Georgetown University Hospital



Physician's Resource

UAE Research at Georgetown University
– Published Papers

Since we began to perform uterine embolization in July of 1997, we have actively studied the results of this therapy. We have always completed our research studies using protocols reviewed and approved by the institutional review board of Georgetown University Medical Center. While the goals of research efforts have varied with the particular questions under study, we are continuously gathering data to present at scientific meetings or published in medical journals. We have summarized our published research papers below, along with the references for finding the original articles in the medical literature.

Transcervical expulsion of a fibroid as a result of uterine artery embolization for leiomyomata.

Authors: Abbara S, Spies JB, Scialli AR, Jha RC, Lage JM, Nikolic B.
Journal Reference: JVIR 1999; 10:409-411.

This case report was one of the first to document that submucosal fibroids (those just under the inner lining of the uterus) can be expelled through the cervix into the vagina as a result of uterine embolization. Usually this occurs spontaneously and, as with the patient reported here, it is a relatively benign event with removal of the fibroid by either a simple pelvic examination or with a minor surgical procedure, such as a D and C or hysteroscopy. The particular patient reported here has done very well in the two years since the fibroid passed.

Ovarian artery supply of uterine fibroids as a cause of treatment failure after uterine artery embolization: a case report.

Authors: Nikolic B, Spies JB, Abbara S, Goodwin SC.
Journal Reference: JVIR 1999;10:1167-1170.

This was the first report of failure of uterine embolization due to supplemental blood supply from the ovarian arteries. This represents an unusual variation in blood supply to the uterus, but may account for up to 5% of patients. The patient reported here had been treated six months earlier at another center and although she had had initial improvement, her symptoms recurred. An arteriogram revealed very large ovarian arteries that supplied the upper portion of the uterus. This blood supply prevented the fibroids from dying and shrinking.

Initial results from uterine fibroid embolization for symptomatic leiomyomata.

Authors: Spies JB, Scialli, AR, Jha RC, Imaoka I, Ascher S, Fraga VM, Barth, KH
Journal Reference: JVIR 1999;10:1149-1157.

This was the initial report of the results of the patients treated at Georgetown University. Sixty-one patients were treated, with the procedure completed successfully in sixty. Menstrual bleeding was improved in 89% and pelvic pain and pressure improved in 79%. At three months post-procedure the medican uterine volume had decreased 34% and the medican dominant fibroid volume decreased 50%. There were few complications and patient satisfaction was very high.

Measurement of health-related quality of life before and after uterine fibroid embolization for symptomatic leiomyomata.

Authors: Spies JB, Warren E, Mathias S, Walsh SM, Pentecost MJ.
Journal Reference: JVIR 1999;10:1293-1303.

The most common method of determining the results of uterine embolization is the use of simple questionnaires that ask questions about the improvement in symptoms after the procedures. This study used a broader measure of outcome, a health-related quality of life (HRQoL) questionnnaire. Not only was symptom status evaluated, but broader measures of health as well, such as general health, energy, vitality, self-image, bodily pain, physical functioning, sexual functioning, and comparative health. The use of these measures is important to ensure that the patient's overall health is improved, not just the symptoms associated with the fibroids.

This study showed a very substantial improvement in all of the symptoms and the broader health indices measured. The general health perception changed from below normal to above normal. This study provides the first evidence using a validated questionnaire that UAE is effective in improving the overall health of patients treated.

Patient radiation dose associated with uterine artery embolization for leiomyomas.

Authors: Nikolic B, Spies JB, Lundsten M.
Journal Reference: Radiology 2000;214:121-125.

This is the first study reporting the amount of X-rays needed to complete UAE. That amount is significantly more than X-rays used for diagnosis of a variety of abdominal conditions, but substantially less than the amount needed to treat cancer. The amount of X-rays needed is well below that expected to cause harm to the ovaries, future children, or the patient's own long term health.

Symptomatic fibroleiomyomata: MR imaging of the uterus before and after uterine arteral embolization.

Authors: Jha RC, Ascher SM, Imaoka I, Spies JB.
Journal Reference: Radiology 2000;217:228-235.

This study reviews the characteristics of fibroids in the uterus before and after embolization. It is the first major review of the findings associated with successful embolization. In particular, the study shows that MRI can determine whether the fibroid has infarcted (died). This is important in cases where the fibroid has had only minor size reduction. In those cases, the MRI reassures us that the procedure was technically successful and, with time, additional shrinkage should occur.

Influence of technique and equipment on absorbed ovarian dose associated with uterine embolization.

Authors: Nikolic B, Abbara S, Levy EB, Lundsten M, Spies JB
Journal Reference: J Vasc Intervent Radiol 2000;11:1173-1178.

This is a technical study to determine the relative contributions of various technical factors in the X-ray dose that occurs during UAE. The findings of this study indicate that fluoroscopy is the major contributor to the X-ray dose and that various measures can be used to reduce the dose. These include the use of pulsed fluoroscopy, minimization of the use of oblique and magnification fluoroscopy, and collimation.

