Current Evidence on Uterine Embolization for Fibroids

Abstract

Strong evidence for both safety and effectiveness of uterine fibroid embolization has been generated since the procedure's introduction. This review will focus on the key articles representing the best evidence to summarize the outcomes from uterine embolization. This review will attempt to answer three important questions associated with uterine embolization. First, does uterine embolization relieve symptoms caused by uterine fibroids? Second, how well does the improvement in symptoms and quality of life after uterine embolization compare with standard surgical options for fibroids? Finally, how durable is the improvement in fibroid-related symptoms and quality of life after embolization?

Keywords

interventional radiology - uterine artery embolization - fibroid - comparative effectiveness

• References

• 1 Goodwin SC, Vedantham S, McLucas B, Forno AE, Perrella R. Preliminary experience with uterine artery embolization for uterine fibroids. J Vasc Interv Radiol 1997; 8 (4) 517-526
• 2 Ravina JH, Herbreteau D, Ciraru-Vigneron N , et al. Arterial embolisation to treat uterine myomata. Lancet 1995; 346 (8976) 671-672
• 3 Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188 (1) 100-107
• 4 Myers ER, Goodwin S, Landow W , et al; FIBROID Investigators. Prospective data collection of a new procedure by a specialty society: the FIBROID registry. Obstet Gynecol 2005; 106 (1) 44-51
• 5 Goodwin SC, McLucas B, Lee M , et al. Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J Vasc Interv Radiol 1999; 10 (9) 1159-1165
• 6 Hutchins Jr FL, Worthington-Kirsch R, Berkowitz RP. Selective uterine artery embolization as primary treatment for symptomatic leiomyomata uteri. J Am Assoc Gynecol Laparosc 1999; 6 (3) 279-284
• 7 Spies JB, Scialli AR, Jha RC , et al. Initial results from uterine fibroid embolization for symptomatic leiomyomata. J Vasc Interv Radiol 1999; 10 (9) 1149-1157
• 8 Pelage JP, Le Dref O, Soyer P , et al. Fibroid-related menorrhagia: treatment with superselective embolization of the uterine arteries and midterm follow-up. Radiology 2000; 215 (2) 428-431
• 9 Brunereau L, Herbreteau D, Gallas S , et al. Uterine artery embolization in the primary treatment of uterine leiomyomas: technical features and prospective follow-up with clinical and sonographic examinations in 58 patients. AJR Am J Roentgenol 2000; 175 (5) 1267-1272
• 10 McLucas B, Adler L, Perrella R. Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids. J Am Coll Surg 2001; 192 (1) 95-105
• 11 Spies JB, Ascher SA, Roth AR, Kim J, Levy EB, Gomez-Jorge J. Uterine artery embolization for leiomyomata. Obstet Gynecol 2001; 98 (1) 29-34
• 12 Walker WJ, Pelage JP. Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG 2002; 109 (11) 1262-1272
• 13 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
• 14 Pron G, Cohen M, Soucie J, Garvin G, Vanderburgh L, Bell S ; Ontario Uterine Fibroid Embolization Collaboration Group. The Ontario Uterine Fibroid Embolization Trial. Part 1. Baseline patient characteristics, fibroid burden, and impact on life. Fertil Steril 2003; 79 (1) 112-119
• 15 Pron G, Mocarski E, Cohen M , et al. Hysterectomy for complications after uterine artery embolization for leiomyoma: results of a Canadian multicenter clinical trial. J Am Assoc Gynecol Laparosc 2003; 10 (1) 99-106
• 16 Spies JB, Coyne K, Guaou Guaou N, Boyle D, Skyrnarz-Murphy K, Gonzalves SM. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 2002; 99 (2) 290-300
• 17 Spies JB, Bradley LD, Guido R, Maxwell GL, Levine BA, Coyne K. Outcomes from leiomyoma therapies: comparison with normal controls. Obstet Gynecol 2010; 116 (3) 641-652
• 18 Spies JB, Myers ER, 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
• 19 Goodwin SC, Spies JB, Worthington-Kirsch R , et al; Fibroid Registry for Outcomes Data (FIBROID) Registry Steering Committee and Core Site Investigators. Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID Registry. Obstet Gynecol 2008; 111 (1) 22-33
• 20 Broder MS, 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
• 21 Siskin GP, Shlansky-Goldberg RD, Goodwin SC , et al; UAE versus Myomectomy Study Group. 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 (8) 1287-1295
