Uterine Artery Embolisation of Fibroids and the Phenomenon of Post-Embolisation Syndrome: A Systematic Review

Abstract

Post-embolisation syndrome (PES) is a prevalent complication that occurs in patients following uterine artery embolisation (UAE) for the treatment of uterine fibroids. The aetiology of PES remains incompletely understood, although postulated to result secondary to tissue infarction resulting in release of inflammatory mediators. We followed PRISMA guidelines and performed a systematic review of studies of PES following UAE from inception to October 2022. Our published protocol was prospectively registered. Our search yielded 54 results. We reviewed 22 full texts, and nine articles were included. Observational studies comprised 6/9 relevant studies, with 5/9 retrospective design. The rate of PES was documented in 5/8 studies (excluding case report) with a reported incidence ranging from 4–34.6%. Five of the nine studies studies postulated that the aetiological basis of PES is inflammatory related. Further research is necessary to advance our understanding of PES to define the biological basis of the syndrome with more certainty and gain a consensus on peri-procedure management to reduce incidence and improve patient outcomes.

Update on Endovascular Therapy for Fibroids and Adenomyosis

“…45 While it is not completely understood, the etiology of PES is believed to be due to the release of inflammatory mediators from tissue infarction after embolization. 46 One prospective study assessed that women who underwent UAE had a mean postprocedural score of 7/10 (AE2.47) and an average hospital stay of 31.2 hours. 39 Many therapies have been tried to decrease postprocedural pain, such as intra-arterial lidocaine and steroids.…”