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Objectives: Digital subtraction angiography (DSA) is the standard imaging method for hypogastric artery (HA) and uterine artery (UA) embolization, but multiple views are frequently required to demonstrate the origin of the target artery, which increases radiation, contrast volume, and procedure time. The purpose of this study was to assess the accuracy and utility of three-dimensional rotational angiography (3D-RA) to select optimal projections and to guide embolization.
Methods: In a series of 30 pelvic (5 HA and 25 UA) embolizations performed over an 18-month period, 3D-RA using a Philips Allura Xper FD20 system was obtained. 3D-RA was used to select the optimal working projection, which automatically synchronized the position of the C-arm. DSA was obtained to confirm the adequacy of the projection and to produce a road map for embolization.
Results: The sensitivity and specificity of 3D-RA were 96% and 86% to determine optimal projection for embolization. The operative technique for embolization was altered based on 3D-RA in 10 patients (40%); specifically, different guiding microcatheters or hydrophilic wires were used in 6 patients (25%). Based on 3D-RA findings, target artery characteristics could be determined with excellent reliability (kappa= 0.81; 95% CI, 0.57-1.06). Patients undergoing HA and UA embolization based on 3D-RA had 100% technical success and no 30-day morbidity or mortality.
Conclusions: 3D-RA is accurate in determining the best projection that demonstrates the origin of the hypogastric and uterine arteries and may alter the plan for embolization in 40% of patients. 3D-RA can, in fact, accurately predict imaging projections and indicate the best devices that may facilitate safe and expeditious pelvic embolizations.