Clinical, Imaging and Procedural Risk Factors for Intrauterine Infective Complications After Uterine Fibroid Embolisatio
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CLINICAL INVESTIGATION
EMBOLISATION (ARTERIAL)
Clinical, Imaging and Procedural Risk Factors for Intrauterine Infective Complications After Uterine Fibroid Embolisation: A Retrospective Case Control Study Josephine Mollier1 • Neeral R. Patel2 • Alison Amoah3 • Mohamad Hamady4 Stephen D. Quinn3
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Received: 23 April 2020 / Accepted: 5 August 2020 The Author(s) 2020
Abstract Introduction This was a retrospective case–control study at a single tertiary centre investigating all UFE procedures between January 2013 and December 2018 for symptomatic fibroids. The aim was to determine the clinical, imaging and procedural risk factors which impact upon the risk of post-uterine fibroid embolisation (UFE) intrauterine infection. Cases were patients which developed intrauterine infection post-procedure, and controls were the background UFE population without infection. Methods Clinical demographics, presenting symptoms, uterine and fibroid characteristics on imaging and procedural variants were analysed. A p value of less than 0.05 was considered statistically significant. The main outcome measures were presence of infection and requirement of emergency hysterectomy. Results 333 technically successful UFE procedures were performed in 330 patients. Infection occurred after 25 procedures (7.5%). 3 of these patients progressed to overwhelming sepsis and required emergency hysterectomy.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00270-020-02622-2) contains supplementary material, which is available to authorised users. & Josephine Mollier [email protected] 1
Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UK
2
Radiology department, Imperial College Healthcare NHS Trust, London, UK
3
Obstetrics and Gynaecology Department, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
4
Radiology department, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
Clinical obesity (BMI [ 30) (OR 1.53 [1.18–1.99]) and uterine volume [ 1000cm3 (2.94 [1.15–7.54]) were found to increase the risk of infection Conclusions UFE is generally safe in patients with symptomatic fibroids. Obese patients (BMI [ 30) and those with large volume uteri ([ 1000cm3) are at slight increased risk of developing infection and require appropriate pre-procedural counselling, as well as careful postUFE follow-up. BMI and uterine volume may be useful to assess before the procedure to help to determine post-UFE infection risk. Keywords Fibroids Uterine fibroid embolisation Infection Endometritis
Introduction Uterine fibroid embolisation (UFE) is a minimally invasive treatment for women with symptomatic fibroids. The procedure has comparable efficacy to surgical myomectomy and hysterectomy in large randomised control trials, with the added benefits of shorter hospital stay as well as the elimination of surgery and anaesthesia-related risks [1–3]. Patient satisfaction rates for UFE are also high, with enhanced mid and long-term quality of life improveme
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