Role of Ovarian Artery to Uterine Artery Anastomosis in Uterine Artery Embolisation: A Retrospective Study

Abstract

Introduction: Uterine Artery Embolisation (UAE) is now extensively recognised as a treatment for uterine fibroids, uterine artery pseudoaneurysms, and Uterine Arterio-Venous Malformations. The occurrence of collateral circulation from the ovarian artery to the uterine artery is one of the reasons for the failure of the process. The occurrence of ovarian failure and premature menopause after the UAE is high in patients with Utero-ovarian Artery (UOA) anastomosis. Aim: To classify UOA as per Razavi MK et al., angiographic classification and to determine the presence of such anastomosis in UAE procedure failure cases. Materials and Methods: A retrospective study was done for a period of two years from November 2017 to October 2019. UAE was performed with Poly Vinyl Alcohol (PVA) microparticles (300 to 500 μm in size) followed by capping with a gelatin sponge in all 25 cases and coils were used in three cases. The presence or absence of UOA and four different types as per Razavi MK et al., angiographic classification were noted. Results: Among 25 cases who underwent UAE, 14 had UOA. The majority (six cases) were type Ib, five cases were type Ia, two cases were type II and one case was type III. The bilateral anastomosis was noted in one case with type Ia and Ib on either side. Eight cases with UOA had successful embolisation. The UAE was successful in 16 cases, and failed in nine cases. Among various causes for failure, six out of nine were due to UOA. Among six failure cases of UOA, two cases were Type Ia, two cases were Type Ib, one case was Type II and one case was Type III anastomosis. Conclusion: UOA is one of the major risk factors in the procedural failures of the UAE. Identification avoids non target ovarian embolisation.

Keywords

• failure of uterine artery embolisation
• ovarian embolisation
• poly vinyl alcohol microparticles
• utero ovarian collateral circulation