Uterine Artery Embolization: A Promising Treatment Modality for Uterine Leiomyomata
Abstract & Commentary
Synopsis: Uterine artery embolization for the treatment of uterine fibroids is a minimally invasive technique with low complication rates and good clinical efficacy.
Source: Goodwin SC, et al. Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J Vasc Interv Radiol 1999;10(9):1159-1165.
Uterine fibroids are fairly common in women in their mid-30s or older with a reported incidence of 20%-40%. Hysterectomy is the traditional treatment modality for symptomatic fibroids. Alternative treatments include myomectomy and hormonal treatment; however, these modalities have their limitations. This study reports a retrospective analysis of the outcome of uterine artery embolization for fibroids in 60 patients. All patients were embolized with polyvinyl alcohol foam particles, 59 bilaterally and one unilaterally. The first 11 procedures were done under general anesthesia and the next 49 under conscious sedation. The access to the uterine arteries was accomplished through the transfemoral approach using standard catherization techniques and a microcatheter was used for superselective catherization. The results showed that all patients had technically successful procedures. No immediate complications were encountered. All patients had pelvic pain after the procedure requiring aggressive pain management. Twenty-two patients required same-day admission for pain management. One patient suffered premature menopause and one required hysterectomy after severe infection. Six patients had post-embolization syndrome (fever, elevated white blood count, and malaise) requiring prolonged admission. Four patients with submucosal fibroids passed them vaginally. Of all patients undergoing bilateral embolization, at last follow-up (mean, 16.3 months), 81% had their uterus and had moderate or better improvement in their symptoms. The mean uterine and dominant fibroid volume reduction was 42.8% and 48.8%, respectively. It was concluded that uterine artery embolization is an excellent treatment alternative for symptomatic fibroids with a relatively low complication rate and a high success rate.
Comment by Moni Stein, MD
Uterine artery embolization for the treatment of fibroids has become a popular patient-driven treatment option. Many patients find information about this procedure through the Internet (for example: http://scvir.org/fibroid/index.htm) and "shop" for an interventional radiologist in their community. Percutaneous uterine arterial embolization has been applied traditionally in obstetrics and gynecology for the emergency control of pelvic bleeding, typically after failure of traditional surgical interventions. Severe pelvic trauma is the most common nongynecologic etiology of poorly controlled pelvic bleeding requiring use of this transcatheter technique. In the last few years, elective transcatheter arterial embolization of uterine leiomyomas has been performed to diminish related symptomatology in an attempt to avoid hysterectomy or myomectomy. To date, more than 4000 of these procedures have been performed in the United States; however, only a few hundred have been reported in the literature. Main indications for this procedure include symptomatic uterine fibroids with menometrorrhagia, anemia, or pain. Success rates seem promising with a low failure rate. This procedure results in substantial (uterine and fibroids) volume reduction of between 40%-80%. Pain is common during the first 24-48 hours after the procedure, requiring intravenous nonsteroidal anti-inflammatory drugs and narcotic analgesia. Infrequent complications include endometritis, pyometra, and uterine necrosis, which may require hysterectomy. Implications on fertility have not yet been carefully studied. Although successful pregnancies following this procedure have occurred, because of the unknown long-term effect of this procedure on fertility or perinatal outcome, this technique should not be routinely recommended when future fertility is desired. Although not currently accepted as the standard of care, this technique is rapidly evolving as a safe and effective alternative to hysterectomy for the treatment of symptomatic uterine fibroids.
References
1. Spies JB, et al. Initial results from uterine fibroid embolization for symptomatic leiomyomata. J Vasc Interv Radiol 1999;10(9):1149-1157.
2. Worthington-Kirsch RL, et al. Uterine arterial embolization for the management of leiomyomas: Quality-of-life assessment and clinical response. Radiology 1998;208(3):625-629.
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