Efficacy of uterine artery embolisation in symptomatic uterine fibroids

Uterine fibroids are the most common benign tumors of the uterus that can cause bleeding, pain, pressure symptoms and infertility. Since medical treatment is ineffective, surgery is the standart treatment of fibroids. However, UAE has been accepted as a uterus-sparing treatment that is an alternative to surgery. In this study, we aim to evaluate the efficacy of UAE in patients that underwent embolisation and have been followed up at Akdeniz University Hospital Interventional Radiology Unit. Thirty-nine patients who underwent embolisation in Akdeniz University Hospital Interventional Radiology Unit or other centers and were followed up in our unit were included in the study. All records were accessed retrospectively from either the patients' file or hospital medical automation systems. Missing datas were obtained by face-to-face or telephone interview. All cases were premenapausal women between 29-50 years (average mean 39.56). UAE was performed from unilateral common femoral access by a single interventional radiologist and continued until sufficient decrease in uterine artery flow or, in patients embolised with 'tris-acryl colalgen' coated microspheres, 'pruned tree view' in control angiographic images were obtained. Technical success was 100% and procedure-related complications were not observed. 27 of 32 cases (84.3%) that could be interviewed face-to-face or via telephone had regressed symptoms. Two cases underwent hysterectomy because of persisting symptoms. One patient reported regression of all symptoms but bleeding and one reported regression of all symptoms but pain. One case had developed permanent amenorrhea; however, the patient reported a regression of symptoms and overall satisfaction from the procedure. Two cases had vaginal expulsion of the fibroid. Seven (17,9 %) cases could not be reached. Procedural success was found to be 93.8 %. We found the minor complication rate to be 13.8%, major complication and re-intervention rates to be 10%. One case had twin babies with in-vitro fertilisation following the procedure. 10 cases had pelvic MRIs before and after the procedure. In 8 of these patients, uterus volume (as calculated by the Formula: length x width x depth x 0.5233) had decreased 18-92.2%, dominant myoma volumes had decreased 9-64 % and contrast enhanced images revealed nonenhanced myomas. In conclusion, uterine artery embolisation is a minimally invasive and safe procedure that is an alternative to surgery for treatment of symptomatic myomas. Even though in long term follow-ups post-procedure re-intervention rates are relatively high, due to being a uterus-sparing procedure with short hospitalisation and quick return to daily routine, patient satisfaction regarding the procedure is high