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Prediction of the likelihood of fibroid expulsion after uterine fibroid embolization (UFE)
SCIENTIFIC SESSIONS: MONDAY
Scientific Session 11 Arterial Embolization: UFE Monday, March 6, 2017 3:00 PM – 4:30 PM Room: 143B
MONDAY: Scientific Sessions
3:00 PM
3:09 PM
Abstract No. 101
Outcomes of abdominal myomectomy vs uterine fibroid embolization in morbidly obese women S. Reddy1, C. McGinn2, S. Butts2, G. Nadolski3, S. Trerotola4, S. Stavropoulos5, R. Shlansky-Goldberg6; 1 Main Line Health System, Bala Cynwyd, PA; 2 University of Pennsylvania, Philadelphia, PA; 3N/A, Wynnewood, PA; 4University of Pennsylvania Medical Center, Philadelphia, PA; 5N/A, Bryn Mawr, PA; 6 University of Pennsylvania. Medical Center, Philadelphia, PA
Abstract No. 100
Prediction of the likelihood of fibroid expulsion after uterine fibroid embolization (UFE)
C. Han1, T. Caridi2, J. Spies2; 1Georgetown University, Washington, DC; 2MedStar Georgetown University Hospital, Washington, DC Purpose: To determine if expulsion of fibroids after UFE can be predicted. Materials: This was a retrospective review of UFE patients treated between 2011 and 2014 and included pre and post procedure records and related medical and surgical records for fibroid expulsion events. In 200 patients, a prediction of the likelihood of expulsion was estimated at the time of initial consultation, provided in percentage risk of expulsion and based on the size of the fibroid and the degree to which it interfaced with the endometrial cavity. Larger fibroids with a large endometrial interface were rated as most likely to have fibroid passage. Demographic data and outcomes were analyzed with descriptive statistics. Analysis of predicted versus actual expulsion used chi square analysis and Fischer's exact test. Results: A total of 230 patients with uterine fibroids who underwent uterine embolization were reviewed for whether fibroid passage occurred or not. Among these patients, 19 (8.23%) had a fibroid pass, while 3 (1.30%) had possible passage. Of these 22 patients, 11 (50%) required no intervention other than phone consultation, 5 (23%) were prescribed medication alone, 2 (9%) visited the IR office, 3 (14%) visited a GYN office, 4 (18%) visited the ER, 1 (4%) had a hospital admission greater than 48 hours, 1 (4%) had a D&C to remove the remaining fibroids, and 2 (9%) had a hysterectomy. For those with a prediction of the likelihood of fibroid expulsion, there was a significant association between the risk score and actual fibroid passage, suggesting that these factors are predictive, with the odds of actual passage 3.87 times higher for a risk score of 15-30% than for a score of o 15%. Conclusions: Fibroid expulsion can be predicted using a combination of fibroid and endometrial interface characteristics. This may be useful in counseling patients at the time of consultation.
Purpose: To determine the safety and efficacy of uterine fibroid embolization (UFE) and myomectomy in morbidly obese patients. Materials: UFEs (N ¼ 45) and myomectomies (N ¼ 45) performed in morbidly obese (BMI Z40 or Z 35 with obesityrelated conditions) women between January 2007 and January 2013 were identified at a single center. Retrospective chart review was performed to assess post-procedure complications, symptom response, length of hospital stay, and need for repeat intervention over the follow up period (median 37 months, range 0.5 -102 months). Results: Median age of patients in the UFE cohort and the myomectomy cohort was 45 and 37, respectively (P ¼ 0.01). Median BMI in both groups was 41 (range 35-67). Median length of hospital stay was 1 day (range 0-2) in the UFE cohort and 2 days (range 0-7) in the myomectomy cohort (Po0.01). The mean number of fibroids in the UFE group (5) was significantly higher than that in the myomectomy group (3.5) (P ¼ 0.03). There were 4 total complications (1 minor and 3 major) observed in 4 patients (8.9%) in the UFE group and 10 total complications (4 minor and 6 major) observed in 9 patients (20%) in the myomectomy group (P ¼ 0.23). Major complications in the UFE group were fever with vaginal discharge (N ¼ 2) and common femoral artery pseudo aneurysm (N ¼ 1). Major complications in the myomectomy cohort included wound dehiscence (N ¼ 1), pulmonary embolism (N ¼ 1), bacteremia (N ¼ 1), fever (N ¼ 1) and post-operative anemia requiring transfusion (N ¼ 2). There was no difference in symptom response between the two groups. Six patients (13%) in the UFE cohort and three patients (7%) in the myomectomy cohort underwent additional interventions or surgeries during the study period (P ¼ 0.48). Conclusions: UFE is safe and effective for treatment of symptomatic fibroids in morbidly obese patients. Risk of major complications after UFE and myomectomy is low and similar, but this may be biased by the myomectomy cohort being younger and having fewer fibroids compared with the UFE cohort. Symptom response and need for additional procedures is similar with either intervention in the morbidly obese population.
