Angiographic Detection of Utero-Ovarian Anastomosis and Influence on Ovarian Function After Uterine Artery Embolization

Purpose To assess the detectability and frequency of the different types of utero-ovarian anastomosis, the correlation between type of anastomosis and ovarian failure after UAE, as well as the impact of coiling as a strategy for the prevention of ovarian failure. Materials and Methods We retrospectively studied a population of 92 women treated with uterine artery embolization at our institution between 2007 and 2017. Utero-ovarian anastomoses were categorized on angiographic sequences by two radiologists based on the classification published by Razavi et al. (Radiology 224(3):707–712, 2002 ), and Cohen’s kappa was calculated. Ovarian failure was defined as an increase in serum FSH above 27 mIU/ml three months after embolization. Results Out of a total of 184 anastomoses, 27% were classified as type Ia, 45% as type Ib, 1% as type II and 24% as type III. Three percent of anastomoses could not be determined. There was very good inter-observer reliability on the classification of utero-ovarian anastomoses ( κ = 0.847). Ovarian failure occurred in six out of 92 women (7%). Each had at least one type Ib ( n = 4) or type III ( n = 1) anastomosis, with the exception of one patient in whom the type of anastomosis could not be determined. All women presenting with ovarian failure were 45 years of age or older. No patient with protective coiling developed ovarian failure. Conclusion Utero-ovarian anastomoses are more common than previously expected and can be reliably classified with very good inter-observer reliability. Patients with type Ib and type III anastomoses carry the risk of ovarian failure after uterine artery embolization. Protective coiling seems to be an adequate strategy for avoiding ovarian failure in those types of anastomoses.