P-746 Clinical, laboratory and ultrasonographic risk factors for uterine artery arteriosclerosis: insights for uterus transplantation
Authors: Renzulli F , Raimondo D , Raffone A , Raimondo I , Raspollini A , Rovero G , Franceschini C , Maletta M , Mollo A , Carbone L , Casadio P , Seracchioli R 
Published: June 2022

Abstract

Study question
What is the uterine artery arteriosclerosis prevalence in women undergoing total hysterectomy for benign diseases?

Summary answer
Uterine artery arteriosclerosis shows a prevalence of 70% in women undergoing total hysterectomy for benign diseases.

What is known already
Arteriosclerosis is defined as a chronic inflammatory disease involving arteries triggered by endothelial dysfunction. The presence of uterine artery arteriosclerosis might identify uteri to be excluded for uterus transplantation. Just one article assessed frequency of UAA in women scheduled for hysterectomy. The Authors observed UAA lesions, from intimal thickness to complex plaque, in all patients; but these data have not been validated in other study populations.

Study design, size, duration
This is a single center, observational, prospective, cohort study, carried out in a tertiary academic center from December 2020 to May 2021. Forty-two consecutive symptomatic patients refuse/ contraindications/intolerance to medical therapy and scheduled for total hysterectomy were enrolled in the study. Exclusion criteria were virgo patients and patients with specimen removal requiring morcellation. Women underwent preoperative assessment of medical history, gynecological examination, transvaginal ultrasound scan and serum tests.

Participants/materials, setting, methods
Two-cm length segments of ascending branch of uterine arteries specimens were harvested at a level of the internal cervical os, then divided, fixed in formalin and then embedded in paraffin. Serial sections were obtained with a thickness of 4 micron. Clinical data and serum tests were collected during preoperative evaluation for each patient. Transvaginal ultrasound was performed. We evaluated PI, RI and PSV as markers of vascular stenosis.

Main results and the role of chance
Forty women were included in the analyses. UAA prevalence was 70%. Among clinical and laboratory factors, means ± SD of body mass index (p = 0.04), total cholesterol (p = 0.03), and triglycerides (p = 0.049) were significantly higher in patients with UAA compared to patients without UAA. On the contrary, HDL mean ± SD (p = 0.02) was significantly lower in patients with UAA than those without UAA. Regarding ultrasonographic factors, uterine arteries with UAA showed higher PSV values compared to vessels without UAA (p = 0.04).

Limitations, reasons for caution
A potential limitation of the present study is the small sample size and the enrollment of women affected by uterine diseases requiring surgery. However, we considered unethical to provide histological data in a cohort of patients with regular uterus, thus not requiring hysterectomy.

Wider implications of the findings
To our knowledge, our study may be the first to evaluate the correlation between both clinical, laboratory and ultrasonographic factors and the presence of UAA. Our findings might direct future studies aiming to improve UTx outcomes.

Trial registration number
Not applicable