A rare but potential complication of UAE is diffuse uterine 终止necrosis. The reported prevalence is less than 1% and even less prevalent if the patient has intact normal pelvic collateral circulation. It is rare because occlusion of the uterine arteries is usually not complete and terminated once the fibroid blood supply is occluded. Uterine perfusion is also supplemented by collateral flow from ovarian, round ligament, cervical, and other pelvic vessels. Uterine necrosis has been associated with intrauterine abscess formation. Patients with abscess present with pelvic pain, vaginal discharge, fever, or leukocytosis. Hysterectomy is often required for treatment.64 Two of the deaths reported in the first 30 days after UAE were due to uterine infection.54,55
Deep vein thrombosis after UAE has a reported prevalence of less than 1%.65 This may be related to compression on large draining pelvic veins by the uterus. Resultant venous stasis leads to thrombus formation. Color Doppler sonography is the first-line modality for imaging patients with suspicion of deep vein thrombosis. The presence of thrombus within the venous lumen limits compressibility, is hypo- to hyperechoic, and may expand the vein. The spectral waveform may be dampened. Isolated reports of pulmonaryembolism after UAE are in the literature with at least 1 resulting in death.56 Both entities are treated with anticoagulation therapy.
Loss of ovarian function has been associated with UAE in up to 14 % of patients. It seems related to patient age with a higher risk in those over 45 years old.66,67 This is thought to be related to fewer remaining oocytes at this age, which are especially vulnerable to ischemia. As embolic particles are injected into a uterine artery, the particles can migrate through anastomotic channels into the ovarian arterial vasculature, compromising ovarian perfusion.68
Continued growth of presumed fibroids after a technically successful embolization procedure may indicate the presence of an underlying malignancy. In this case, more definitive therapy is indicated. At least 4 cases have been reported of leiomyosarcoma discovered after UAE.53,69–71 There are currently no published US imaging criteria to reliably distinguish sarcomatous degeneration from other types of degeneration. MRI may be helpful to distinguish fibroids from uterine sarcoma; however, there are few published data to support this.72