Clinical Question: What are the long-term outcomes for uterine artery embolization to treat uterine fibroids?

Setting: Outpatient (specialty)

Study Design: Cohort (prospective)

Allocation: Concealed

Synopsis: Uterine artery embolization is a less invasive intervention for the treatment of uterine fibroids than hysterectomy or myomectomy. In this cohort study, 200 women with uterine fibroids and associated symptoms were treated with uterine artery embolization. To be included in the study, women must have failed medical therapy, had contraindications to medical therapy, or refused it. Anatomic exclusion criteria were pedunculated fibroids resectable by hysteroscopy or uterine size greater than that at 24 weeks’ gestation. Symptoms could be one or more of the following: (1) heavy menstrual periods (with or without anemia), (2) pain, or (3) urinary symptoms associated with bladder or ureteral compression. Fibroid volume was calculated according to magnetic resonance imaging of the pelvis performed before and again three months after embolization. Embolization was performed bilaterally until the vasculature of the fibroid was occluded and there was slow flow near stasis in the main uterine artery. Most women (78 percent) were older than 40 years, and 85 percent had two or more fibroids. Eighteen women (9 percent) were lost during the five years of follow-up. Treatment failure was defined as the need for a hysterectomy, myomectomy, or repeat embolization or the lack of improvement in symptoms. Treatment failed in 25 percent of patients. Better treatment outcomes and patient satisfaction were associated with a fibroid volume reduction greater than 56 percent at three months compared with baseline. Better outcomes also were associated with baseline fibroid volumes less than the median for the group (median = 151 mL).

Bottom Line: Uterine artery embolization for the treatment of symptomatic uterine fibroids has a long-term success rate of 75 percent over the five years following treatment. This approach has the potential to avoid most hysterectomies for fibroid-caused symptoms and deserves futher study. (Level of Evidence: 2b)