Scientific Session 11 Arterial Embolization: UFE Monday, March 6, 2017 3:00 PM – 4:30 PM Room: 143B
MONDAY: Scientific Sessions
3:00 PM
3:09 PM
Abstract No. 101
Outcomes of abdominal myomectomy vs uterine fibroid embolization in morbidly obese women S. Reddy1, C. McGinn2, S. Butts2, G. Nadolski3, S. Trerotola4, S. Stavropoulos5, R. Shlansky-Goldberg6; 1 Main Line Health System, Bala Cynwyd, PA; 2 University of Pennsylvania, Philadelphia, PA; 3N/A, Wynnewood, PA; 4University of Pennsylvania Medical Center, Philadelphia, PA; 5N/A, Bryn Mawr, PA; 6 University of Pennsylvania. Medical Center, Philadelphia, PA
Abstract No. 100
Prediction of the likelihood of fibroid expulsion after uterine fibroid embolization (UFE)
C. Han1, T. Caridi2, J. Spies2; 1Georgetown University, Washington, DC; 2MedStar Georgetown University Hospital, Washington, DC Purpose: To determine if expulsion of fibroids after UFE can be predicted. Materials: This was a retrospective review of UFE patients treated between 2011 and 2014 and included pre and post procedure records and related medical and surgical records for fibroid expulsion events. In 200 patients, a prediction of the likelihood of expulsion was estimated at the time of initial consultation, provided in percentage risk of expulsion and based on the size of the fibroid and the degree to which it interfaced with the endometrial cavity. Larger fibroids with a large endometrial interface were rated as most likely to have fibroid passage. Demographic data and outcomes were analyzed with descriptive statistics. Analysis of predicted versus actual expulsion used chi square analysis and Fischer's exact test. Results: A total of 230 patients with uterine fibroids who underwent uterine embolization were reviewed for whether fibroid passage occurred or not. Among these patients, 19 (8.23%) had a fibroid pass, while 3 (1.30%) had possible passage. Of these 22 patients, 11 (50%) required no intervention other than phone consultation, 5 (23%) were prescribed medication alone, 2 (9%) visited the IR office, 3 (14%) visited a GYN office, 4 (18%) visited the ER, 1 (4%) had a hospital admission greater than 48 hours, 1 (4%) had a D&C to remove the remaining fibroids, and 2 (9%) had a hysterectomy. For those with a prediction of the likelihood of fibroid expulsion, there was a significant association between the risk score and actual fibroid passage, suggesting that these factors are predictive, with the odds of actual passage 3.87 times higher for a risk score of 15-30% than for a score of o 15%. Conclusions: Fibroid expulsion can be predicted using a combination of fibroid and endometrial interface characteristics. This may be useful in counseling patients at the time of consultation.
Purpose: To determine the safety and efficacy of uterine fibroid embolization (UFE) and myomectomy in morbidly obese patients. Materials: UFEs (N ¼ 45) and myomectomies (N ¼ 45) performed in morbidly obese (BMI Z40 or Z 35 with obesityrelated conditions) women between January 2007 and January 2013 were identified at a single center. Retrospective chart review was performed to assess post-procedure complications, symptom response, length of hospital stay, and need for repeat intervention over the follow up period (median 37 months, range 0.5 -102 months). Results: Median age of patients in the UFE cohort and the myomectomy cohort was 45 and 37, respectively (P ¼ 0.01). Median BMI in both groups was 41 (range 35-67). Median length of hospital stay was 1 day (range 0-2) in the UFE cohort and 2 days (range 0-7) in the myomectomy cohort (Po0.01). The mean number of fibroids in the UFE group (5) was significantly higher than that in the myomectomy group (3.5) (P ¼ 0.03). There were 4 total complications (1 minor and 3 major) observed in 4 patients (8.9%) in the UFE group and 10 total complications (4 minor and 6 major) observed in 9 patients (20%) in the myomectomy group (P ¼ 0.23). Major complications in the UFE group were fever with vaginal discharge (N ¼ 2) and common femoral artery pseudo aneurysm (N ¼ 1). Major complications in the myomectomy cohort included wound dehiscence (N ¼ 1), pulmonary embolism (N ¼ 1), bacteremia (N ¼ 1), fever (N ¼ 1) and post-operative anemia requiring transfusion (N ¼ 2). There was no difference in symptom response between the two groups. Six patients (13%) in the UFE cohort and three patients (7%) in the myomectomy cohort underwent additional interventions or surgeries during the study period (P ¼ 0.48). Conclusions: UFE is safe and effective for treatment of symptomatic fibroids in morbidly obese patients. Risk of major complications after UFE and myomectomy is low and similar, but this may be biased by the myomectomy cohort being younger and having fewer fibroids compared with the UFE cohort. Symptom response and need for additional procedures is similar with either intervention in the morbidly obese population.