CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2023; 07(03): 179-182
DOI: 10.1055/s-0043-1768942
Original Article

A Prospective Pilot Study of the Safety and Effectiveness of Uterine Artery Embolization for the Treatment of Endometriosis: The UAE-E Study

Jim Koukounaras
1   Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
2   Department of Surgery, Monash University, Melbourne, Victoria, Australia
,
1   Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
2   Department of Surgery, Monash University, Melbourne, Victoria, Australia
3   National Trauma Research Institute, Melbourne, Victoria, Australia
,
4   Department of Obstetrics and Gynaecology, Royal Women's Hospital, Melbourne, Victoria, Australia
5   Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
,
1   Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
,
1   Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
6   Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
,
7   Department of Radiology, Cork University Hospital, Cork, Ireland
,
1   Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
2   Department of Surgery, Monash University, Melbourne, Victoria, Australia
› Author Affiliations
Funding None.

Abstract

Purpose Uterine artery embolization (UAE) evidence is increasing in the setting of adenomyosis, which shares pathological similarities to endometriosis. Endometriosis is characterized by the presence of endometrium-like tissue outside of the uterus, and the retrograde menstruation hypothesis may account for disease development. In women where fertility is no longer desired, hysterectomy can be offered to improve pain-related symptoms. The authors hypothesize that this cohort of patients may similarly respond to UAE. The aim of this pilot study is to assess the safety and effectiveness of UAE in the management of endometriosis-related symptoms.

Methods Six-patient prospective single-arm pilot study in female, premenopausal patients over 40 years with symptoms of endometriosis. Institutional review board approval was obtained.

Inclusion criteria include completed family, premenopausal, pelvic endometriosis as confirmed by laparoscopy within the last 5 years, and symptoms of endometriosis impacting quality of life as evidenced by the British Society of Gynaecological Endoscopy pelvic pain and Short Form-36 questionnaires.

Results The primary endpoint will be safety, as assessed by the composite number of procedural and postprocedural complications during procedure, predischarge, and at 6 weeks, 3 months, 6 months, and 12 months. Secondary endpoints will include technical success, clinical success, and durability.

Discussion This study will be a novel application of UAE in the setting of endometriosis and has the potential to improve patient quality of life. This pilot study will assess safety and allow the investigators to design a prospective randomized controlled study.

Ethical Approval

Ethical approval is not required for publication of this study protocol, however, approval was obtained for the described study by The Alfred Human Research and Ethics Committee.


Informed Consent

Informed consent is not required for publication of this study protocol, however, informed written consent will be obtained for individual participants in the study.


Consent for Publication

Consent is not required for publication of this study protocol, however, written consent will be obtained for individual participants in the study including consent for publication.


Clinical Registration

WHO approved clinical trials registry: Australian New Zealand Clinical Trials Register, approval number ACTRN12622001301752, approval date 07/10/2022.




Publication History

Article published online:
10 May 2023

© 2023. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 de Bruijn AM, Ankum WM, Reekers JA. et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol 2016; 215 (06) 745.e1-745.e12
  • 2 Clements W, Moriarty HK, Koukounaras J, Joseph T, Phan T, Goh GS. The cost to perform uterine fibroid embolisation in the Australian public hospital system. J Med Imaging Radiat Oncol 2020; 64 (01) 18-22
  • 3 Ma J, Brown B, Liang E. Long-term durability of uterine artery embolisation for treatment of symptomatic adenomyosis. Aust N Z J Obstet Gynaecol 2021; 61 (02) 290-296
  • 4 Sandström A, Bixo M, Johansson M, Bäckström T, Turkmen S. Effect of hysterectomy on pain in women with endometriosis: a population-based registry study. BJOG 2020; 127 (13) 1628-1635
  • 5 Ruff M, Abbott J. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Endometriosis clinical practice guideline [internet]. Accessed December 29, 2022 at: https://ranzcog.edu.au/resources/endometriosis-clinical-practice-guideline/
  • 6 Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 2014; 10 (05) 261-275
  • 7 Chalermchockchareonkit A, Tekasakul P, Chaisilwattana P, Sirimai K, Wahab N. Laparoscopic hysterectomy versus abdominal hysterectomy for severe pelvic endometriosis. Int J Gynaecol Obstet 2012; 116 (02) 109-111
  • 8 MacDonald SR, Klock SC, Milad MP. Long-term outcome of nonconservative surgery (hysterectomy) for endometriosis-associated pain in women <30 years old. Am J Obstet Gynecol 1999; 180 (6 Pt 1): 1360-1363
  • 9 Varol N, Healey M, Tang P, Sheehan P, Maher P, Hill D. Ten-year review of hysterectomy morbidity and mortality: can we change direction?. Aust N Z J Obstet Gynaecol 2001; 41 (03) 295-302
  • 10 Poorthuis MHF, Yao P, Chen Y. et al; China Kadoorie Biobank Collaborative Group. Risks of stroke and heart disease following hysterectomy and oophorectomy in Chinese premenopausal women. Stroke 2022; 53 (10) 3064-3071
  • 11 Kiran A, Hilton P, Cromwell DA. The risk of ureteric injury associated with hysterectomy: a 10-year retrospective cohort study. BJOG 2016; 123 (07) 1184-1191
  • 12 Chan AW, Tetzlaff JM, Altman DG. et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 2013; 158 (03) 200-207
  • 13 Liang E, Brown B, Rachinsky M. Clinical efficacy of uterine artery embolization using PVA form particles to treat symptomatic adenomyosis. J Vasc Interv Radiol 2016; 27 (03) S202
  • 14 Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. CIRSE quality assurance document and standards for classification of complications: the CIRSE classification system. Cardiovasc Intervent Radiol 2017; 40 (08) 1141-1146