Myoma necrosis following Gelfoam embolization of uterine myomata.

The aim of this study was to assess the risk and clinical significance of purulent necrosis following Gelfoam uterine artery embolization in the minimally invasive management of uterine leiomyomata. This study compares the incidence of purulent necrosis in leiomyomata affecting women who underwent Gelfoam embolization with those who had embolization with traditional particles. From January 20 to May 26, 2005, 54 patients were embolized for symptomatic fibroids. Forty-three were embolized with traditional particles, 11 with Gelfoam alone. Of the Gelfoam group, four women suffered purulent necrosis of leiomyomata, whereas in the traditional particle group, only one patient experienced this complication (p = 0.005). The women in the Gelfoam group were generally younger than those in the particle group (p = 0.00014). The average gravida and parity of the Gelfoam group were less than for the particle group--(p = 0.221) and (p = 0.041), respectively. The total uterine volume was similar for both groups. Within the Gelfoam 50% shaded block group there was no significant difference in fertility, age, total uterine volume, largest fibroid size, or number of pledglets used (P > 0.05) when comparing women with and without purulent necrosis. The average time from embolization to onset of symptomatic purulent necrosis was 11 days. All four patients with purulent necrosis of leiomyomata were successfully treated with myomectomy (three abdominal, one vaginal). Notwithstanding the small numbers in the series, patients embolized with Gelfoam appear to be at higher risk for development of post-embolization purulent necrosis of leiomyomata than patients who are embolized with traditional particles.