Ovarian Artery–to–Uterine Artery Anastomoses

Understanding Ovarian Artery-to-Uterine Artery Anastomoses plays a pivotal role when planning for uterine artery embolization.  We examine how the presence and nature of these anastomoses, particularly the subtype Ib, III impact the efficacy of UAE, shaping both procedural strategy and potential complications. Here we aims to provide a detailed exploration of the anatomic and physiological factors underpinning these vascular connections, their identification during angiography, and their implications in the context of UAE. This analysis is instrumental for interventional radiologists in optimizing treatment plans and mitigating risks, ensuring a comprehensive approach to fibroid management through UAE.

 
AspectDetails
Ovarian Artery Role1. Identified as a key source of collateral flow and potential cause of UAE failure.
2. Ovarian artery embolisation is also a consideration in conjunction with UAE.
Anastomosis Patterns1. Type I: Ovarian artery supplies fibroids via connections to intramural uterine artery. Uterine artery embolisation typically blocks flow distal to anastomosis point.
- Subtype Ia indicated by sufficient tubal artery flow, preventing ovarian artery reflux.
- SubType Ib: Low flow in tubal artery allows reflux into ovarian artery during UAE. At the end of contrast injection (in uterine artery) the flow of contrast in tubo-ovarian artery is towards uterus.
2. Type II: Direct ovarian artery feeding to fibroids, indicating a higher likelihood of UAE failure.
3. Type III: Ovarian supply appears to originate from the uterine artery. At the end of contrast injection (in uterine artery) the flow of contrast in tubo-ovarian artery is away from uterus.
Clinical Implications of Anastomosis Types1. Type I and Ib: Lower risk of ovarian embolisation during UAE. Needs to be careful during embolisation of Type Ib.
2. Type II: Higher risk of UAE failure, may require ovarian artery embolisation.
3. Type III: High likelihood of ovarian embolisation during UAE.
Risk of Premature MenopauseLinked to non-target embolisation of ovaries, particularly in patients with bilateral types Ib and III anastomoses.
Clinical Importance of Identifying Anastomoses1. Aids in avoiding non-target ovarian embolisation,
2. Determining risk of clinical failure, and
3. Identifying candidates for ovarian artery embolisation.
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