Computed tomography angiogram for failed uterine artery embolization

It was the aim of this study to discuss the efficacy of computed tomography angiograpy after failed uterine artery embolization. We performed a review of cases where embolization of myomata failed to relieve symptoms, or shrink myomata. If MRI showed continued uptake, patients were offered CT angiograms to better direct therapy. Repeat embolization details were compared with findings on CT angiogram. During the study, 675 patients underwent uterine artery embolization. 229 patients underwent follow-up MRI with intravenous contrast, 29 of which showed persistent uptake into myomata. Twelve patients had CT angiogram of the abdomen following MRI and six elected to undergo repeat UAE after CT angiogram. There was a 75% concurrence between CT angiograms and live studies (angiogram during repeat uterine artery embolization). With CTA, five patients showed a unilateral non-uterine blood supply, one showed a bilateral non-gonadal supply to the uterus, and two showed a normal blood supply, with all but two cases confirmed on live angiogram. Based on post-repeat MRI, one of the six repeat UAE patients shows no continued uptake of intravenous contrast to myomata. Four show continued uptake, however, one patient did show decreased size of myomata. CT angiography is a valuable tool to identify collateral and persistent uterine artery supply, and offers great potential for accurate identification and evaluation of extra-gonadal supply to the uterus. It will allow for pre-operative planning, as well as discussion of risks and benefits with patients.