Complications associated with uterine artery embolisation for fibroids

The clinical efficacy and influencing factors of uterine artery embolization in the treatment of different types of uterine adenomyosis

Uterine adenomyosis, a common benign tumor disease in gynecology, mainly manifested as chronic pelvic pain, menstrual disorders, dysmenorrhea, etc., has a great impact on patients' daily life and work. Compared with traditional surgery and drug therapy, uterine artery embolization (UAE), as a new treatment with less trauma, faster recovery and uterine preservation, can relieve pain while preserving normal physiological and reproductive functions of the uterus, which is favored by the majority of patients. In this study, the patients were divided into two groups based on magnetic resonance imaging (MRI) test. Their serum CA125 level was detected, and the degree of symptom relief and health index were evaluated, aiming to explore the clinical efficacy and influencing factors of UAE in the treatment of adenomyosis. The results showed that before UAE, CA125 level in group B was significantly higher than that in group A, and 2 days after UAE, CA125 level in both groups was lower than before treatment, indicating that the serum CA125 level may be related to the type of adenomyosis, but UAE has a good therapeutic effect on both focal and diffuse adenomyosis. 3 months after interventional treatment, the patients had significantly reduced symptoms with dramatically improved health status and the VAS pain score was significantly reduced, indicating that UAE can significantly improve the clinical symptoms of patients with adenomyosis. Uterine artery embolization was performed in both groups. No serious complications occurred during the operation, and the technical success rate reached 100%. In summary, UAE, as a minimally invasive treatment, has obvious and significant clinical effects in the treatment of adenomyosis, and is an important alternative treatment for adenomyosis.

Uterine Artery Embolization: A Growing Pillar of Gynecological Intervention

Uterine Artery Embolization (UAE) is a minimally invasive procedure that has emerged as a transformative option for managing uterine leiomyomas (fibroids), postpartum hemorrhage, and other gynecological conditions. While traditional surgical interventions like hysterectomy and myomectomy remain standard, UAE offers a safer alternative for patients seeking uterine preservation or fertility maintenance. This article examines the efficacy, innovations, and challenges of UAE, with a focus on its expanding applications and implications for patient care. Existing research highlights high success rates of UAE, achieving significant symptom relief in over 90% of cases by occluding uterine arterial blood supply with embolic agents to induce localized ischemia and fibroid necrosis. Innovations in embolic materials, such as hydrophobic injectable liquids, and procedural techniques like transradial access have enhanced safety, reduced complications, and improved patient outcomes. The effectiveness of UAE in treating rarer conditions, including uterine arteriovenous malformations and adenomyosis, demonstrates its versatility. However, questions remain about its long-term reproductive impact, especially concerning fertility outcomes and pregnancy rates, as conflicting data suggest potential risks. This critical review addresses these gaps by synthesizing existing studies to assess comparative efficacy of UAE against surgical options, its safety profile, and its role in advancing minimally invasive gynecology. By exploring both well-established and emerging applications, this article underscores the importance of UAE in reducing morbidity, improving quality of life, and preserving reproductive potential. Further research is essential to refine patient selection criteria, optimize techniques, and better understand the long-term outcomes of the procedure, ensuring UAE continues to evolve as a valuable minimally invasive option within modern gynecological care.

Can uterine artery embolization be an alternative to plastic and reconstructive uterus operation by minimally invasive surgery?

Introduction: Plastic and reconstructive minimally invasive surgery has been established as gold standard in myomectomy. Therapy failure eventually leads to future surgical interventions or hysterectomy: surgeons and patients should be aware of the risks and benefits. We conducted a systematic review to analyse the evidence on the therapeutic indications and adverse events associated with uterine artery embolization and thereby evaluating if this method could be a valid alternative therapy. Methods: In concordance with PRISMA guidelines, literature research was made in PubMed, Cochrane Library, UpToDate, Amboss and Medline databases. Clinical trials, reviews and case reports published in English between January 2010 and June 2020 were included. Results: 44 articles were included out of 838 papers identified at initial search. Regarding uterine fibroids, three original papers and one Cochrane review reported the benefits of the procedure as an alternative to surgery, even in large and giant fibroids. Furthermore, several studies discussed the use of embolization for postpartum haemorrhage to decrease rates of hysterectomy after other haemostatic methods were exhausted, because of the potential risk of abnormal placentation in a future pregnancy. The procedure can also be successfully used as prophylactic method in different obstetrical procedures. Conclusions: The use of embolization in different uterine pathologies is a minimally invasive procedure as an alternative to surgery, especially in women who desire to preserve their uterus. Its related complications are described and can be avoided by a stringent indication of the procedure. More evidence regarding fertility after UAE, use of the procedure prophylactically in obstetrical haemorrhage or in adenomyosis is needed.

Uterine Artery Embolization: An Analysis of Online Patient Information Quality and Readability with Historical Comparison

RATIONALE AND OBJECTIVES

Investigators aimed to assess online information describing uterine artery embolization (UAE) to examine the quality and readability of websites patients are accessing.

MATERIALS AND METHODS

A list of applicable, commonly used searchable terms was generated, including "Uterine Artery Embolization," "Fibroid Embolization," "Uterine Fibroid Embolization," and "Uterine Artery Embolisation." Each possible term was assessed across the five most-used English language search engines to determine the most commonly used term. The most common term was then investigated across each search engine, with the first 25 pages returned by each engine included for analysis. Duplicate pages, nontext content such as video or audio, and pages behind paywalls were excluded. Pages were analyzed for quality and readability using validated tools including DISCERN score, JAMA Benchmark Criteria, HONcode Certification, Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Gunning-Fog Index. Secondary features such as age, rank, author, and publisher were recorded.

