Uterine Artery Embolization for Fibroids: A Review of Current Outcomes

ABSTRACT

Since its introduction in 1995, uterine artery embolization (UAE) for fibroids has been extensively investigated. Particularly in the last 3 to 4 years, several high-quality studies assessing its outcome have been completed. Randomized trials and long-term observational studies have demonstrated that when successful, UAE can provide symptom control similar to that obtained after surgery. Although hysterectomy remains more effective in symptom control and durability, many women are seeking uterine-sparing alternatives. UAE has emerged as the leading minimally invasive treatment for fibroids: Morbidity is low and recovery rapid; serious complications are quite rare. With a few anatomical exceptions, UAE is appropriate for most patients with symptomatic fibroids who have completed childbearing. Although pregnancy is certainly possible after embolization, existing data suggest better reproductive outcomes for myomectomy in the first 2 years after treatment. The current recommendation is for myomectomy as a first choice for patients seeking to become pregnant.

KEYWORDS

Leiomyomas - uterine artery embolization - outcomes

REFERENCES

• 1 Ravina J H, Herbreteau D, Ciraru-Vigneron N et al.. Arterial embolisation to treat uterine myomata.  Lancet. 1995;  346(8976) 671-672
• 2 Goodwin S C, Vedantham S, McLucas B, Forno A E, Perrella R. Preliminary experience with uterine artery embolization for uterine fibroids.  J Vasc Interv Radiol. 1997;  8(4) 517-526
• 3 Greenwood L H, Glickman M G, Schwartz P E, Morse S S, Denny D F. Obstetric and nonmalignant gynecologic bleeding: treatment with angiographic embolization.  Radiology. 1987;  164(1) 155-159
• 4 Mueller G C, Gemmete J J, Carlos R C. Diagnostic imaging and vascular embolization for uterine leiomyomas.  Semin Reprod Med. 2004;  22(2) 131-142
• 5 American College of Obstetricians and Gynecologists . ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas.  Obstet Gynecol. 2008;  112(2 Pt 1) 387-400
• 6 Chrisman H B, Rajeswaran S, Dhand S et al.. Effect of postprocedural pelvic MR imaging on medical decision-making in women who have undergone uterine artery embolization.  J Vasc Interv Radiol. 2009;  20(7) 977-980
• 7 Ghai S, Rajan D K, Benjamin M S, Asch M R, Ghai S. Uterine artery embolization for leiomyomas: pre- and postprocedural evaluation with US.  Radiographics. 2005;  25(5) 1159-1172, discussion 1173–1176
• 8 Myers E R, Goodwin S, Landow W FIBROID Investigators et al. Prospective data collection of a new procedure by a specialty society: the FIBROID registry.  Obstet Gynecol. 2005;  106(1) 44-51
• 9 Radeleff B, Eiers M, Bellemann N, Ramsauer S, Rimbach S, Kauczor H U et al.. Expulsion of dominant submucosal fibroids after uterine artery embolization.  Eur J Radiol. 2009;  , August 17 (Epub ahead of print)
• 10 Smeets A J, Nijenhuis R J, Boekkooi P F et al.. Safety and effectiveness of uterine artery embolization in patients with pedunculated fibroids.  J Vasc Interv Radiol. 2009;  20(9) 1172-1175
• 11 Bratby M J, Ramachandran N, Sheppard N, Kyriou J, Munneke G M, Belli A M. Prospective study of elective bilateral versus unilateral femoral arterial puncture for uterine artery embolization.  Cardiovasc Intervent Radiol. 2007;  30(6) 1139-1143
• 12 Bruno J, Sterbis K, Flick P et al.. Recovery after uterine artery embolization for leiomyomas: a detailed analysis of its duration and severity.  J Vasc Interv Radiol. 2004;  15(8) 801-807
• 13 Hutchins Jr F L, Worthington-Kirsch R, Berkowitz R P. Selective uterine artery embolization as primary treatment for symptomatic leiomyomata uteri.  J Am Assoc Gynecol Laparosc. 1999;  6(3) 279-284
• 14 Spies J B, Ascher S A, Roth A R, Kim J, Levy E B, Gomez-Jorge J. Uterine artery embolization for leiomyomata.  Obstet Gynecol. 2001;  98(1) 29-34
• 15 Walker W J, Pelage J. Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up.  BJOG. 2002;  109 1262-1272
• 16 Pron G, Bennett J, Common A, Wall J, Asch M, Sniderman K. Ontario Uterine Fibroid Embolization Collaboration Group . The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids.  Fertil Steril. 2003;  79(1) 120-127
• 17 Spies J B, Myers E R, Worthington-Kirsch R, Mulgund J, Goodwin S, Mauro M. FIBROID Registry Investigators . The FIBROID Registry: symptom and quality-of-life status 1 year after therapy.  Obstet Gynecol. 2005;  106(6) 1309-1318
• 18 Worthington-Kirsch R, Spies J B, Myers E R FIBROID Investigators et al. The Fibroid Registry for outcomes data (FIBROID) for uterine embolization: short-term outcomes.  Obstet Gynecol. 2005;  106(1) 52-59
