Percutaneous uterine artery embolization for the treatment of symptomatic fibroids: current status

• Published in: European journal of radiology Vol. 54; no. 1; pp. 136 - 147
• Main Authors: Lupattelli, Tommaso, Basile, Antonio, Garaci, Francesco Giuseppe, Simonetti, Giovanni
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.04.2005; Elsevier Science
• Subjects: Biological and medical sciences; Delivery. Postpartum. Lactation; Diagnostic Imaging; Embolization; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Female; Female genital diseases; Fibroid; Gynecology. Andrology. Obstetrics; Humans; Leiomyoma - therapy; Medical sciences; Non tumoral diseases; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Uterine artery; Uterine Neoplasms - therapy; Uterus; Uterus - blood supply; Embolization; Uterus; Fibroid; Uterine artery; Growth; Alcohol; Birth; Hemorrhage; Menorrhagia; Blood; Percutaneous route; Ovary; Fertility; Surgery; Uterine diseases; Amenorrhea; Complication; Female; Woman; Failure; Human; Menstruation disorders; Instrumentation therapy; Hysterectomy; Puerperium; Long term; Female genital diseases; Pregnancy; Symptomatology; Perfusion; Delivery
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2004.04.006

Uterine artery embolization (UAE) is increasingly being used as an alternative treatment to hysterectomy for symptomatic fibroids. Symptoms of pelvic pressure, urinary frequency and menorrhagia are controlled in 73–98% of patients who undergo UAE. At the 1-year follow-up, the uterus may shrink by up to 55% but re-growth of fibroid may however occur. The rate of major complications and amenorrhoea following this procedure is low, ranging in most series from 1 to 3.5% and 1 to 7%, respectively. Nevertheless, the rate of amenorrhoea in women over 45 seems to be higher. In order to completely block the arterial supply to the fibroid, UAE is typically performed in both uterine arteries. Different embolic agents are used such as polyvinyl alcohol, gelfoam and more recently gelatine tris-acryl microspheres. After UAE, perfusion of the uterus is maintained. Uterine function is therefore conserved and although women who become pregnant after UAE seem to be at risk for malpresentation, pre-term birth, cesarean delivery and postpartum hemorrhage, successful pregnancies after UAE have been reported in some series. A major technical problem with UAE remains the possible presence of fibroid blood supply from other sources, such as the ovarian arteries or other pelvic branches, which can lead to failure of the procedure. In conclusion, although randomized trials are still underway, UAE appears a good option for those patients who whish to conserve their fertility or when surgery is contra-indicated. However, to evaluate the long-term effects of UAE longer follow up is required.