Comparison of Polyvinyl alcohol particles and Tris-Acryl gelatin microspheres embolic agents used in uterine artery embolization: a systematic review and meta-analysis

Objective:
To identify the preferred agent by comparing the therapeutic efficacy, degree of infarction, and side effects of Polyvinyl alcohol particles (PVA) and Tris-Acryl gelatin embolization (TAGM) agents in uterine artery embolization (UAE).

Methods:
We included available articles comparing PVA with TAGM embolization agents in the management of fibroids. The primary outcomes included the decrease in uterine volume (%), decrease in dominant tumor volume (%), fibroid infarction rate, complete infarction of fibroid, complications, pain score after 24 hours, procedure time (minutes), duration of hospital stay, fluoroscopy time (minutes), and the change of symptom severity score.

Results:
Eight articles met our inclusion criteria and were included in this study. Our analysis yielded an overall superiority of PVA compared to TAGM regarding complete fibroid infarction rate at the first 24 hours. On the other hand, TAGM was better than PVA concerning <90% infarction rate outcome. While both embolization techniques showed similar effects regarding the change of symptom severity score, the percentage of decrease in uterine volume, percentage of decrease of dominant tumor volume, 90-99% infarction rate, complete infarction rate when assessed after the first 24 hours, pain score after the first 24 hours, procedure time, fluoroscopy time, minor, and major complications.

Conclusion:
Both PVA and TAGM embolization agents are effective and safe modalities in treating patients with fibroids, with no significant variation of both agents in the majority of outcomes.