Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.
Helios Park-Klinikum Leipzig, Leipzig, Germany.
Clin Hemorheol Microcirc. 2024;88(s1):S69-S84. doi: 10.3233/CH-248106.
In uterine artery embolization (UAE) for the treatment of fibroids, nondegradable particles permanently occlude the uterine artery (UA). These particles remain in the vessels and can cause secondary undesirable effects, such as severe pain after embolization and fertility issues. In this prospective experimental study, we aimed to evaluate the angiographic recanalization, local and systemic reactions, and uterine damage occurring after performing UAE with newly developed degradable starch microspheres (DSMs) in sheep.
Under general anesthesia, eight nonpregnant sheep underwent bilateral UAE using DSMs to achieve stasis. Angiographic evaluation was performed on days 1, 3 and 7 after embolization to assess in vivo recanalization. In addition, the angiographic series were scored via a modified embolization score. A postmortem tissue examination was performed to determine whether DSMs and foreign body inflammatory reactions were present and to assess uterine necrosis.
Complete bilateral embolization of the UA and cervicovaginal branches was achieved in all treated animals. Recanalization of the occluded arteries was evident in 25 of 27 arteries during the angiographic evaluation. In all sheep, there were multifocal areas of uterine necrosis, and some uterine vessels contained intraluminal material consistent with DSMs. The average weight of both uterine horns was significantly correlated with both the number of microspheres needed for complete embolization (r = 0.69, ρ<0.01) and the average percentage of necrosis in both uterine horns (r = 0.64, ρ<0.05).
Our findings demonstrated the efficacy of vascular embolization with DSM by inducing ischemic changes in the uterus and subsequent recanalization of previously occluded arteries.
在子宫动脉栓塞术（UAE）治疗子宫肌瘤中，不可降解颗粒永久性地闭塞子宫动脉（UA）。这些颗粒会留在血管中，引起继发性不良影响，如栓塞后严重疼痛和生育问题。在这项前瞻性实验研究中，我们旨在评估在绵羊中使用新开发的可降解淀粉微球（DSMs）进行 UAE 后的血管再通、局部和全身反应以及子宫损伤。
在全身麻醉下，8 只非妊娠绵羊进行双侧 UAE，使用 DSM 实现停滞。栓塞后第 1、3 和 7 天进行血管造影评估，以评估体内再通情况。此外，通过改良的栓塞评分对血管造影系列进行评分。进行尸检组织检查以确定是否存在 DSM 和异物炎症反应，并评估子宫坏死情况。
所有治疗动物的 UA 和宫颈阴道分支均实现了完全双侧栓塞。在血管造影评估中，27 条闭塞动脉中有 25 条显示再通。所有绵羊均有子宫坏死的多灶性区域，一些子宫血管内含有与 DSM 一致的管腔内物质。双侧子宫角的平均重量与完全栓塞所需的微球数量（r=0.69，ρ<0.01）和双侧子宫角的平均坏死百分比（r=0.64，ρ<0.05）呈显著正相关。
我们的研究结果表明，通过在子宫中引起缺血性变化并随后再通先前闭塞的动脉，DSMs 血管栓塞可有效诱导子宫动脉栓塞。
