Utility of nonselective abdominal aortography in demonstrating ovarian artery collaterals in patients undergoing uterine artery embolization for fibroids

PURPOSE: To review the incidence of ovarian collateral supply to uterine fi broids as demonstrated by nonselective abdominal aortography before uterine artery embolization (UAE) and to evaluate the effect of such visualization on interventional management. MATERIALS AND METHODS: The aortograms of 51 consecutive patients (mean age, 42.4 y; range, 30-53 y) undergoing UAE for symptomatic uterine fibroids we re reviewed retrospectively for the visualization of ovarian arteries exten ding into the pelvis. If ovarian arteries were visualized, their size relat ive to the ipsilateral external iliac artery was measured. Arteries believe d large enough to represent a significant blood supply to the uterine fibro ids were further evaluated after UAE to determine whether flow persisted. RESULTS: In 13 of 51 patients (25%), a total of 18 ovarian arteries were id entified. They were bilateral in five patients and unilateral in eight. The ir sizes relative to the ipsilateral external iliac artery ranged from 8% t o 57% (mean, 26%). Eight ovarian arteries with a relative size greater than or equal to 25% were further evaluated. Five of the eight (62.5%) were not visible after UAE. Of the three persistent ovarian collateral arteries, tw o were successfully embolized. The patient with the untreated collateral ar tery experienced persistent menorrhagia. CONCLUSION: Preembolization aortography with the catheter tip at level of t he renal arteries demonstrated ovarian collateral arteries in 25% of patien ts with uterine fibroids. However, their detection influenced treatment in only 6% of the reported cases.