Pain After Uterine Artery Embolization for Leiomyomata: can its severity be predicted and does the severity predict outcome?

Authors: Roth, AR, Spies JB. Walsh SM, Wood, BJ., Gomez-Jorge J, Levy, EB.
Journal Reference: J Vasc Interv Radiol 2000; 11:1047-1052.

This study was intended to determine whether the pain that occurs in the first 24 hours after UAE can be predicted pre-procedure. There was not any relationship with either the size of the fibroids or the uterus pre-procedure. In addition, the severity of the pain does not predict how much the uterus or fibroids will shrink after UAE nor does it predict symptom improvement.

Patient radiation dose associated with uterine artery embolization for leiomyomata: reduced dose using a refined technique.

Authors: Nikolic B, Spies JB, Campbell L, Walsh SM, Abbara S, Lundsten MJ.
Journal Reference :J Vasc Interv Radiol 2001;12:39-44.

This paper demonstrated that by using technical advances in performing UAE that were pioneered at Georgetown, the X-ray dose associated with this procedure can be reduced 60% on average over conventional techniques. While the amount of X-rays used in the procedure are unlikely to have any health effects, our goal is to have the lowest possible use of X-rays for any patient.

Ovarian function after uterine artery embolization: assessment using serum follicle-stimulating hormone assay.

Authors: Spies JB, Roth, AR, Gonsalves, SM, Murphy-Skrzyniarz, KM.
Journal Reference :J Vasc Interv Radiol 2001;12:437-442.

This is the first study published assessing the effect of uterine embolization on ovarian function. It demonstrates that among women under the age of 45, there was no evidence of any change in ovarian function. This finding is important for women who wish to have children in the future. In 15% of women over the age of 45, a change in ovarian function can be detected by hormone testing. The onset of menopause as a result of UAE is rare.

Uterine Artery Embolization for leiomyomata: resource use and cost estimation.

Authors: Subramanian S, Spies JB.
Journal Reference: J Vasc Interv Radiol 2001;12:571-574.

This is the first economic study of the cost of UAE. The average hospital cost of UAE was approximately $3100, considerably less than the reported cost of hysterectomy or myomectomy. The difference in cost was primarily due to the shorter length of stay for UAE (1 day versus 3 to 4 days)

Uterine Artery Embolization for Leiomyomata.

Authors: Spies JB, Ascher SA, Roth AR, Kim J, Levy EB, Gomez-Jorge J.
Journal Reference: Obstetrics and Gynecology 2001;98:29-34.

This paper reports on the results of UAE in the first 200 patients treated at Georgetown, with a minimum of 12 months and 21 months average follow-up. Ninety percent of patients had symptomatic improvement after treatment and the effects are durable for most patients. It is the first paper to report on symptom outcome, complications and subsequent treatments on a large group of patients with long-term follow-up. It demonstrates that UAE is both safe and effective and that the results are durable.

Initial US experience with Embospheres™ Microspheres for uterine leiomyomata

Authors: Spies JB, Benenati, JF, Worthington-Kirsch, RL.
Journal Reference: J Vasc Intervent Rad 2001;12:1059-1063

This is the first report of the use of Embospheres for UAE. These are a new embolic agent that may offer certain advantages over traditional embolics for uterine embolization. This study, which was a Phase I FDA approved multi-center study, demonstrated the effectiveness of Embospheres in embolization of uterine fibroids, with control of symptoms in the large majority of patients.

Initial experience with intra-arterial lidocaine in controlling pain after uterine artery embolization for leiomyomata.

Authors: Keyoung JA, Levy EB, Roth AR, Gomez-Jorge J, Chang TC, Spies JB.
Journal Reference: J Vasc Intervent Rad 2001;12:1065-1069.

This technical study was intended to determine if the pain after uterine embolization could be reduced by the intra-arterial lidocaine, which has been effective in other types of embolization procedures. This study was a randomized blinded study and demonstrated that the lidocaine causes severe spasm of the uterine arteries. This unexpected result suggests that the use of intra-arterial lidocaine may hinder successful completion of the embolization and therefore its use is not recommended

Uterine artery embolization for leiomyomata: factors associated with successful symptomatic and imaging outcome.

Authors: Spies JB, Roth, AR, Jha RC, Gomez-Jorge J, Levy EB, Chang TC, Ascher SA
Journal Reference: Radiology: in Press.

This extensive statistical analysis of the results of treatment in the first 200 patients to determine if baseline factors could be identified that would predict outcome from treatment. This analysis showed that smaller fibroids shrink more rapidly than larger fibroids and those deeper in the in the uterus shrink more rapidly than those on the outside of the uterus. However, though bleeding improvement improves more rapidly in deep fibroids and smaller fibroids, by one year after treatment there is no difference in symptom improvement based on any of these factors.