Uterine Artery Embolization End Points and Collateral Circulation: Value of Intra-Procedural Non-Contrast Cone Beam CT

Main Article Content

Jaron Tepper, MD Jacob Cynamon, MD, FACR, FSIR


Uterine artery embolization (UAE) is a well-accepted treatment for symptomatic uterine fibroids, but endpoints of UAE remain controversial. This is of significant concern as incomplete embolization can lead to treatment failure, necessitating repeat embolization or alternative treatments such as hysterectomy. Multiple potential causes of UAE failure have been described including failure to catheterize one or both of the uterine arteries, uterine artery spasm, clumping of embolic material and collateral blood supply vascularizing the fibroids. In this review, we discuss potential approaches to identifying collateral blood supply to the uterus and suggest that intra-procedural non-contrast cone beam CT provides unique advantages to addressing this issue.

Article Details

How to Cite
TEPPER, Jaron; CYNAMON, Jacob. Uterine Artery Embolization End Points and Collateral Circulation: Value of Intra-Procedural Non-Contrast Cone Beam CT. Medical Research Archives, [S.l.], v. 9, n. 3, mar. 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2352>. Date accessed: 08 aug. 2022. doi: https://doi.org/10.18103/mra.v9i3.2352.
Research Articles


Goodwin SC, Spies JB, Worthington-Kirsch R, et al. Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID Registry. Obstet Gynecol. 2008;111(1):22-33. doi:10.1097/01.AOG.0000296526.71749.c9

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(6):745.e1-745.e12. doi:10.1016/j.ajog.2016.06.051

Barth MM, Spies JB. Ovarian artery embolization supplementing uterine embolization for leiomyomata. J Vasc Interv Radiol. 2003;14(9 Pt 1):1177-1182. doi:10.1097/01.rvi.0000085772.71254.cf

Kroencke TJ, Scheurig C, Poellinger A, Gronewold M, Hamm B. Uterine artery embolization for leiomyomas: percentage of infarction predicts clinical outcome. Radiology. 2010;255(3):834-841. doi:10.1148/radiol.10090977

Spies JB. Uterine artery embolization for fibroids: understanding the technical causes of failure. J Vasc Interv Radiol. 2003;14(1):11-14. doi:10.1097/01.rvi.0000052286.26939.f9

Matson M, Nicholson A, Belli AM. Anastomoses of the ovarian and uterine arteries: a potential pitfall and cause of failure of uterine embolization. Cardiovasc Intervent Radiol. 2000;23(5):393-396. doi:10.1007/s002700010090

Nikolic B, Spies JB, Abbara S, Goodwin SC. Ovarian artery supply of uterine fibroids as a cause of treatment failure after uterine artery embolization: a case report. J Vasc Interv Radiol. 1999;10(9):1167-1170. doi:10.1016/s1051-0443(99)70215-0

White AM, Banovac F, Yousefi S, Slack RS, Spies JB. Uterine fibroid embolization: the utility of aortography in detecting ovarian artery collateral supply. Radiology. 2007;244(1):291-298. doi:10.1148/radiol.2441060796

Razavi MK, Wolanske KA, Hwang GL, Sze DY, Kee ST, Dake MD. Angiographic classification of ovarian artery-to-uterine artery anastomoses: initial observations in uterine fibroid embolization. Radiology. 2002;224(3):707-712. doi:10.1148/radiol.2243011513

Saraiya PV, Chang TC, Pelage JP, Spies JB. Uterine artery replacement by the round ligament artery: an anatomic variant discovered during uterine artery embolization for leiomyomata. J Vasc Interv Radiol. 2002;13(9 Pt 1):939-941. doi:10.1016/s1051-0443(07)61779-5

Pelage JP, Cazejust J, Pluot E, et al. Uterine fibroid vascularization and clinical relevance to uterine fibroid embolization. Radiographics. 2005;25 Suppl 1:S99-S117. doi:10.1148/rg.25si055510

Korff RA, Warhit M, Jagust MB, Golowa YS, Cynamon J. The Role of Non-Contrast Cone Beam CT in Identifying Incomplete Treatment during Uterine Artery Embolization. J Vasc Interv Radiol. 2019;30(5):679-686. doi:10.1016/j.jvir.2018.11.036

Kroencke TJ, Scheurig C, Kluner C, Taupitz M, Schnorr J, Hamm B. Uterine fibroids: contrast-enhanced MR angiography to predict ovarian artery supply--initial experience. Radiology. 2006;241(1):181-189. doi:10.1148/radiol.2411051075

Lee MS, Kim MD, Lee M, et al. Contrast-enhanced MR angiography of uterine arteries for the prediction of ovarian artery embolization in 349 patients. J Vasc Interv Radiol. 2012;23(9):1174-1179. doi:10.1016/j.jvir.2012.06.015

Pelage JP, Walker WJ, Le Dref O, Rymer R. Ovarian artery: angiographic appearance, embolization and relevance to uterine fibroid embolization. Cardiovasc Intervent Radiol. 2003;26(3):227-233. doi:10.1007/s00270-002-1875-3