• 22 Spies JB, Cooper JM, Worthington-Kirsch R, Lipman JC, Mills BB, Benenati JF. Outcome of uterine embolization and hysterectomy for leiomyomas: results of a multicenter study. Am J Obstet Gynecol 2004; 191 (1) 22-31
• 23 Pinto I, Chimeno P, Romo A , et al. Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment—a prospective, randomized, and controlled clinical trial. Radiology 2003; 226 (2) 425-431
• 24 Hehenkamp WJ, Volkers NA, Donderwinkel PF , 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
• 25 Hehenkamp WJ, Volkers NA, Birnie E, Reekers JA, Ankum WM. 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
• 26 Volkers NA, Hehenkamp WJ, Birnie E, Ankum WM, Reekers JA. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial. Am J Obstet Gynecol 2007; 196 (6) e1-e11
• 27 Ananthakrishnan G, Murray L, Ritchie M , et al. Randomized comparison of uterine artery embolization (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): subanalysis of 5-year MRI findings. Cardiovasc Intervent Radiol 2013; 36 (3) 676-681
• 28 Edwards RD, Moss JG, Lumsden MA , et al; Committee of the Randomized Trial of Embolization versus Surgical Treatment for Fibroids. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 2007; 356 (4) 360-370
• 29 Moss JG, Cooper KG, Khaund A , et al. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG 2011; 118 (8) 936-944
• 30 Rashid S, Khaund A, Murray LS , et al. The effects of uterine artery embolisation and surgical treatment on ovarian function in women with uterine fibroids. BJOG 2010; 117 (8) 985-989
• 31 Ruuskanen A, Hippeläinen M, Sipola P, Manninen H. Uterine artery embolisation versus hysterectomy for leiomyomas: primary and 2-year follow-up results of a randomised prospective clinical trial. Eur Radiol 2010; 20 (10) 2524-2532
• 32 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
• 33 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
• 34 Manyonda IT, Bratby M, Horst JS, Banu N, Gorti M, Belli AM. Uterine artery embolization versus myomectomy: impact on quality of life—results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) trial. Cardiovasc Intervent Radiol 2012; 35 (3) 530-536
• 35 Jun F, Yamin L, Xinli X , et al. Uterine artery embolization versus surgery for symptomatic uterine fibroids: a randomized controlled trial and a meta-analysis of the literature. Arch Gynecol Obstet 2012; 285 (5) 1407-1413
• 36 van der Kooij SM, Bipat S, Hehenkamp WJ, Ankum WM, Reekers JA. Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol 2011; 205 (4) e1-e18
• 37 Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev 2012; 5: CD005073
• 38 Gabriel-Cox K, Jacobson GF, Armstrong MA, Hung YY, Learman LA. Predictors of hysterectomy after uterine artery embolization for leiomyoma. Am J Obstet Gynecol 2007; 196 (6) e1-e6
• 39 Lohle PN, Voogt MJ, 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
• 40 Narayan A, Lee AS, Kuo GP, Powe N, Kim HS. Uterine artery embolization versus abdominal myomectomy: a long-term clinical outcome comparison. J Vasc Interv Radiol 2010; 21 (7) 1011-1017
• 41 Popovic M, Berzaczy D, Puchner S, Zadina A, Lammer J, Bucek RA. Long-term quality of life assessment among patients undergoing uterine fibroid embolization. AJR Am J Roentgenol 2009; 193 (1) 267-271
• 42 Poulsen B, Munk T, Ravn P. Long-term follow up after uterine artery embolization for symptomatic uterine leiomyomas. Acta Obstet Gynecol Scand 2011; 90 (11) 1281-1283
• 43 Scheurig-Muenkler C, Koesters C, Powerski MJ, Grieser C, Froeling V, Kroencke TJ. Clinical long-term outcome after uterine artery embolization: sustained symptom control and improvement of quality of life. J Vasc Interv Radiol 2013; 24 (6) 765-771
• 44 Spies JB, Bruno J, Czeyda-Pommersheim F, Magee ST, Ascher SA, Jha RC. Long-term outcome of uterine artery embolization of leiomyomata. Obstet Gynecol 2005; 106 (5 Pt 1) 933-939
• 45 van der Kooij SM, Hehenkamp WJ, Volkers NA, Birnie E, Ankum WM, Reekers JA. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial. Am J Obstet Gynecol 2010; 203 (2) e1-e13
• 46 Walker WJ, 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