

Superior hypogastric nerve block for pain control in outpatient uterine artery embolization

PURPOSE: To assess the efficacy of the superior hypogastric nerve block (SHNB) in permitting uterine artery embolization (UAE) to be performed as a routine outpatient procedure. MATERIALS AND METHODS: One hundred thirty-nine patients who underwent UAE in a prospective single-arm clinical trial in an academic institution underwent SHNB from an anterior abdominal approach to control acute postprocedural pain, in addition to conventional conscious sedation. They were discharged and prescribed one of two drug combinations started during the in-hospital recovery period. Regimen A included short-acting morphine tablets and indomethacin rectal suppositories and regimen B included long-acting morphine tablets for baseline pain supplemented with short-acting morphine tablets for breakthrough pain, and naproxen rectal suppositories. All patients were contacted by phone on the third and fifth postprocedural days and their peak pain experience was recorded on a scale of 0 to 10. RESULTS: All patients were able to be discharged the day of the procedure. Seven patients (5%) returned to the hospital because of pain. One was discharged after undergoing a second SHNB and four were discharged after receiving intravenous analgesics; two required longer admission for intravenous analgesia. The mean (+/-SD) peak pain score in the first 5 days after the procedure for all patients was 4.8 +/- 2.6. There was a significant difference between regimens A (mean pain score, 5.7 +/- 2.2) and B (mean pain score, 2.7 +/- 2.5; Mann-Whitney, 5.94; P < .01). CONCLUSION: The addition of SHNB to the more conventional post-UAE pain management methodology enhances pain control, enabling the procedure to be offered with minimum pain on a routine outpatient basis.     

Outcomes after uterine artery embolization for pedunculated subserosal leiomyomas

PURPOSE: To assess the safety and efficacy of uterine artery embolization (UAE) treatment of pedunculated subserosal leiomyomas. MATERIALS AND METHODS: A review of patients undergoing UAE in a 30-month period (July 2004 to December 2006) was performed. Cases in which a pedunculated subserosal tumor (volume>or=4 cm3) was embolized were analyzed. The preprocedural volumes of the pedunculated tumor and uterus and the diameter and vascularity of the tumor and stalk were recorded. Posttreatment sizes of the pedunculated leiomyoma, stalk, and uterus were recorded, as was the presence or absence of complication(s). RESULTS: A total of 240 patients underwent embolization. Pedunculated subserosal leiomyomas were treated in 16 women, with a technical success rate of 100%. Preprocedural mean tumor and uterine volumes were 372 cm3 and 789 cm3, respectively. The mean stalk diameter was 2.7 cm (range, 0.8-7.8 cm). All pedunculated leiomyomas exhibited enhancement on contrast agent-enhanced magnetic resonance (MR) imaging (n=13) or vascularity on Doppler ultrasonography (US; n=3). Stalk vascularity was noted on MR imaging in 13 patients and was not assessed in the remaining three, who underwent US imaging. Imaging follow-up (mean, 5.9 months after UAE) demonstrated mean tumor volume reduction of 39.3% (95% confidence interval [CI], 28.2%-50.5%) and mean uterine volume reduction of 37.6% (95% CI, 26%-49.3%). There were no cases of continued tumor perfusion and no major complications. There was one minor complication of prolonged hospital stay (36 hours) for pain control. CONCLUSION: UAE was successfully and safely performed for pedunculated subserosal leiomyomas, with a tumor volume reduction of 39% and no unique complications related to these lesions.     

Effects of utero-ovarian anastomoses on basal follicle-stimulating hormone level change after uterine artery embolization with tris-acryl gelatin microspheres

PURPOSE: To assess the prevalence of anastomoses between uterine and ovarian arteries on angiography and their impact on changes in basal follicle-stimulating hormone (FSH) level after uterine artery embolization (UAE). MATERIALS AND METHODS: Consecutive premenopausal women who underwent UAE for symptomatic uterine leiomyomata according to a uniform embolization technique with tris-acryl gelatin microspheres at a single institution were included in the study. Basal FSH levels before UAE and 6 months after UAE were compared for patients with and without anastomoses between uterine and ovarian arteries on angiography. RESULTS: Among 124 patients included in the study (mean age, 43.1+/-5.7 years), patent anastomoses between the uterine and ovarian arteries were detected by angiography in 55 patients (44.4%). Overall, 11.3% of 124 patients showed an increase in basal serum FSH level of greater than 20 mIU/mL after UAE. In patients with utero-ovarian anastomoses, 18.2% showed an increase of greater than 20 mIU/mL after UAE, compared with 5.8% of patients without such anastomoses (P=.03). Mean basal FSH increase after UAE in patients with anastomoses was 8.4+/-20.2 mIU/mL, compared with 2.7+/-10.6 mIU/mL in patients without anastomoses (P=.047). Among patients with anastomoses, the 50- to 54-year age group had the highest percentage of patients with an FSH increase greater than 20 mIU/mL (50.0%) after UAE, followed by patients in the 45- to 49-year age group (15.4%). CONCLUSIONS: Angiographically detected anastomoses between the uterine artery and the ovarian artery are not uncommon. UAE in patients with anastomoses is associated with a greater risk of significant increase of basal FSH level than in UAE in patients without anastomoses. The pathophysiologic processes resulting in change of FSH level may be a reflection of diminished ovarian function, but further study is warranted to delineate the precise mechanism.     

