Uterine fibroid embolization: Nonsurgical treatment for symptomatic fibroids

BACKGROUND: Earlier studies demonstrated the efficacy of uterine fibroid em bolization (UFE). We seek to demonstrate the success of the procedure in a community hospital setting, and we attempt to identify patients likely not to benefit from embolization, if possible, before the procedure. STUDY DESIGN: The study followed all women treated with UFE for menorrhagia or postmenopausal bleeding at a community hospital between 1997 and 1999. Relief of symptoms, ultrasound changes, and complications were documented. Six months after the procedure, analysis was performed on ultrasound and in terview data from patients who underwent UFE. A smaller number of patients has been followed for 12 months and were available for the analysis. We exa mined characteristics of patients and procedures performed in an attempt to identify likely failures of treatment. We calculated complication and fail ure rates based on the entire group of patients. RESULTS: From 183 patients who applied for UFE, 16 were excluded because of pathologic conditions found during preembolization evaluation; 167 women h ad an embolization, 163 were successfully embolized bilaterally, and 4 were embolized unilaterally because of technical failure. Eighty-eight percent of the patients (147 of 167 patients) reported an improvement or stabilizat ion of symptoms 6 months after UFE. Forty-six patients followed for 12 mont hs experienced myoma shrinkage of 37% (a significant shrinkage over 6 month s, p < 0.001), and total uterine volume decreased 52%. Analysis of shrinkag e data revealed no demographic or procedure variable associated with shrink age. Six patients underwent hysterectomy (3.5%) after embolization, one as a result of postprocedure infection. Pain in the first 24 hours postprocedu re affected almost all patients. Five percent of the patients passed submuc ous myomata after UFE; all these patients at risk were identified at preemb olization hysteroscopy. Four patients experienced premature menopause after embolization early in the study. There were three criteria for failure, of which a patient had to meet only one: hysterectomy, < 10% shrinkage of myo ma 6 months after UFE, or worsening symptoms after UFE. No variables of age or size of the uterus could be shown to predict failure. Patients who had undergone earlier pelvic surgery were more likely to fail UFE (p = 0.012). CONCLUSIONS: Uterine fibroid embolization, an alternative treatment for myo mas, offering low morbidity, can be performed in a community hospital setti ng. Eighty-eight percent of patients reported improvement or stabilization of symptoms. Total uterine volume decreased an average of 49% at 6 months a fter embolization. Shrinkage was unaffected by the size of the uterus, myom a, or patient characteristic before UFE. Longterm followup study reveals a significant continuing shrinkage of total uterine volume and myomata at 12 months. There has been no regrowth of fibroids. Earlier surgery was a facto r predicting failure of UFE in our series. The risks to future fertility we re small. (J Am Coll Surg 2001;192:95-105. (C) 2001 by the American College of Surgeons).