News for Your Practice

Uterine artery embolization for symptomatic fibroids: Pros and cons

OBG Manag. 2003 April;15(4):69-79

References

1. Floridon C, Lund N, Thomsen SG. Alternative treatment for symptomatic fibroids. Curr Opin Obstet Gynecol. 2001;13:491-495.

2. Stenchever MA, Droegemueller W, Herbst AL, Mishell DR. Comprehensive Gynecology. 4th ed. St. Louis, Mo: Mosby; 2001.

3. Goodwin SC, Walker WJ. Uterine artery embolization for the treatment of uterine fibroids. Curr Opin Obstet Gynecol. 1998;10:315-320.

4. Schwartz ML, Klein A, McLucas B. Using uterine artery embolization to treat fibroids. Contemporary OB/GYN. 2001;8:14-37.

5. Ravina J, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolization to treat uterine myomata. Lancet. 1995;346:671-672.

6. Spies JB, Ascher SA, Roth AR, Kim J, Levy EB, Gomez-Jorge J. Uterine artery embolization for leiomyomata. Obstet Gynecol. 2001;98:29-34.

7. Demello AB. Uterine artery embolization. AORN J. 2001;73:788-814.

8. Bradley EA, Reidy JF, Forman RG, Jarosz J, Braude PR. Transcatheter uterine artery embolization to treat large uterine fibroids. Br J Obstet Gynaecol. 1998;15:235-240.

9. Goodwin SC, Vedantham S, McLucas B, Forno A, Perrella R. Preliminary experience with uterine artery embolization for uterine fibroids. J Vasc Interv Radiol. 1997;8:517-520.

10. Godfrey CD, Zbella EA. Uterine necrosis after uterine artery embolization for leiomyoma. Obstet Gynecol. 2001;98:950-952.

11. Broder MS, Goodwin S, Chen G, et al. Comparison of long-term outcomes of myomectomy and uterine artery embolization. Obstet Gynecol. 2002;100:864-868.

12. Spies JB, Spector A, Roth A, Baker C, Mauro L, Murphy-Skyrynarz K. Complications after uterine artery embolization for leiomyomas. Obstet Gynecol. 2002;100:873-880.

13. Amato P, Roberts AC. Transient ovarian failure: a complication of uterine artery embolization. Fertil Steril. 2001;75:438-439.

14. Lai AC, Goodwin SC, Bonilla SM, et al. Sexual dysfunction after uterine artery embolization. J Vasc Interv Radiol. 2000;11:755-758.

15. Stringer N. Diagnosis and management of long-term complications of uterine artery embolization. Female Patient. 2002;27(11):13-24.

16. Vashisht A, Studd J, Carey A, Burn P. Fatal septicaemia after fibroid embolisation. Lancet. 1999;354:307-308.

17. Sultana CJ, Goldberg J, Aizenman L, Chon JK. Vesicouterine fistula after uterine artery embolization: a case report. Am J Obstet Gynecol. 2002;187:1726-1727.

18. Yeagley T, Goldberg J, Klein T, Bonn J. Labial necrosis after uterine artery embolization for leiomyomas. Obstet Gynecol. 2002;100:881.-

19. Vashisht A, Smith JR, Thorpe-Beeston G, McCall J. Pregnancy subsequent to uterine artery embolization. Fertil Steril. 2001;75:1246-1247.

20. Ravina JH, Vigneron NC, Aymard A, Le Dref O, Merland JJ. Pregnancy after embolization of uterine myoma: Report of 12 cases. Fertil Steril. 2000;73:1241-1243.

21. Goldberg J, Pereira L, Berghella V. Pregnancy after uterine artery embolization. Obstet Gynecol. 2002;100:869-872.

22. Seracchioli R, Rossi S, Govoni F, et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: A randomized comparison with abdominal myomectomy. Hum Reprod. 2000;15:2663-2668.

23. Dessolle L, Soriano D, Poncelet C, Benifla JL, Madelenat P, Darai E. Determinants of pregnancy rate and obstetric outcome after laparoscopic myomectomy for infertility. Fertil Steril. 2001;76:370-374.

24. Walker W, Green A, Sutton C. Bilateral uterine artery embolization for myomata: Results, complications, and failures. Min Invas Ther Allied Technol. 1999;8:449-454.

Pregnancy outcomes following myomectomy have been reported in several case series, with rates of premature delivery and other complications similar to those for the general population.^22,23 Confounding factors (for example, residual fibroids) and the absence of randomized controlled trials, however, make well-founded comparisons of pregnancy outcomes following UAE and myomectomy difficult.

Theoretical concerns about risk of growth restriction and preeclampsia following UAE have been raised. In our study, we did not observe an increase of small-for-gestational-age infants following embolization.²¹ Uterine rupture during pregnancy after UAE also has been reported.²⁴

TABLE

Rates of pregnancy complications after UAE and in the general population

PREGNANCY	COMPLICATIONS OF PREGNANCY % (NUMBER AFFECTED/NUMBER OF SUBJECTS STUDIED)
	SPONTANEOUS ABORTION	POSTPARTUM HEMORRHAGE	PREMATURE DELIVERY	CESAREAN DELIVERY	SMALL FOR GESTATIONAL AGE	MAL.*
After UAE for leiomyomata	32 (11/34)	9(2/23)	22 (5/23)	65 (15/23)	9 (2/22)	22 (5/23)
In the general population	10-15	4-6	5-10	22	10	5
UAE=uterine artery embolization
*MAL=malpresentation
Reprinted from the American Journal of Obstetrics and Gynecology, 100, Goldberg J, Pereira L, Berghella V, Pregnancy after uterine artery embolization, 869-872, 2002, with permission from Elsevier.

Internet Resources

Society of Cardiovascular and Interventional Radiologists (www.SIRweb.org)
Fibroid Uterine Artery Embolization Registry (www.fibroidregistry.org)
American College of Obstetricians and Gynecologists (www.acog.org)

The authors report no financial relationships with any companies whose products are mentioned in this article.