不同镇痛方法在子宫肌瘤介入治疗中的效果分析

目的：探讨不同镇痛方法对子宫动脉栓塞后疼痛的镇痛效果与-临床应用价值。方法：根据不同的镇痛方法，将52例确诊为子宫肌瘤的患者分为A组(肌注哌嗒啶)、B组(宫腔浸润麻醉)、C组(患者自控止痛术，PCA)，行子宫动脉超选插管造影、栓塞，观察栓塞后疼痛的发生并作出评价。结果：A组疼痛发生率100％，镇痛优良率0％，B组、C组的疼痛发生率明显低于A组，分别为16、7％和5．3％(背景剂量 自控量为0％)，镇痛优良率分别为89％和100％。结论：A组效果欠佳，B、C组效果优良，可有效控制疼痛症状，保证手术顺利进行和术后恢复。     

Uterine artery embolization for symptomatic adenomyosis with or without uterine leiomyomas with the use of calibrated tris-acryl gelatin microspheres: midterm clinical and MR imaging follow-up

PURPOSE: To evaluate clinical and magnetic resonance (MR) imaging results after uterine artery embolization (UAE) in women with symptomatic adenomyosis with or without uterine leiomyomas. MATERIALS AND METHODS: Thirty-eight women with symptomatic adenomyosis with or without uterine leiomyomas were treated with UAE with calibrated tris-acryl gelatin microspheres. Based on MR findings, women were categorized as having pure adenomyosis (group A; n = 15), adenomyosis dominance with fibroid tumors (group B; n = 14), or fibroid tumor dominance with adenomyosis (group C; n = 9). RESULTS: Heavy menstrual bleeding, pain, and bulk-related symptoms at last follow-up at a median of 16.5 months (range, 3-38 months) were compared with baseline symptoms. With follow-up MR imaging at a median of 12 months (range, 3-36 months), changes in uterine volume, leiomyoma volume, junctional zone thickness, and contrast enhancement of adenomyosis were assessed. After embolization, adenomyosis infarction could be depicted on contrast medium-enhanced MR in 44.1% of cases. Median reductions of uterine volume, fibroid tumor volume, and junctional zone thickness were 44.8%, 77.1%, and 23.9%, respectively. In group A, three patients needed additional surgery after UAE, in addition to two in group B and one in group C. In the remaining 32 patients, except for one patient in group C, all preexisting symptoms (eg, bleeding, pain, bulk-related symptoms) improved or resolved after UAE. Overall, 84.2% of women were satisfied with the results of UAE. CONCLUSION: In this study, midterm results (at a median of 16.5 months) showed that UAE in symptomatic adenomyosis with or without uterine leiomyomas is effective. Hysterectomy was avoided in the vast majority of patients. MR imaging showed reduction of uterine volume and junctional zone thickness.     

Clinical failure after uterine artery embolization: evaluation of patient and MR imaging characteristics

PURPOSE: To investigate the patient and magnetic resonance (MR) imaging characteristics associated with clinical failure after uterine artery embolization (UAE). MATERIALS AND METHODS: Seventy-eight consecutive patients who underwent UAE were examined. Contrast-enhanced MR imaging was performed before and 4 months after the procedure, and clinical follow-up was performed at 15 months. Patients were divided into success and failure groups strictly on the basis of their clinical outcomes. Clinical follow-up included evaluation of fibroid symptoms and the need for further treatment after UAE. Findings at pre- and postprocedural MR imaging were compared, and data collected included changes in uterine and fibroid volumes, fibroid location, and fibroid perfusion. RESULTS: Fifty-eight patients were placed into the success group and 20 into the failure group. There were no differences between the baseline characteristics of the two groups. The reduction in uterine and dominant fibroid volumes was greater in the success group compared with the failure group; however, the difference was not statistically significant (success group: [295/845] 34.9% vs [80/282.5] 28.3%, respectively, P=.18; failure group: [317/733] 43.2% vs [114/337.6] 33.9%, P=.32). The reduction in total fibroid volume was greater in the success group than the failure group ([189.6/393.5] 48.2% vs [148.7/439.9] 33.8%, respectively; P=.02) despite the fact that the percentage of fibroids completely infarcted was similar between the two groups ([136/172] 79% vs [41/50] 82%, P=.77). Pedunculated subserosal fibroids were more common in the failure group than in the success group (P<.03) and did not reduce in volume as significantly (53.8% vs 14.7%, respectively; P=.02). CONCLUSIONS: In general, the reduction in total fibroid volume after embolization is smaller in patients with poor clinical improvement. In addition, these patients have a higher number of pedunculated subserosal fibroids, and these fibroids tend to reduce in volume to a lesser extent.     

