Fibroid-related Menorrhagia: Treatment with Superselective Embolization of the Uterine Arteries and Midterm Follow-up

TLDR

The ideal embolic regimen for uterine artery embolization remains to be determined. The study prospectively evaluates the effectiveness and safety of selective uterine artery embolization for symptomatic uterine leiomyoma. The authors performed superselective embolization with polyvinyl alcohol particles in 80 women, followed by office visits and ultrasound at 2, 6, 12, and 24 months, with bilateral embolization in 76 and unilateral in 4. Menorrhagia resolved in 90% of women, 6% required additional surgery, one hysterectomy was performed for necrosis, normal menses resumed in all but six, and three full‑term pregnancies were achieved, demonstrating effective control of symptomatic leiomyoma.

Abstract

To prospectively evaluate the effectiveness and safety of selective embolization of the uterine arteries in the management of symptomatic uterine leiomyoma.Eighty consecutive women (mean age, 44.7 years) with symptomatic uterine leiomyoma, none of whom desired future pregnancy, underwent superselective embolization of the uterine arteries with polyvinyl alcohol particles. In all women, arterial embolization was performed because of persistent, fibroid-related menorrhagia after failure of hormonal therapy. Follow-up consisted of office visits at 2, 6, 12, and 24 months and of ultrasonography at 2 and 6 months after the procedure.Bilateral embolization of the uterine arteries was performed in 76 women; unilateral embolization, in four women. Menorrhagia disappeared in 72 (90%) women. In five (6%) women (including three women with unilateral embolization), clinical improvement was not observed, and myomectomy was needed. In one woman with a large submucosal uterine leiomyoma, hysterectomy was needed because of septic uterine necrosis. Normal menstruation resumed in all but six women. Full-term pregnancy occurred in three women after the procedure.Superselective arterial embolization of the uterine arteries is an effective means of controlling symptomatic uterine leiomyoma. However, the ideal embolic regimen remains to be determined.