Uterine Artery Embolization: A Safe and Effective, Minimally Invasive, Uterine-Sparing Treatment Option for Symptomatic Fibroids

ABSTRACT

Leiomyomas (or fibroids) are exceedingly common lesions. The indications to initiate treatment are based on the symptoms that can arise from their presence. In general, medical therapy should be considered the first line of treatment. Currently, the treatment of fibroids is in evolution. Since uterine artery embolization (UAE) was first described by Ravina et al in 1995, it has been shown to be a safe, efficacious, and cost-effective alternative to traditional surgical options, with data from long-term studies now available. Appropriate patient evaluation and selection are vital; the ideal candidate is one who is premenopausal, has symptomatic fibroids resistant to medical therapy, no longer desires fertility, and wishes to maintain her uterus. Uterine artery embolization is primarily an angiographic procedure, but periprocedural clinical management is critical for patient satisfaction. This article discusses the various embolic materials that are commonly used and available for UAE; understanding the technical nuances is critical for long-term success.

KEYWORDS

Uterine artery embolization - fibroids - embolic material

REFERENCES

• 1 Goodwin S C, Spies J B, Worthington-Kirsch R et al.. Uterine artery embolization for treatment of leiomyomata.  Obstet Gynecol. 2008;  111 22-33
• 2 Ravina J H, Herbreteau D, Ciraru-Vigneron N et al.. Arterial embolisation to treat uterine myomata.  Lancet. 1995;  346 671-672
• 3 Siskin G P, Shlansky-Goldberg R D, Goodwin S C et al.. A prospective multicenter comparative study between myomectomy and uterine artery embolization with polyvinyl alcohol microspheres: Long-term clinical outcomes in patients with symptomatic uterine fibroids.  J Vasc Interv Radiol. 2006;  17 1287-1295
• 4 Wu O, Briggs A, Dutton S et al.. Uterine artery embolisation or hysterectomy for the treatment of symptomatic uterine fibroids: a cost-utility analysis of the HOPEFUL study.  BJOG. 2007;  114 1352-1362
• 5 Management of uterine fibroids. Summary, evidence report/technology assessment: Number 34. AHRQ Publication No. 01–E051, January 2001 Agency for Healthcare Research and Quality, Rockville, MD. Available at http://www.ahrq.gov.offcampus.lib.washington.edu/clinic/epcsums/utersumm.htm
• 6 Usadi R S, Marshburn P B. The impact of uterine artery embolization on fertility and pregnancy outcome.  Curr Opin Obstet Gynecol. 2007;  19 279-283
• 7 Spies J B, Roth A R, Gonsalves S M et al.. Ovarian function after uterine artery embolization: assessment using serum follicle-stimulating hormone assay.  J Vasc Interv Radiol. 2001;  12 437-442
• 8 Goldberg J, Pereira L, Berghella V. Pregnancy after uterine artery embolization.  Obstet Gynecol. 2002;  100 869-872
• 9 Pron G, Mocarski E, Bennett J et al.. Pregnancy after uterine artery embolization for leiomyomata; the Ontario multicenter trial.  Obstet Gynecol. 2005;  105 67-76
• 10 Marshburn P B, Matthews M L, Hurst B S. Uterine artery embolization as a treatment option for uterine myomas.  Obstet Gynecol Clin North Am. 2006;  33(1) 125-144
• 11 Rajan D K, Beecroft J R, Clark T W et al.. Risk of intrauterine infectious complications after uterine artery embolization.  J Vasc Interv Radiol. 2004;  15 1415-1421
• 12 Mui W L, Kwong W H, Li A C et al.. Premedication with intravenous ketorolac trometamol (Toradol) in colonoscopy: a randomized controlled trial.  Am J Gastroenterol. 2005;  100 2669-2673
• 13 Denison G L, Ha T V, Keblinskas D. Treatment of uterine artery vasospasm with transdermal nitroglycerin ointment during uterine artery embolization.  Cardiovasc Intervent Radiol. 2005;  28 670-672
• 14 Nicholson T. Outcome in patients undergoing unilateral uterine artery embolization for symptomatic fibroids.  Clin Radiol. 2004;  59 186-191
• 15 Gabriel-Cox K, Jacobson G F, Armstrong M A et al.. Predictors of hysterectomy after uterine artery embolization for leiomyoma.  Am J Obstet Gynecol. 2007;  196(6) 588.e1-5888.e6
• 16 Lampmann L E, Lohle P N, Smeets A et al.. Pain management during uterine artery embolization for symptomatic uterine fibroids.  Cardiovasc Intervent Radiol. 2007;  30(4) 809-811
• 17 Pelage J P, Guaou N G, Jha R C et al.. Uterine fibroid tumors: long-term MR imaging outcome after embolization.  Radiology. 2004;  230 803-809
• 18 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
• 19 Spies J B, Allison S, Flick P et al.. Polyvinyl alcohol particles and tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a randomized comparative study.  J Vasc Interv Radiol. 2004;  15(8) 793-800
• 20 Spies J B, Allsion S, Flick P et al.. Spherical polyvinyl alcohol versus tris-acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a limited randomized comparative study.  J Vasc Interv Radiol. 2005;  16(11) 1431-1437
• 21 Siskin G P, Englander M, Stainken B F et al.. Embolic agents used for uterine fibroid embolization.  AJR Am J Roentgenol. 2000;  175 767-773
• 22 Rasuli P, Hammond I, Al-Matairi B et al.. Spherical versus conventional polyvinyl alcohol particles for uterine artery embolization.  J Vasc Interv Radiol. 2008;  19 42-46
• 23 Kroencke T J, Scheurig C, Lampmann L E et al.. Acrylamido polyvinyl alcohol microspheres for uterine artery embolization: 12-month clinical and MR imaging results.  J Vasc Interv Radiol. 2008;  19 47-57
• 24 Ryu R K. Uterine artery embolization: current implications of embolic agent choice.  J Vasc Interv Radiol. 2005;  16 1419-1422
• 25 Spies J B, Spector A, Roth A R et al.. Complications after uterine artery embolization for leiomyomas.  Obstet Gynecol. 2002;  100 873-880
• 26 Gupta J K, Sinha A S, Lumsden M A, Hickey M et al.. Uterine artery embolization for symptomatic uterine fibroids.  Cochrane Database Syst Rev. 2006;  (1) CD005073
• 27 Spies J B. Uterine artery embolization for fibroids: understanding the technical causes of failure.  J Vasc Interv Radiol. 2003;  14 11-14
• 28 Andrews R T, Bromley P J, Pfister M E. Successful embolization of collaterals from the ovarian artery during uterine artery embolization for fibroids: a case report.  J Vasc Interv Radiol. 2000;  11 607-610