Selective arterial embolization for hemorrhagic uterine leiomyomas

OBJECTIVES: Selective arterial embolization was proposed in 81 women aged 30 to 54 years who suffered from invalidating bleeding from uterine myomas. This new therapy was assessed as an alternative to the initially planned surgery, PATIENTS AND METHODS: Selective arterial embolization was performed under local anesthesia or neuroleptanalgesia. Retrograde catheterization of the uterine arteries was achieved via femoral puncture, allowing free-flow embolization with poiyvinylformaldehyde particles which was continued until complete devascularization of the myoma was achieved. RESULTS: Among the 76 cases which could be assessed, there were 8 procedure failures. Bleeding ceased in all the other cases. After a 20-month follow-up, there has been no recurrence. Embolization also produced a major reduction in myoma volume. Residual volume 6 months after embolization was less than one-third of the initial volume. In 80% of the cases, embolization led to pelvic pain which lasted 12 to 18 hours and required analgesics. There was one partial dissection of an uterine artery which had no consequence, but the necrosis of one voluminous fibroma led to an occlusive syndrome requiring subsequent hysterectomy with bowel resection. DISCUSSION: The high success rate in this series (89%) was the same as in a preliminary trial and confirmed the usefulness of selective arterial embolization as an alternative to surgery to control hemorrhage from uterine leiomyomas. Further studies are needed to identify the limitations and indications of this procedure. (C) 1998, Masson, Paris.