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CardioVascular and Interventional Radiology

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01-10-2014 | Clinical Investigation

Comparison of Embolic Agents Used in Uterine Artery Embolisation: A Systematic Review and Meta-Analysis

Authors: Raj Das, Rita Champaneria, Jane P. Daniels, Anna-Maria Belli

Published in: CardioVascular and Interventional Radiology | Issue 5/2014

Abstract

Purpose

This study was designed to undertake systematic review and meta-analysis of published comparative trials comparing embolic agents used in uterine artery embolisation (UAE) for uterine leiomyomata.

Methods

Systematic literature searches were performed in MEDLINE, Embase, PubMed, and Cochrane Central databases from database inception to July 2012. Randomised and nonrandomised trials comparing two or more embolic agents used in UAE were included. Assessment included five widely used embolic agents: nonspherical polyvinyl alcohol (PVA) (Contour PVA, Boston Scientific or PVA Cook Medical); spherical PVA (Contour SE, Boston Scientific); acrylamido PVA (Beadblock, Biocompatibles, Terumo); tris-acryl gelatin microspheres (TAGM) (Embospheres, Merit Medical Inc); and polyzene-F hydrogel microspheres (Embozenes, CeloNova Biosciences). Outcomes assessed included: quality of life (QOL), assessment, magnetic resonance imaging (MRI), uterine and fibroid volumes and degrees of MRI fibroid enhancement and devascularisation. A total of 262 citations were reviewed with 5 randomised, controlled trials involving 295 women and 5 non-RCTs involving 617 women included.

Results

No evidence of superiority of any embolic agent was demonstrated. Meta-analysis was performed between TAGM (Embospheres) and spherical PVA microspheres. Two RCTs found a trend toward greater uterine and dominant fibroid volume reductions with Embospheres but the combined differences were not statistically significant (p = 0.78 and p = 0.94 respectively). Embospheres demonstrated greater percentage fibroid devascularisation than spherical PVA (p = 0.039).

Conclusions

This study confirms that the current evidence demonstrates superiority of Embospheres over spherical PVA but no reported differences in outcomes between any of the other agents. Comparison of embolic agents was limited by lack of RCT data and further research is warranted.

Manyonda IT, Bratby M, Horst JS, Banu N, Gorti M, Belli AM (2012) Uterine artery embolization versus myomectomy: impact on quality of life—results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial. Cardiovasc Intervent Radiol 35(3):530–536CrossRefPubMed

The REST Investigators (2007) Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 356:337–360

Hehenkamp WJ, Volkers NA, Birnie E, Reekers JA, Ankum WM (2008) Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy—results from the randomized clinical Embolisation versus Hysterectomy (EMMY) Trial. Radiology 246(3):823–832CrossRefPubMed

Ravina JH, Herbreteau D, Ciraru-Vigneron N, Bouret JM, Houdart E, Aymard A, Merland JJ (1995) Arterial embolisation to treat uterine myomata. Lancet 346(8976):671–672CrossRefPubMed

Das R, Gonsalves M, Vlahos I, Manyonda I, Belli AM (2013) MRI assessment of uterine artery patency and fibroid infarction rates 6 months after uterine artery embolization with nonspherical polyvinyl alcohol. Cardiovasc Intervent Radiol 36(5):1280–1287

Pelage JP, Laurent A, Wassef M et al (2002) Uterine artery embolization in sheep: comparison of acute effects with polyvinyl alcohol particles and calibrated microspheres. Radiology 224:436–445CrossRefPubMed

Andrews RT, Binkert CA (2003) Relative rates of blood flow reduction during transcatheter arterial embolization with tris-acryl gelatin microspheres or polyvinyl alcohol: quantitative comparison in a swine model. J Vasc Interv Radiol 14:1311–1316CrossRefPubMed

Chua GC, Wilsher M, Young MP, Manyonda I, Morgan R, Belli AM (2005) Comparison of particle penetration with non-spherical polyvinyl alcohol versus trisacryl gelatin microspheres in women undergoing premyomectomy uterine artery embolization. Clin Radiol 60(1):116–122CrossRefPubMed

Siskin GP, Beck A, Schuster M, Mandato K, Englander M, Herr A (2008) Leiomyoma infarction after uterine artery embolization: a prospective randomized study comparing tris-acryl gelatin microspheres versus polyvinyl alcohol microspheres. J Vasc Interv Radiol 19(1):58–65CrossRefPubMed

10.

Spies JB, Allison S, Flick P, Cramp M, Bruno J, Jha RC, Ascher SA (2005) Spherical polyvinyl alcohol versus tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a limited randomized comparative study. J Vasc Interv Radiol 16(11):1431–1437CrossRefPubMed

11.

Rasuli P, Hammond I, Al-Mutairi B, French GJ, Aquino J, Hadziomerovic A, Goulet S, Jolly EE (2008) Spherical versus conventional polyvinyl alcohol particles for uterine artery embolization. J Vasc Interv Radiol 19(1):42–46CrossRefPubMed

12.

Siskin GP, Englander M, Stainken BF, Ahn J, Dowling K, Dolen EG (2000) Embolic agents used for uterine fibroid embolization. AJR Am J Roentgenol 175(3):767–773CrossRefPubMed

13.

Katsumori T, Kasahara T, Akazawa K (2006) Long-term outcomes of uterine artery embolization using gelatin sponge particles alone for symptomatic fibroids. AJR Am J Roentgenol 186(3):848–854CrossRefPubMed

14.

