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

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 μm nonspherical polyvinyl alcohol (PVA) particles or with 700–900 μm 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.

Key Words: Embolization, uterine artery, fertility, animal model, foreign body reaction, vessel remodeling