SELECTIVE ARTERIAL EMBOLIZATION FOR HEMOR RHAGIC UTERINE LEIOMYOMAS

OBJECTIVES: Selective arterial embolization was proposed in 81 women a ged 30 to 54 years who suffered from invalidating bleeding from uterin e myomas. This new therapy was assessed as an alternative to the initi ally planned surgery, PATIENTS AND METHODS: Selective arterial emboliz ation was performed under local anesthesia or neuroleptanalgesia. Retr ograde catheterization of the uterine arteries was achieved via femora l 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 assess ed, there were 8 procedure failures. Bleeding ceased in all the other cases. After a 20-month follow-up, there has been no recurrence. Embol ization also produced a major reduction in myoma volume. Residual volu me 6 months after embolization was less than one-third of the initial volume. In 80% of the cases, embolization led to pelvic pain which las ted 12 to 18 hours and required analgesics. There was one partial diss ection of an uterine artery which had no consequence, but the necrosis of one voluminous fibroma led to an occlusive syndrome requiring subs equent 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 alte rnative to surgery to control hemorrhage from uterine leiomyomas. Furt her studies are needed to identify the limitations and indications of this procedure. (C) 1998, Masson, Paris.