• 19 Hehenkamp W J, Volkers N A, Birnie E, Reekers J A, Ankum W M. Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy—results from the randomized clinical Embolisation versus Hysterectomy (EMMY) Trial.  Radiology. 2008;  246(3) 823-832
• 20 Hehenkamp W J, Volkers N A, Donderwinkel P F et al.. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri- and postprocedural results from a randomized controlled trial.  Am J Obstet Gynecol. 2005;  193(5) 1618-1629
• 21 Edwards R D, Moss J G, Lumsden M A Committee of the Randomized Trial of Embolization versus Surgical Treatment for Fibroids et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids.  N Engl J Med. 2007;  356(4) 360-370
• 22 Broder M S, Goodwin S, Chen G et al.. Comparison of long-term outcomes of myomectomy and uterine artery embolization.  Obstet Gynecol. 2002;  100(5 Pt 1) 864-868
• 23 Bucek R A, Puchner S, Lammer J. Mid- and long-term quality-of-life assessment in patients undergoing uterine fibroid embolization.  AJR Am J Roentgenol. 2006;  186(3) 877-882
• 24 Katsumori T, Kasahara T, Akazawa K. Long-term outcomes of uterine artery embolization using gelatin sponge particles alone for symptomatic fibroids.  AJR Am J Roentgenol. 2006;  186 848-854
• 25 Spies J B, Cornell C, Worthington-Kirsch R, Lipman J C, Benenati J F. Long-term outcome from uterine fibroid embolization with tris-acryl gelatin microspheres: results of a multicenter study.  J Vasc Interv Radiol. 2007;  18(2) 203-207
• 26 Gabriel-Cox K, Jacobson G F, Armstrong M A, Hung Y Y, Learman L A. Predictors of hysterectomy after uterine artery embolization for leiomyoma.  Am J Obstet Gynecol. 2007;  196 588.e1-6
• 27 Lohle P N, Voogt M J, De Vries J et al.. Long-term outcome of uterine artery embolization for symptomatic uterine leiomyomas.  J Vasc Interv Radiol. 2008;  19(3) 319-326
• 28 Spies J B, Bruno J, Czeyda-Pommersheim F, Magee S T, Ascher S A, Jha R C. Long-term outcome of uterine artery embolization of leiomyomata.  Obstet Gynecol. 2005;  106(5 Pt 1) 933-939
• 29 Walker W J, Barton-Smith P. Long-term follow up of uterine artery embolisation—an effective alternative in the treatment of fibroids.  BJOG. 2006;  113(4) 464-468
• 30 Reed S D, Newton K M, Thompson L B, McCrummen B A, Warolin A K. The incidence of repeat uterine surgery following myomectomy.  J Womens Health (Larchmt). 2006;  15(9) 1046-1052
• 31 Spies J B, Roth A R, Jha R C, Gomez-Jorge J et al.. Leiomyomata treated with uterine artery embolization: factors associated with successful symptomatic and imaging outcome.  Radiology. 2002;  222 45-52
• 32 Spies J B, Spector A, Roth A R, Baker C M, Mauro L, Murphy-Skrynarz K. Complications after uterine artery embolization for leiomyomas.  Obstet Gynecol. 2002;  100(5 Pt 1) 873-880
• 33 de Blok S, de Vries C, Prinssen H M, Blaauwgeers H L, Jorna-Meijer L B. Fatal sepsis after uterine artery embolization with microspheres.  J Vasc Interv Radiol. 2003;  14(6) 779-783
• 34 Vashisht A, Studd J, Carey A, Burn P. Fatal septicaemia after fibroid embolisation.  Lancet. 1999;  354(9175) 307-308
• 35 Czeyda-Pommersheim F, Magee S T, Cooper C, Hahn W Y, Spies J B. Venous thromboembolism after uterine fibroid embolization.  Cardiovasc Intervent Radiol. 2006;  29(6) 1136-1140
• 36 Nikolic B, Kessler C M, Jacobs H M et al.. Changes in blood coagulation markers associated with uterine artery embolization for leiomyomata.  J Vasc Interv Radiol. 2003;  14(9 Pt 1) 1147-1153
• 37 Chrisman H B, Saker M B, Ryu R K et al.. The impact of uterine fibroid embolization on resumption of menses and ovarian function.  J Vasc Interv Radiol. 2000;  11(6) 699-703
• 38 Healey S, Buzaglo K, Seti L, Valenti D, Tulandi T. Ovarian function after uterine artery embolization and hysterectomy.  J Am Assoc Gynecol Laparosc. 2004;  11(3) 348-352
• 39 Spies J B, Roth A R, Gonsalves S M, Murphy-Skrzyniarz K M. Ovarian function after uterine artery embolization for leiomyomata: assessment with use of serum follicle stimulating hormone assay.  J Vasc Interv Radiol. 2001;  12(4) 437-442
• 40 Tropeano G, Di Stasi C, Litwicka K, Romano D, Draisci G, Mancuso S. Uterine artery embolization for fibroids does not have adverse effects on ovarian reserve in regularly cycling women younger than 40 years.  Fertil Steril. 2004;  81 1055-1061
• 41 Mara M, Fucikova Z, Maskova J, Kuzel D, Haakova L. Uterine fibroid embolization versus myomectomy in women wishing to preserve fertility: preliminary results of a randomized controlled trial.  Eur J Obstet Gynecol Reprod Biol. 2006;  126(2) 226-233
• 42 Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy.  Cardiovasc Intervent Radiol. 2008;  31(1) 73-85
• 43 Homer H, Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage.  Fertil Steril. 2009;  , April 8 (Epub ahead of print)