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Uterine Fibroid Embolization: An Alternative to Surgery



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Am Fam Physician. 2001 Aug 15;64(4):665-666.

Uterine fibroid embolization (UFE) has been used to treat acute pelvic hemorrhage and to shrink myomata. Many patients who have undergone UFE have been spared myomectomy or hysterectomy. McLucas and associates evaluated UFE as therapy for uterine myomata in the community hospital setting and identified characteristics of patients who are not likely to benefit from UFE.

Patients with menorrhagia or postmenopausal bleeding secondary to uterine myomas and without contraindications to angiography and embolization were considered for participation in the study. All patients were screened by pelvic ultrasonography, hysteroscopy, endometrial biopsy and laparoscopy, with a needle biopsy of the largest myoma. Symptoms of bleeding, pain and pressure were evaluated before embolization. During the UFE procedure, polyvinyl alcohol particles were injected into the myoma blood supply under direct visualization via selective catheterization of uterine blood vessels bilaterally. Ultrasonography was repeated at six weeks and six months after embolization. Patients were interviewed five months after UFE to evaluate postprocedure symptoms.

Complications Following Fibroid Embolization

Complication Number of patients (%)

Fever

12 (7.0)

Nausea/vomiting

2 (1.0)

Passage of submucous myoma

8 (5.0)

Premature menopause

4 (2.4)

Hysterectomy

6 (3.5)


Adapted with permission from McLucas B, Adler L, Perrella R. Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids. J Am Coll Surg 2001;192:100.

Complications Following Fibroid Embolization

View Table

Complications Following Fibroid Embolization

Complication Number of patients (%)

Fever

12 (7.0)

Nausea/vomiting

2 (1.0)

Passage of submucous myoma

8 (5.0)

Premature menopause

4 (2.4)

Hysterectomy

6 (3.5)


Adapted with permission from McLucas B, Adler L, Perrella R. Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids. J Am Coll Surg 2001;192:100.

Of the 167 women who underwent the procedure, four could not be successfully embolized bilaterally. Six months after UFE, 92 percent of patients reported stabilization or improvement in menorrhagia. Of the patients with pain and pressure, 69.7 percent reported some pain relief. Post-UFE complications are described in the accompanying table.

The failure group included 21 patients: six who underwent hysterectomy for varied reasons, six with shrinkage of less than 10 percent and 13 with worsening symptoms after UFE. Several patients overlapped categories. The only variable associated with failure was the occurrence of earlier surgery. Patients with coexistent myomata and adenomyosis had a lower success rate based on their greater need for hysterectomy after UFE. Three patients could not be embolized because of uterine artery anomalies on one side. The authors recommend that patients be counseled about the small risk of infertility as a result of premature menopause after UFE.

The authors conclude that UFE is an acceptable method of treatment for myomata, with a success rate of approximately 88 percent. Although pain and postoperative fever are common in patients immediately following UFE, these side effects are minor compared with the possible morbidity of a surgical procedure.

RICHARD SADOVSKY, M.D.

McLucas B, et al. Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids. J Am Coll Surg. January 2001;192:95–105.



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