Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up

Abstract

Objective To evaluate the mid-term efficacy and complications of uterine artery embolisation in women with symptomatic fibroids. To assess reduction in uterine and dominant fibroid volumes using ultrasound and magnetic resonance imaging. Design Prospective observational single-centre study.Setting A district general hospital in Surrey and a private hospital in London.Methods Four hundred consecutive women were treated between December 1996 and February 2001.Indications for treatment were menorrhagia, menstrual pain, abdominal swelling or bloating and other pressure effects. Uterine artery embolisation was performed using polyvinyl alcohol particles and platinum coils. Main outcome measures Imaging was performed before embolisation and at regular intervals thereafter.Clinical evaluation was made at regular intervals after embolisation to assess patient outcome. Results Bilateral uterine artery embolisation was achieved in 395 women, while 5 women had a unilateral procedure. With a mean clinical follow up of 16.7 months, menstrual bleeding was improved in 84% of women and menstrual pain was improved in 79%. Using ultrasound, the median uterine and dominant fibroid volumes before embolisation were 608 and 112 cc, respectively, and after embolisation 255 and 19 cc, respectively ( P ¼ .0001). Three (1%) infective complications requiring emergency hysterectomy occurred. Twenty-three (6%) patients had clinical failure or recurrence. Of these, nine (2%) had a hysterectomy. Twenty-six (7%) women had permanent amenorrhoea after embolisation including four patients under the age of 45 (2%). Of these, amenorrhea started between 4 and 18 months after embolisation, and only three had elevated follicle stimulating hormone levels when amenorrhea developed. Thirteen (4%) women had chronic vaginal discharge considered as a major irritant. Thirteen pregnancies occurred in 12 patients. Ninety-seven percent of women were pleased with the outcome and would recommend this treatment to others. Conclusions Uterine artery embolisation is associated with a high clinical success rate and good fibroid volume reduction. Infective complications requiring hysterectomy, amenorrhoea under the age of 45 and chronic vaginal discharge may complicate the procedure. INTRODUCTIONS

Is Embolization Equal to Hysterectomy in Treating Uterine Fibroids?

“…Transient or permanent amenorrhea with other symptoms of ovarian failure has been reported in up to 5% of women after UAE. There have been anecdotal reports of ovarian failure in younger women (Pron et al, 2003b;Spies et al 2002b;Walker & Pelage, 2002). Permanent loss of ovarian function after UAE resulting in menopause has been reported in several studies.…”

“…Most complications were minor and occurred during the first 3 months after the procedure. A relatively common complication of UAE is vaginal expulsion of an infarcted fibroid, with a reported rate of up to 10% (Spies et al 2002b;Walker & Pelage, 2002). This complication is more frequently seen in patients with submucosal fibroids or intramural fibroids with a submucosal component.…”

“…This condition can be treated effectively by hysteroscopic resection of the necrotic fibroid material (Ogliari et al, 2005;Walker et al, 2004). The most serious, although rare, complication of UAE is the occurrence of intrauterine infection, which has been reported in less than 1% of procedures (Pron et al, 2003b;Walker & Pelage, 2002;Worthington-Kirsch et al, 2005).…”

“…Large case series with less than 2 years of followup reported rates of treatment failure, defined as the need for subsequent interventions, ranging from 5.5 to 9.5% (Huang et al, 2006;Spies et al, 2005a;Walker & Pelage, 2002).…”

Clinical experience and fertility outcome after uterine artery occlusion and embolization

“…Major complications after UAE for uterine fibroids are estimated to occur in 1-5% of cases [10]. Serious infectious complications affect 1% to 2% of cases, and this problem is encountered more frequently with embolization of larger fibroids [11].…”