Outcome in patients undergoing unilateral uterine artery embolization for symptomatic fibroids

Unilateral Uterine Artery Embolization as a Treatment for Patients with Symptomatic Fibroids-Experience in a Case Series

Background and Objectives: Uterine artery embolization (UAE) has become an accepted and widely performed therapy for patients with symptomatic (reporting at least two of the following symptoms: severe or prolonged menstrual bleeding, abdominal pain, tension in abdomen, problems with urination, constipation or anemia) uterine fibroids. Although in the majority of cases, bilateral occlusion is required to obtain a successful clinical outcome, there are patients in whom treatment of only one uterine artery could be attempted. There are several reasons for unilateral UAE: hemodynamic conditions, technical difficulties, anatomical variants and unilateral dominancy of blood supply to the fibroid. Our aim is to present our 10-year experience with unilateral UAE and evaluate the radiological and clinical outcomes. Materials and Methods: Records of 369 patients with fibroids who underwent UAE from 2010 to 2021 were analyzed. We identified 26 patients treated with unilateral uterine artery embolization and analyzed the data of these patients. All patients attended medical consultation, were assessed using a five-grade symptom scale and underwent MRI examination. Clinical response was evaluated at least 6 months after the procedure and was categorized to one of the following groups: complete improvement, partial improvement, no change and a worsening in symptoms. Results: Twenty-two patients (85%) reported at least partial improvement 6 months following the procedure. One patient required secondary embolization due to recanalization. The secondary procedure was successful, and complete improvement was achieved. One patient did not observe any clinical improvement, and in two cases, symptom recurrence was observed. All three patients were referred for surgical treatment. No major complications were noted. Overall, the success rate was 88%. Conclusions: The results of our study support the statement that elective unilateral embolization is an appropriate treatment in patients with a dominant uterine artery.

Uterine artery embolization: a safe and effective, minimally invasive, uterine-sparing treatment option for symptomatic fibroids

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.

Predictors of hysterectomy after uterine artery embolization for leiomyoma

OBJECTIVE

This study was undertaken to describe long-term outcomes after uterine artery embolization for leiomyoma.

STUDY DESIGN

Data from Kaiser Permanente Northern California members undergoing uterine artery embolization for leiomyoma before July 2001 were collected. Survival analysis was performed to describe hysterectomy rates and identify predictors of hysterectomy.

RESULTS

Uterine artery embolization was performed in 562 women from 1997-2001. Thirty-three women (5.9%) had unilateral uterine artery embolization. One hundred women (18%) underwent hysterectomy after uterine artery embolization, and 32 (5.7%) had additional uterine sparing procedures. Only unilateral uterine artery embolization predicted subsequent hysterectomy (relative risk = 2.19; 95% CI 1.34-3.57), whereas age, indication, uterine volume, embolizing particle, and radiologist experience did not. The rate of hysterectomy at 5 years was 19.7%; rates for bilateral and unilateral uterine artery embolizations were 18.5% and 39.2%, respectively. Fifty-four women (9.6%) had emergency room visits and 17 (3%) had unplanned readmissions.

CONCLUSIONS

Uterine artery embolization for leiomyoma permits uterine conservation in more than 80% of women monitored long-term. When bilateral procedures cannot be performed, failure rates are considerably higher.

Uterine artery embolization as a treatment for symptomatic uterine fibroids: a review of literature and case report

PURPOSE

To provide a case presentation and review of the literature on uterine artery embolization (UAE) as a treatment alternative for symptomatic uterine fibroids and to guide the nurse practitioner (NP) in patient selection, education, and periprocedural management of patients undergoing this procedure.

DATA SOURCES

Research articles, clinical articles, and case studies pertaining to UAE.

CONCLUSIONS

UAE is a safe, well tolerated, and effective nonsurgical treatment option for symptomatic uterine fibroids. This uterus-sparing procedure has low complication rates with excellent clinical outcomes and high patient satisfaction rates. The majority of women who undergo UAE report marked reduction in the severity of fibroid specific symptoms and significant improvement in their quality of life. Uterine fibroids are common in women and often produce symptoms that have a negative impact on quality of life.

IMPLICATIONS FOR PRACTICE

The NP is instrumental in identifying which patients may be appropriate candidates for UAE, educating them about the risks and benefits of the procedure, and managing these patients before and after the procedure.

Recent advances in uterine fibroid embolization

PURPOSE OF REVIEW

To summarize the literature on uterine embolization for fibroids published in 2004 and 2005.

RECENT FINDINGS

During the last two years, our understanding of the outcome of uterine fibroid embolization has increased. The outcomes are comparable to those that occur after hysterectomy. Health-related quality-of-life studies have confirmed the positive impact of the procedure. Improvement in menorrhagia has been quantified using the alkaline hematin method, objectively confirming the outcome. Recovery is also better understood and quantified, with most patients experiencing only moderate pain over the first few days after embolization. In two pregnancy-outcome studies, an increased frequency of cesarean section occurred and possibly a greater likelihood of abnormal placentation, although the data are too few to draw conclusions at this time. Contrast-enhanced magnetic resonance imaging (MRI) has emerged as the primary tool for assessing the potential of complications following the procedure, and our understanding of vaginal discharge and uterine infarction has been increased as a result of its use.

SUMMARY

Within the last few years, uterine embolization has become an accepted therapy for uterine fibroids. The increase in understanding gained in recent years has helped to confirm the effectiveness and relative tolerability of this therapy.

Uterine Fibroid Vascularization and Clinical Relevance to Uterine Fibroid Embolization

Embolization has become a first-line treatment for symptomatic uterine fibroid tumors. Selective catheterization and embolization of both uterine arteries, which are the predominant source of blood flow to fibroid tumors in most cases, is the cornerstone of treatment. Although embolization for treatment of uterine fibroid tumors is widely accepted, great familiarity with the normal and variant pelvic arterial anatomy is needed to ensure the safety and success of the procedure. The uterine artery classically arises as a first or second branch of the anterior division of the internal iliac artery and is usually dilated in the presence of a uterine fibroid tumor. Angiography is used for comprehensive pretreatment assessment of the pelvic arterial anatomy; for noninvasive evaluation, Doppler ultrasonography, contrast material-enhanced magnetic resonance (MR) imaging, and MR angiography also may be used. After the uterine artery is identified, selective catheterization should be performed distal to its cervicovaginal branch. For targeted embolization of the perifibroid arterial plexus, injection of particles with diameters larger than 500 mum is generally recommended. Excessive embolization may injure normal myometrium, ovaries, or fallopian tubes and lead to uterine necrosis or infection or to ovarian failure. Incomplete treatment or additional blood supply to the tumor (eg, via an ovarian artery) may result in clinical failure. The common postembolization angiographic end point is occlusion of the uterine arterial branches to the fibroid tumor while antegrade flow is maintained in the main uterine artery.