Recanalization and particle exclusion after embolization of uterine arteries in sheep: a long-term study
Received 20 August 2007; received in revised form 5 December 2007; accepted 5 December 2007. published online 05 March 2008.
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.
aDepartment of Interventional Neuroradiology, AP-HP, Lariboisière Hospital, Paris, France
bCenter for Research of Interventional Imaging (CR2i), AP-HP, INRA, Paris, France
cDepartment of Pathology, AP-HP, Lariboisière Hospital, Paris, France
dUnit of Physiology of Reproduction, INRA, Paris, France
eBiomaterials and Polymers, CNRS UMR 8612, Paris, France
fDepartment of Radiology and Interventional Imaging, AP-HP, Ambroise Paré Hospital, Paris, France
Reprint requests: Alexandre Laurent, M.D., Ph.D., APHP - Hopital Lariboisiere, Department of Interventional Neuroradiology, 3 rue A. Pare, F-75010 Paris, France (FAX: 33-1-49-95-83-56).
A.L. and M.W. contributed equally to the work, and therefore should both be considered first authors.
A.L. and M.W. are the inventors of TGMS, the patent of which assignee is Assistance Publique Hôpitaux de Paris (APHP). J.N. has nothing to disclose. J.M. has nothing to disclose. D.L. has nothing to disclose. J.-P.P. has nothing to disclose.
Presented at the Cardiovascular and Interventional Society of Europe (CIRSE), Antalya, Turkey, September 20–24, 2003.
ABSTRACT