Results: The average age of patient undergoing FE was 44⫾5 (SD) years with 12 being nulliparous and 21 being multiparous. On average, FE took place 12.1⫾17.6(SD) weeks after UAE (range 1.6-106 weeks). Most FEs were associated with a clinical presentation of a menses of longer than expected duration and an increase in intensity of dysmenorrhea with discharge. The majority of patients expelled an entire or large fragment of fibroid while only a few had fibroids that slowly sloughed or melted away. The mean size of expelling fibroid was 8.2 cm⫹3.6 cm (SD) in greatest dimension, range 1.6-15 cm. The FE patients had a statistically greater mean uterine volume decrease, 56.1% ⫾ 18.8% (SD) as compared to a group of matched control patients who underwent UAE without FE, 31.6% ⫾ 18.6 (SD) (p⬍0.01). 14 patients either expelled symptomatically at home or had an office/ED transvaginal myomectomy, 10 had an operative transvaginal myomectomy, 3 had a hysteroscopic resection, and 1 expelled asymptomatically. 4 patients (12%) developed fevers and incomplete evacuation of material resulting in hysterectomy. 3 of these were nulliparous. In all, 25% of nulliparous patients and 5% of multiparous patients underwent urgent hysterectomy. One multiporous patient wth late FE after 2 years had an elective hystectomy for recurrent bleeding. Conclusion: Most patients have a satifactory clinical result after FE; However, FE may result in additional procedures and may lead to hysterectomy for incomplete FE. Nulliparous women experiencing FE may be at greater risk for urgent hysterectomy.
Abstract No. 58
Significance of incidentally discovered dilated ovarian veins on CT of the abdomen and pelvis A. Rajput1, J.D. Jaskolka2, V. Agarwal3, C. Massey3, J.R. Kachura4; 1University of Toronto, Toronto, ON, Canada; 2Mount Sinai Hospital, Toronto, ON, Canada; 3UHN, Toronto, ON, Canada; 4TGH, Toronto, ON, Canada. Purpose: Dilated ovarian veins with venous reflux are features of pelvic congestion syndrome. However, the significance of dilated ovarian veins incidentally discovered on a CT scan of the abdomen and pelvis is not well known. The goal of this study was to establish or rule out a relationship between dilated ovarian veins and pelvic pain (PP). Materials and Methods: This was a prospective, IRB approved study of female patients undergoing a venous phase contrast enhanced CT scan of the abdomen and pelvis for any indication. Each patient completed a standardized questionnaire on the day of their CT scan, asking about the presence or absence of pelvic pain along with nature, severity and duration of pain if present. Patients were also questioned about past medical history. The CT scans were then evaluated for the presence of “reflux” in the ovarian veins defined by ovarian vein diameter ⬎ 6mm and enhancement of more than the top 50% of the vein. Data was analyzed using Fisher‘s exact test and positive predictive values were calculated to assess for a relationship between dilated ovarian veins and PP. Results: The study included 174 consecutive women (mean age 58, range 18-90). Of these patients, 56 (32.3%) reported PP. Reflux was seen in 30 (17.2%) patients. The combinaS24
tion of reflux and PP was seen in 15 (8.6%) patients. Of the 30 patients with reflux, 15 (50%) reported PP, whereas of the 144 patients without these findings, only 41 (28%) reported PP. Using Fisher‘s exact test, a statistically significant association was identified between patients with reflux and PP (p⫽0.031). The positive predictive value of reflux for the presence of PP was 50% (CI⫽31-69%). Sensitivity and specificity for prediction of PP were 26.8% and 87.3% respectively. Conclusion: Our results show a significant association between incidentally detected dilated ovarian veins on CT scan and pelvic pain. If dilated ovarian veins are visualized, the radiologist should suggest clinical correlation for evidence of pelvic pain. If positive, these patients may benefit from embolotherapy.
Abstract No. 59
Elective use of unilateral uterine artery embolization for symptomatic uterine leiomyomata L.E. Stall, J.S. Lee, B. Hansford, M. McCullough, J. Spies; Georgetown University Hospital, Washington, DC. Purpose: To evaluate the effectiveness of elective unilateral uterine artery embolization in patients whose fibroids are limited to one side of the uterus and have unilateral arterial supply. Materials and Methods: A retrospective review of 1290 patients treated with uterine artery embolization for symptomatic leiomyomata from September 2004 through July 2009 identified 75 patients who underwent unilateral uterine artery embolization. Most of these patients had an absent uterine artery and some had a failure of catheterization of one uterine artery. However, 27 had intentional embolization of a single uterine artery because of unilateral fibroid disease on MRI and arterial supply to the fibroids from only the ipsilateral uterine artery on angiography. Post-procedure MR imaging was available for evaluation on 18 of these patients and the extent of fibroid infarction was determined. Fifteen patients returned for 3-month clinical follow-up and symptom improvement was evaluated with a standard post-procedure questionnaire. Descriptive statistics were used to summarize results in these patients. Results: Sixteen of 18 patients (89%) who returned for post embolization contrast enhanced MRI had complete infarction of their fibroids compared to pre-procedural imaging. Two of 18 patients (11%) had incomplete infarction of fibroids, with none having greater than 25% residual enhancement. Fifteen patients completed 3-month clinical follow-up. Of these patients, 4 were very satisfied, 7 patients were satisfied, 3 patients were neutral, and 1 patient reported dissatisfaction with the procedure. Symptom resolution in these unilateral embolization patients was similar to that seen in previously published studies of patients undergoing bilateral uterine artery embolization. Conclusion: Indications for unilateral embolization are rare. However, in the infrequent circumstance when unilateral fibroid disease is present and arterial supply to the fibroids is from a single uterine artery, these preliminary results suggest that intentional unilateral embolization may be effective.