Uterine artery embolization for the treatment of uterine fibroids

Uterine fibroids have been treated mainly with resection via hysteroscopy, laparoscopy or laparotomy, or with hysterectomy. Transcatheter embolization of the uterine arteries (UAE) has been used to treat obstetric bleeding complications, bleeding from pelvic tumors, and, recently, uterine fibroids. The potential advantages are preservation of the uterus with a minimally invasive technique, avoidance of surgery and surgical complications, and reduced costs. Published reports indicate improvement of bleeding problems in 85-95% of patients within 3-9 months of the procedure and reduction of uterine or fibroid volume by 60-80%. Overall 60-80% of patients are satisfied with the results of UAE and would recommend the procedure. A number of uneventful pregnancies subsequent to UAE have been reported. Diffuse abdominal pain of varying intensity and duration, slight fever, leucocytosis and signs of peritoneal irritation are common after embolization. Endometritis, myometrial necrosis (2%), and two deaths (sepsis, pulmonary embolism) have been reported among the 7000 published procedures. The effects of UAE on ovarian function are unclear. A registration of long-term results, recurrence rates, side effects and complications would help physicians counsel patients about the role of UAE in the treatment of uterine fibroids.