RESULTS

The most common applicable term was "Uterine Artery Embolization" (492,900 results). Mean DISCERN quality of information provided by UAE websites is "fair"; however, it has declined since comparative 2012 studies. Adherence to JAMA Benchmark Criteria has reduced to 6.7%. UAE website readability remains more difficult than the World Health Organization-recommended 7-8th grade reading levels. HONcode-certified websites (35.6%) demonstrated significantly higher quality than noncertified websites.

CONCLUSIONS

Quality of online UAE information remains "fair." Adherence to JAMA benchmark criteria is poor. Readability is above recommended 7-8th grade levels. HONcode certification was predictive of higher website quality, a useful guide to patients requesting additional information.

Cost and Distribution of Hysterectomy and Uterine Artery Embolization in the United States: Regional/Rural/Urban Disparities

Hysterectomy, the driving force for symptomatic uterine fibroids since 1895, has decreased over the years, but it is still the number one choice for many women. Since 1995, uterine artery embolization (UAE) has been proven by many researchers to be an effective treatment for uterine fibroids while allowing women to keep their uteri. The preponderance of data collection and research has focused on care quality in terms of efficiency and effectiveness, with little on location and viability related to care utilization, accessibility and physical availability. The purpose of this study was to determine and compare the cost of UAE and classical abdominal hysterectomy with regard to race/ethnicity, region, and location. Data from National Hospital Discharge for 2004 through 2008 were accessed and analyzed for uterine artery embolization and hysterectomy. Frequency analyses were performed to determine distribution of variables by race/ethnicity, location, region, insurance coverage, cost and procedure. Based on frequency distributions of cost and length of stay, outliers were trimmed and categorized. Crosstabs were used to determine cost distributions by region, place/location, procedure, race, and primary payer. For abdominal hysterectomy, 9.8% of the sample were performed in rural locations accross the country. However, for UAE, only seven procedures were performed nationally in the same period. Therefore, all inferential analyses and associations for UAE were assumed for urban locations only. The pattern differed from region to region, regarding the volume of care (numbers of cases by location) and care cost. Comparing hysterectomy and UAE, the patterns indicate generally higher costs for UAE with a mean cost difference of $4223.52. Of the hysterectomies performed for fibroids on Black women in the rural setting, 92.08% were in the south. Overall, data analyzed in this examination indicated a significant disparity between rural and urban residence in both data collection and number of procedures conducted. Further research should determine the background to cost and care location differentials between races and between rural and urban settings. Further, factors driving racial differences in the proportions of hysterectomies in the rural south should be identified to eliminate disparities. Data are needed on the prevalence of uterine fibroids in rural settings.

Uterine fibroid therapy using interventional radiology mini-invasive treatments: current perspective

Uterine fibroids are common benign tumors of unclear etiopathology that affect the female reproductive tract. They are responsible for considerable morbidity and deterioration of life quality, and may have a negative impact on the reproductive system as well. Besides surgery aided by uterus-saving techniques, several minimally invasive procedures are now available within the field of interventional radiology that represent a valid solution for women who desire pregnancy and relief from disease-specific symptomatology. The main advantages offered by these techniques are low grade of invasiveness and short times of hospitalization. The most diffuse techniques are uterine artery embolization (UAE) and magnetic resonance-guided high-intensity focused ultrasound (MRgFUS). UAE is an endovascular procedure whose goal is obtained by provoking ischemia of the uterine vessels. MRgFUS is a thermoablation procedure that selectively ablates the symptomatic fibroids. In this review study, both procedures will be described, including a description of technical details, indications, contraindications, complications, and outcomes.

High-Intensity Focused Ultrasound Ablation of Uterine Fibroids - Potential Impact on Fertility and Pregnancy Outcome

Laparoscopic myomectomy is regarded as the gold standard for women with symptomatic fibroids who wish to become pregnant. High-intensity focused ultrasound (HIFU or MRgFUS) ablation of uterine fibroids is also being discussed as a non-surgical, minimally invasive, therapeutic option. This review examines the available data on the impact of HIFU/MRgFUS on fertility and pregnancy, focusing particularly on potential direct side-effects of this type of intervention on ovaries, fallopian tubes and uterus and potential late effects on pregnancy and birth, based on the current literature. All pregnancies after HIFU/MRgFUS published to date (around 100 cases) were evaluated. The published case series suggest that HIFU/MRgFUS ablation has no impact on the rate of miscarriages or other obstetrical outcome parameters. Because no prospective studies exist which permit firm conclusions to be drawn on the impact of HIFU/MRgFUS on fertility and pregnancy outcome in women with symptomatic fibroids, this approach is currently only recommended for women with suspected fertility problems due to uterine fibroids who either decline surgery or who have an unacceptably high surgical risk.

Uterine Fibroid Embolisation - Potential Impact on Fertility and Pregnancy Outcome

The current standard therapy to treat myomas in women wishing to have children consists of minimally invasive surgical myomectomy. Uterine artery embolisation (UAE) has also been discussed as another minimally invasive treatment option to treat myomas. This review evaluates the literature of the past 10 years on fibroid embolisation and its impact on fertility and pregnancy. Potential problems associated with UAE such as radiation exposure of the ovaries, impairment of ovarian function and the impact on pregnancy and child birth are discussed in detail. Previously published reports of at least 337 pregnancies after UAE were evaluated. The review concludes that UAE to treat myomas can only be recommended in women with fertility problems due to myomas who refuse surgery or women with an unacceptably high surgical risk, because the evaluated case reports and studies show that UAE significantly increases the risk of spontaneous abortion; there is also evidence of pathologically increased levels for other obstetric outcome parameters. There are still very few prospective studies which provide sufficient evidence for a definitive statement on the impact of UAE therapy on fertility rates and pregnancy outcomes.