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. 2023 Nov;33(11):8157-8164.
doi: 10.1007/s00330-023-09794-8. Epub 2023 Jun 7.

Incidence and changes in endometrial-leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis

Yasuteru Sasakura  1 , Tetsuya Katsumori  2 , Kaori Nishizawa  2 , Tomoaki Nishimura  2 , Tatsuya Yoshikawa  3 , Akiko Takahata  3 , Kei Yamada  3
Affiliations

Incidence and changes in endometrial-leiomyoma fistula following uterine artery embolization: a single-center retrospective analysis

Yasuteru Sasakura et al. Eur Radiol. 2023 Nov.

Abstract

Objectives: To investigate whether the number and size of endometrial-leiomyoma fistulas (ELFs) change following uterine artery embolization (UAE) for leiomyoma and the correlation between ELFs and vaginal discharge (VD).

Materials & methods: This study was a retrospective analysis of 100 patients who underwent UAE at a single institution between May 2016 and March 2021. They all underwent MRI at baseline, 4 months, and 1 year after UAE. The number and size of the ELFs were compared with the MRI images each time. The ELF tumor characteristics and the correlation between the ELFs and VD were assessed. Additional gynecologic interventions due to VD associated with ELFs were evaluated.

Results: No ELF was observed at baseline. Ten ELFs were noted in nine patients at 4 months, and 35 ELFs were noted in 32 patients 1 year after UAE. The ELFs significantly increased over time (p = 0.004, baseline vs. 4 months; p < 0.001, 4 months vs. 1 year). The ELF size did not significantly change over time (p = 0.941). The tumors developing ELFs after UAE were mainly located at the submucosal or intramural area contacting the endometrium at baseline, with a mean size of 7.1 (2.6) cm. Nineteen patients (19%) had VD 1 year after UAE. There was no significant correlation between VD and the number of ELFs (p = 0.80). No patients underwent additional gynecologic interventions due to VD associated with ELFs.

Conclusion: ELFs increased in number and did not disappear over time after UAE in most tumors.

Clinical relevance statement: Despite the MR imaging findings, within the limited data of this study, ELFs were not seemingly associated with clinical symptoms, including VD.

Key points: • Endometrial-leiomyoma fistula (ELF) is a complication of uterine artery embolization (UAE). • ELFs increased in number over time after UAE and did not disappear in most tumors. • Most tumors developing ELFs after UAE were located near/contacted the endometrium and were larger.

Keywords: Endometrium; Fistula; Leiomyoma; Uterine artery embolization; Uterus.

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