In uterine artery embolization (UAE) for fibroids, the endpoint of embolization is determined by:

• A Complete infarction of the uterus assessed by total absence of any uterine blush
• B Pruned-tree appearance with stasis in the main uterine artery and absence of fibroid blush ✓
• C Embolization of individual fibroid vessels until each fibroid is devascularised separately
• D Reduction of the uterine artery diameter by >50% on arteriogram

Explanation

The angiographic endpoint for UAE is the 'pruned tree' appearance — near-complete stasis or markedly reduced flow in the uterine artery with loss of the fibroid vascular blush, achieved by injecting embolic particles (typically 500-700 μm PVA or tris-acryl gelatin microspheres) until sluggish flow remains in the main uterine artery. Complete cessation is avoided to preserve normal myometrium and ovarian supply. The goal is fibroid devascularization (leading to ischemic infarction and shrinkage) while preserving normal uterine vascularity through collaterals. Full uterine infarction would preclude future pregnancy and risk uterine necrosis.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.