Uterine artery embolization as an alternative to hysterectomy, in patients with uterine myomas (original) (raw)

Uterine Artery Embolization as Nonsurgical Treatment of Uterine Myomas

ISRN Obstetrics and Gynecology, 2011

The purpose of this study was to evaluate safety, efficacy or complications of uterine artery embolization (UAE). Patients with symptomatic uterine fibroids (n = 157) were treated by selective bilateral UAE using 350-500 µm sized polyvinyl alcohol particles. Bilateral UAE was successful in 152 (96.8%) cases. Baseline measures of clinical symptoms and MRI taken before the procedure were compared to those taken 3, 6, and 12 months after embolotherapy. Also, complications and outcomes were analyzed after procedure. All patients had an uneventful recovery and were able to return to normal activity within two weeks of embolization. After the procedure, most patients experienced crampy pelvic pain, of variable intensity, which was well managed with the standard analgesia protocol. Five (3%) of participants had persisting amenorrhea after procedure. None reported any new gynecologic or medical problem during the follow-up period. There were no deaths and no major permanent injuries. Reductions in mean uterine volume were 61% (P < 0.01) and in dominant fibroid volume 66% (P ≤ 0.01). The follow-up showed significant improvement of bleeding. In conclusion, uterine artery embolization is a successful, minimal invasive treatment of uterine fibroids that preserves the uterus, had minimal complications, and requires short hospitalization and recovery.

Uterine artery embolization for symptomatic uterine myomas

Fertility and Sterility, 2000

Objective: To evaluate the role of uterine artery embolization as treatment for symptomatic uterine myomas. Design: Medline literature review, cross-reference of published data, and review of selected meeting abstracts. Result(s): Results from clinical series have shown a consistent short-term reduction in uterine size, subjective improvement in uterine bleeding, and reduced pain following treatment. Posttreatment hospitalization and recovery tend to be shorter after uterine artery embolization compared with hysterectomy. Randomized controlled trials have not been conducted, and long-term efficacy has not been studied. A limited number of deliveries have been reported following uterine artery embolization for uterine myomas. Conclusion(s): Uterine artery embolization is a unique new treatment for symptomatic uterine myomas. Even without controlled studies, demand for this procedure has increased rapidly. Uterine artery embolization may be considered an alternative to hysterectomy, or perhaps myomectomy, in well-selected cases. At the present time, however, uterine artery embolization should not be routinely recommended for women who desire future fertility.

Selective uterine artery embolization in the management of uterine myomas

Fertility and Sterility, 2001

To evaluate the effectiveness of uterine artery embolization in women with uterine myomas in terms of the clinical results for the relief of related symptoms. A pilot study on 26 women affected by uterine single myoma. Tertiary level care in an university hospital. Twenty-six patients, aged 32 to 54 years, suffering of menorrhagia, pelvic pain, and abdominal mass for single myoma, intramural localization. Selective uterine artery embolization performed under peridural anesthesia. We measured the x-ray dose to which patients were exposed. Color power Doppler ultrasound examinations were performed during the follow-up evaluations at 1 to 6 months and 1 year after the procedure. Uterine artery embolization was successfully performed in 100% of cases. The mean fluoroscopy time was of 20 minutes during the procedure. The mean dose of x-ray absorbed by the ovary was estimated at 18.7 cGy and the mean dose of x-ray absorbed by the skin was 126.7 cGy. A reduction of myoma volume of 55% was found at 6 months&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; ultrasound examination and 75% at the 1-year examination. Patients are well satisfied and have short recovery times with this procedure. Uterine artery embolization may be a valid alternative to traditional surgery.

Evaluation of uterine artery embolization on myoma shrinkage: Results from a large cohort analysis