Kroencke TJ, Scheurig C, Lampmann LE, Boekkooi PF, Kissner L, Kluner C, Weichert W, Hamm B, Lohle PN (2008) Acrylamido polyvinyl alcohol microspheres for uterine artery embolization: 12-month clinical and MR imaging results. J Vasc Interv Radiol 19(1):47–57CrossRefPubMed

15.

Chrisman HB, Dhand S, Rajeswaran S, Nikolaidis P, Vogelzang RL, Corpuz B, Gilbertson P, Omary RA (2010) Prospective evaluation of the embolic agent bead block in the treatment of uterine leiomyomas with uterine artery embolization: a phase II study. J Vasc Interv Radiol 21(4):484–489CrossRefPubMed

16.

Worthington-Kirsch RL, Siskin GP, Hegener P, Chesnick R (2011) Comparison of the efficacy of the embolic agents acrylamido polyvinyl alcohol microspheres and tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: a prospective randomized controlled trial. Cardiovasc Intervent Radiol 34(3):493–501CrossRefPubMed

17.

Smeets AJ, Nijenhuis RJ, van Rooij WJ, Lampmann LE, Boekkooi PF, Vervest HA, De Vries J, Lohle PN (2010) Embolization of uterine leiomyomas with polyzene F-coated hydrogel microspheres: initial experience. J Vasc Interv Radiol 21(12):1830–1834CrossRefPubMed

18.

Stampfl U, Radeleff B, Sommer C, Stampfl S, Dahlke A, Bellemann N, Kauczor HU, Richter GM (2011) Midterm results of uterine artery embolization using narrow-size calibrated embozene microspheres. Cardiovasc Intervent Radiol 34(2):295–305CrossRefPubMed

19.

Spies JB, Coyne K, Guaou Guaou N, Boyle D, Skyrnarz-Murphy K, Gonzalves SM (2002) The UFS–QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 99(2):290–300CrossRefPubMed

20.

Kirby JM, Burrows D, Haider E, Maizlin Z, Midia M (2011) Utility of MRI before and after uterine fibroid embolization: why to do it and what to look for. Cardiovasc Intervent Radiol 34(4):705–716CrossRefPubMed

21.

Katsumori T, Kasahara T, Kin Y, Nozaki T (2008) Infarction of uterine fibroids after embolization: relationship between postprocedural enhanced MRI findings and long-term clinical outcomes. Cardiovasc Intervent Radiol 31(1):66–72CrossRefPubMed

22.

Kroencke TJ, Scheurig C, Poellinger A, Gronewold M, Hamm B (2010) Uterine artery embolization for leiomyomas: percentage of infarction predicts clinical outcome. Radiology 255(3):834–841CrossRefPubMed

23.

Spies JB (2009) What evidence should we demand before accepting a new embolic material for uterine artery embolization? J Vasc Interv Radiol 20(5):567–570CrossRefPubMed

24.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535PubMedCentralCrossRefPubMed

25.

http://www.mrc-bsu.cam.ac.uk/cochrane/handbook/chapter_13/table_13_2_a_list_of_study_design_features_studies_with.htm. Accessed 27 Nov 2013

26.

Yu SC, Lok I, Ho SS, Tong MM, Hui JW (2011) Comparison of clinical outcomes of tris-acryl microspheres versus polyvinyl alcohol microspheres for uterine artery embolization for leiomyomas: results of a randomized trial. J Vasc Interv Radiol 22(9):1229–1235CrossRefPubMed

27.

Spies JB, Allison S, Flick P, McCullough M, Sterbis K, Cramp M, Bruno J, Jha R (2004) Polyvinyl alcohol particles and tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a randomized comparative study. J Vasc Interv Radiol 15(8):793–800CrossRefPubMed

28.

Liaw JV, Yun CH, Walker TG, Kalva SP, Janne d’Othée B (2012) Comparison of clinical and MR imaging outcomes after uterine fibroid embolization with Bead Block and Embosphere. Eur J Radiol 81(6):1371–1375CrossRefPubMed

29.

Galvez JA, McCarthy S, Weinreb J, Zelterman D, White RI, Pollak J, Tal MG (2008) Comparison of MRI outcomes of uterine artery embolization for uterine leiomyoma using tris-acryl gelatin microspheres, polyvinyl alcohol spheres, and polyvinyl alcohol particles. J Comput Assist Tomogr 32(3):356–361CrossRefPubMed

30.

Abramowitz SD, Israel GM, McCarthy SM, Pollak JS, White RI Jr, Tal MG (2009) Comparison of four embolic materials at uterine artery embolization by using postprocedural MR imaging enhancement. Radiology 250(2):482–487CrossRefPubMed

31.

Lohle PN, Boekkooi FP, Smeets AJ, Pieters JJ, Vervest HA, Lampmann LE, Sluzewski M (2006) Limited uterine artery embolization for leiomyomas with tris-acryl gelatin microspheres: 1-year follow-up. J Vasc Interv Radiol 17(2 Pt 1):283–287CrossRefPubMed

32.

http://hiv.cochrane.org/sites/hiv.cochrane.org/files/uploads/Ch13_NRS.pdf. Accessed 27 Nov 2013

Title: Comparison of Embolic Agents Used in Uterine Artery Embolisation: A Systematic Review and Meta-Analysis
Authors: Raj Das
Rita Champaneria
Jane P. Daniels
Anna-Maria Belli
Publication date: 01-10-2014
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 5/2014
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-013-0790-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of Embolic Agents Used in Uterine Artery Embolisation: A Systematic Review and Meta-Analysis

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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