In uterine artery embolisation (UAE) for symptomatic fibroids, the target of embolisation is the uterine arteries. Which embolic agent size is MOST appropriate to achieve fibroid infarction without compromising the uterine myometrium?

• A Very small particles (50–100 microns) to reach terminal arterioles
• B Coils placed in the main uterine artery trunk only
• C 500–900 micron particles (trisacryl gelatin microspheres or PVA) targeting fibroid-specific vessels ✓
• D Absolute alcohol (ethanol) for chemical ablation

Explanation

UAE uses calibrated microspheres or polyvinyl alcohol (PVA) particles of 500–900 microns to achieve distal occlusion within the fibroid vasculature (which consists of hypertrophied perforating arteries). This size selectively targets fibroid perfusion while sparing the normal myometrium (which has a more abundant dual vascular supply from ovarian collaterals). Particles that are too small risk non-target embolisation of ovarian or vaginal vessels. Proximal coil occlusion of the main trunk is inadequate and prevents re-treatment.

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

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