Gynecology and Minimally Invasive Therapy

IntroductIon Uterine fibroids are the most common benign tumors in females with the incidence ranging from 20% to 25%. [1-3] The clinical manifestations of uterine fibroids mainly include menorrhagia and/or metrorrhagia which can lead to anemia, pain (dysmenorrhea, dyspareunia, and low back pain), issues with urinary function (frequency or obstruction), and constipation due to pressure on surrounding structures. [4,5] Uterine fibroids have also been associated with infertility even in asymptomatic women, [6] and their enlargement is dependent, at least in part, by hormonal influence. [7,8] Till date, surgery represents the gold standard treatments for several benign [9-11] and oncological [12-14] conditions. In this scenario, symptomatic uterine fibroids larger Objective: There are still contradictory opinions on the success rates of uterine artery embolization (UAE) for the treatment of myomas. In this scenario, our study aims to assess the effect of UAE on myoma shrinkage. Materials and Methods: The study included 337 women in reproductive age affected by a single symptomatic intramural myoma and declined surgery, undergoing UAE. The uterus and myoma diameters and volumes were determined on ultrasonographic scans before and 3, 6, and 12 months after the procedure. Results: The mean uterine volume before intervention was 226.46 ± 307.67 mm 3 , whereas myoma volume was 51.53 ± 65.53 mm 3. Further myoma progression was registered in only four patients. In remaining women, uterus volume in average decreased for 149.99 ± 156.63 mm 3 , whereas myomas decreased for 36.57 ± 47.96 mm 3. The mean volume reduction rate of the uterus was 49.54 ± 35.62 and for myoma was 57.58 ± 30.71. A significant decrease in both uterine and myoma volume was registered in every stage of the follow-up. The highest average decrease in uterine volume was in the first 3 months and myoma volume between 3 and 6 months following UAE. After 12 months follow-up, successful outcome (volume regression >50% respect to the baseline) was registered for uterus in 97.4% and for myoma in 67.9% of investigated patients. Conclusion: UAE was proven to allow a good success rate and can be considered as an effective alternative procedure for myoma treatment.

Uterine artery embolization versus myomectomy: a multicenter comparative study

Fertility and Sterility, 2006

To determine whether there is significant quality of life score improvement after uterine artery embolization (UAE) and to compare UAE and myomectomy outcomes. Prospective cohort controlled study. Sixteen medical centers in the United States. One hundred forty-nine UAE patients and 60 myomectomy patients. Patients were assigned to myomectomy or UAE on the basis of a best treatment decision made by the patient and her physician. All patients were observed for 6 months. The UAE patients also had follow-up examinations at 1 year. Myomectomy or UAE. Quality of life score changes, menstrual bleeding score changes, uterine size differences, time off, and adverse events. Both groups experienced statistically significant improvements in the uterine fibroid quality of life score, menstrual bleeding, uterine volume, and overall postoperative quality of life. The mean hospital stay was 1 day for the UAE patients, compared with 2.5 days for the myomectomy patients. The UAE and myomectomy patients returned to their normal activities in 15 days and 44 days, respectively, and returned to work in 10 days and 37 days, respectively. At least one adverse event occurred in 40.1% of the myomectomy patients, compared with 22.1% in the UAE group. The uterine fibroid quality of life score was significantly improved in both groups. No significant differences were observed in bleeding improvement, uterine volume reduction, uterine fibroid quality of life score improvement, and overall quality of life score improvement between groups. Patients receiving UAE required fewer days off work, fewer hospital days, and experienced fewer adverse events.

Clinical care of patients undergoing uterine artery embolization

Seminars in interventional radiology, 2006

Uterine artery embolization (UAE) is a relatively recent, safe, and minimally invasive procedure for women experiencing symptomatic fibroids. This process of percutaneous occlusion of blood vessels to disrupt blood flow will consequently impede nourishment to the uterine fibroids and cause infarction. To have proper patient treatment to optimize overall clinical success, guidelines should be rigorously followed. This article will delineate a suitable patient care process for UAE in which subsequent interventional radiologists can employ.

Uterine artery embolization for the treatment of uterine fibroids

PubMed, 2004

Uterine artery embolization can be regarded as a less invasive procedure for the treatment of fibroids compared with myomectomy, hysterectomy, and laparoscopic myolysis. The aim of this study was the evaluation of safety and efficacy of uterine artery embolization and of womens' opinion about this treatment. After gynecological examination sixty-nine premenopausal women underwent uterine artery embolization. All procedures but four were technically successful; three women underwent unilateral embolization because of vascular malformation and one of them had an allergic reaction to contrast medium. Of the 69 patients: 58 went home the day after embolization, and 11 within first week. The follow-up examinations after 3, 6 and 12 month showed a significant reduction of uterine and fibroid volume with significant improvement of bleeding. Therefore, according to this report, uterine artery embolization is a successful, minimal invasive treatment of myoma that preserves the uterus and requires shorter hospitalization and recovery times than surgery.