UAE success increases with experience

Experienced physicians perform uterine artery embolizations in a timelier manner than their inexperienced counterparts, according to results from one of the largest studies delving into the safety of UAE.

Investigators in the Ontario Uterine Fibroid Embolization Trial reported high levels of success and few complications for the procedure in a variety of clinical settings. But they also found that increased experience in performing UAE reduced procedure and fluoroscopy time significantly.

Led by Gaylene Pron, Ph.D., an assistant professor at the University of Toronto, researchers performed a multicenter prospective single-arm clinical trial. It included the practices of 11 interventional radiologists at eight university-affiliated teaching and community hospitals. The study was published in the May issue of the Journal of Vascular Interventional Radiology.

The embolization procedure included vascular access with percutaneous femoral artery approach and was followed by transcatheter delivery of polyvinyl alcohol particles into uterine arteries with fluoroscopic guidance.

Pron and colleagues found that the complication rate for 570 embolization procedures performed in 555 patients was 5.3%. While procedure time averaged 61 minutes and fluoroscopy time 18.9 minutes, these times dropped 27% and 24%, respectively, with increasing UAE experience.

The effect of physician experience could have important implications on discussions regarding which physicians are better suited to perform the procedure. In an article published in the March 2003 issue of Clinical Obstetrics and Gynecology, Dr. Bruce McLucas, an associate professor of ob/gyn at the University of California, Los Angeles, called for the credentialing of ob/gyns for the procedure, citing their familiarity with this portion of the female anatomy.

Some interventional radiologists do not agree with McLucas's assessment.

"Interventional radiologists are the only physicians who have specific training in angiographic interventions, particularly embolotherapy. It is also all that they do, so all of their time is dedicated to maintaining those specific skills," said Dr. Robert L. Worthington-Kirsch, president of Image Guided Surgery Associates, a private medical practice specializing in interventional radiology and image-guided surgery in suburban Philadelphia.

Kirsch went on to say that the issue should focus not on what type of physician does the procedure, but rather on the standards for training and practice.

"The Society of Interventional Radiology has published a training standard for UAE. Any physician - IR, gynecologist, dermatologist - who fulfils that training standard should be well enough trained to evaluate and treat patients with fibroid disease by UAE," he said.

For more information from the Diagnostic Imaging online archives:

? Uterine fibroid embolization takes on new challenges
http://www.dimag.com/db_area/archives/2003/0308.news7.di.shtml

? Younger women discover UFE for fibroid reduction
http://www.dimag.com/db_area/archives/europe/2003/0306.imagingnews6.die.shtml