经导管子宫动脉栓塞治疗症状性子宫平滑肌瘤的初步经验

目的 评价经导管子宫动脉栓塞（ＵＡＥ）对症状性子宫平滑肌瘤（ＵＦ）的疗效并探讨治疗技术。方法 １０例患者主要症状包括阴道出血（月经过多）,盆腔压迫症状（尿频）,盆区疼痛。ＵＦ的诊断经影像学检查和专科医师检查确定,并排除与症状有关的其它妇科疾病。１０例患者行１１例次子宫动脉栓塞,其中双侧者１０例次,单侧者１例次。栓塞剂为ＰＶＡ微球。结果 栓塞技术成功率为１００％,无严重并发症。随访９例,术后症状有明     

Comparison of Pain After Uterine Artery Embolization Using Tris-Acryl Gelatin Microspheres Versus Polyvinyl Alcohol Particles

When compared in a uterine artery embolization (UAE) animal model, Embospheres (ES) (Biosphere Medical, Rockland, MA) were found to induce less uterine ischemia than polyvinyl alcohol (PVA) particles. Given this finding, we aimed to test the hypothesis that ES is associated with less pain after UAE than PVA in human patients. We performed retrospective analysis on data from 72 consecutive UAE patients, collected from a prospectively acquired database. Patient-controlled analgesia (PCA) pump-delivered morphine sulfate (MS) dosages were compared between patients who received ES versus PVA. Subjective pain scores (SPS) were also compared between the two groups. Secondary outcome measures, including embolic volume and clinical outcome data, were also collected. Linear regression and t-test statistical analyses were performed. Null hypotheses were rejected at the p < 0.05 level. Mean follow-up period in the PVA population was 178 days (range 28–426), versus 96 days (range 24–197) in the ES population. The mean MS doses used by ES and PVA patients were 37.2 (s.d. 23.5) versus 47.1 (s.d. 26.8), respectively. This difference was not significant (p > 0.15). Utilizing a standard 0–10 pain scale, the mean peak SPS for the ES and PVA groups were 5.58 (s.d. 2.77) and 5.07 (s.d. 2.99), respectively. The difference was not significant. The mean amount of embolic material used in each ES and PVA patient was 4.86 cc (s.d. 3.01) and 3.52 cc (s.d. 1.63), respectively. The difference revealed a strong trend toward statistical significance (p = 0.05). There was one treatment failure in each group of patients. Within both patient samples, no significant correlation was found when comparing the volume of embolic used and subsequent MS dose. Despite a strong trend toward a significantly higher volume of ES used per patient, there is no subjective or objective difference in pain after UAE with ES when compared to PVA.     

Ovarian function after uterine artery embolization for leiomyomata: assessment with use of serum follicle stimulating hormone assay

PURPOSE: To determine if uterine artery embolization (UAE) for leiomyomata causes a change in ovarian function as measured by serial basal follicle stimulating hormone (FSH) assay. MATERIALS AND METHODS: Sixty-three patients undergoing UAE for symptomatic leiomyomata had blood samples obtained on day 3 of a menstrual cycle before UAE and on day 3 during menstrual cycles 3 and 6 months after treatment. Analysis of variance was used to detect differences in FSH levels among age groups at each interval. Repeated measures analysis of variance was used to determine if individual mean change occurred for the group as a whole and for each age group. Onset of new menopausal symptoms was compared between groups with use of the chi(2) test. RESULTS: There was no significant change in basal FSH levels for the group as a whole (P =.16), but there was a statistically significant difference when age groups were compared (P =.03). Individual change of >2 SD from baseline mean FSH level occurred at 6 months in seven patients, all 45-50 years of age. Four of these patients (15% of patients over age 44) had FSH levels increase to more than 20 IU/L. chi(2) analysis did not reveal any difference among the groups studied in the onset of menopausal symptoms. CONCLUSIONS: Most patients had no change in ovarian function as measured by basal FSH after UAE. For patients aged 45 or older, there is approximately a 15% chance of an increase in basal FSH into the perimenopausal range.