Recanalization and particle exclusion after embolization of uterine arteries in sheep: a long-term study.

Abstract

OBJECTIVE:

To compare the long-term evolution of uterine arteries after embolization with the two most commonly used embolic agents for fibroid embolization: nonspherical polyvinyl alcohol (PVA) particles and trisacryl gelatin microspheres (TGMS).

DESIGN:

Prospective study.

SETTING:

University-based interventional radiology, pathology, and reproductive physiology units.

ANIMAL(S):

Two groups of 10 sheep embolized in the uterine artery.

INTERVENTION(S):

Embolization of the uterine artery with either 600-1000 microm nonspherical polyvinyl alcohol (PVA) particles or with 700-900 microm trisacryl gelatin microspheres (TGMS). Animals were synchronized and naturally inseminated. Animals were killed at 26 months.

MAIN OUTCOME MEASURE(S):

Uteri were examined pathologically for vessel size, site of occlusion, recanalization rate of vessels, and particle location within the vascular wall.

RESULT(S):

The PVA particles were more numerous in the vessels' lumen than the TGMS particles (13.3 +/- 20.8 vs. 2.5 +/- 2.7), were located more proximally than TGMS (97% vs. 68% in the trunk and first branches of the uterine artery), and were found almost exclusively in the intima (99.2%). In contrast, 54.4% of the TGMS particles were found in the intima, and 45.6% partially or totally excluded. The rate of recanalization was not statistically significantly different for PVA and TGMS (65.2% vs. 60.6%).

CONCLUSION(S):

The long-term evolution of uterine arteries was different after uterine artery embolization with PVA and TGMS because PVA particles formed large-sized aggregates that occluded proximal vessels and remained in the vessel intima. Microspheres occluded more distal vessels, and about 50% of them were partially or totally excluded from the vessel.

• Authors: Alexandre Laurent, Michel Wassef, Julien Namur, Jacques Martal, Denis Labarre, Jean-Pierre Pelage
• Journal: Fertility and sterility (Fertil Steril) Vol. 91 Issue 3 Pg. 884-92 (Mar 2009) ISSN: 1556-5653 [Electronic] United States
• PMID: 18321492 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Acrylic Resins
• trisacryl gelatin microspheres
• Gelatin
• Polyvinyl Alcohol

Topics

• Acrylic Resins (administration & dosage, adverse effects, metabolism)
• Animals
• Arteries (metabolism, pathology)
• Female
• Fertility
• Foreign-Body Reaction (etiology, pathology)
• Gelatin (administration & dosage, adverse effects, metabolism)
• Models, Animal
• Particle Size
• Polyvinyl Alcohol (administration & dosage, adverse effects, metabolism)
• Pregnancy
• Prospective Studies
• Sheep
• Time Factors
• Uterine Artery Embolization (adverse effects, methods)
• Uterus (blood supply, pathology, physiopathology)