Analysis of Related Influencing Factors of Hysterectomy in Patients With Placenta Accreta Spectrum Disorders After Uterine Artery Embolization

Objective: To estimate the related factors of hysterectomy in patients with Placenta accreta spectrum (PAS) after uterine artery embolization (UAE), and try to evaluate the effectiveness and safety of UAE in patients with PAS.Methods: From January 2012 to July 2020, a retrospective analysis was performed in 85 patients undergoing TAE for PAS. Information regarding clinical data, angiography as well as embolization details, and clinical outcomes was obtained. Univariate and multivariate analyses were performed to determine the factors related to hysterectomy.Results: Bleeding greater than or equal to 500ml during the delivery(p = 0.037), the placenta type by MR or US(placenta increta vs placenta percreta, P = 0.01) and the type of ovarian artery(No vs Bilateral, P = 0.005; Unilateral vs Bilateral, P = 0.01) were independent risk factors of hysterectomy in PAS patients treated with UAE. The area under the curve (AUC) of the predictive model that incorporated the independent risk factors was 0.844. Abnormal collateral vessels communicating with uterine artery were observed on angiography in 24 patients (28.2%) with 31 abnormal collateral vessels. The major abnormal collateral vessel was the abnormal branches of the internal iliac artery(n = 13), followed by the inferior vesical artery (n = 11), internal pudendal artery(n = 3), obturator artery (n = 2), vaginal artery(n = 1) and the abnormal branches of the external iliac artery(n = 1).Conclusions: TAE is safe and effective for patients with PAS. Bleeding greater than or equal to 500ml during the delivery, the placenta type by MR or US and the type of ovarian artery were related to the hysterectomy. For patients with hypertrophic ovarian-uterine artery anastomosis and no fertility requirements, Ovarian artery embolization(OAE) could be a feasible choice.