La radiologia medica

, Volume 123, Issue 5, pp 385–397 | Cite as

Uterine fibroid embolization efficacy and safety: 15 years experience in an elevated turnout rate center

  • Carmine Di Stasi
  • Alessandro Cina
  • Francesco Rosella
  • Andrea Paladini
  • Sonia Amoroso
  • Daniela Romualdi
  • Riccardo Manfredi
  • Cesare Colosimo
VASCULAR AND INTERVENTIONAL RADIOLOGY
  • 68 Downloads

Abstract

Objective

To evaluate effectiveness and safety of UFE as alternative to surgery, in treatment of uterine fibromatosis.

Methods/materials

255 patients (aged 26–55) with symptomatic UF, indication for surgery, followed in our center (2000–2014), single or multiple fibroids, pain and/or functional/compressive disorders, underwent embolization: injection of PVA particles (150–900 μm) from distal portion of uterine arteries (ascending section). Primary end-point: flow-stop distally to injection site, disappearance of lesion design, preservation of flow in main trunk of UA. Secondary end-point: control of pain and functional/compressive disorders during follow-up (2–7 years).

Results

Procedure was performed bilaterally in 250 patients (98%). Mean duration: 47 min (average fluoroscopy: 10:50 min). Post-embolization pelvic pain (according with VAS score) was on average 2.2 at discharge (24 h). Follow-up at 2 years: resolution of menstrual disorders in 78% of patients and improvement in 14%; pain disappeared in 66%; significant improvement of menstrual flow and HCT/HB levels, decrease in total uterine (57.7%)/dominant fibroid (76.1%) volume. Recurrence in 18 patients.

Conclusions

UFE represents an excellent alternative to surgical treatment: it is safe, tolerable and effective both in short and long term, with evident advantages in economic and social terms.

Keywords

Uterine fibroid Uterine fibroid embolization UFE efficacy UFE safety UFE versus surgery 

Abbreviations

CI

Confidence interval

FSH

Follicle-stimulating hormone

HR

Hazard ratio

HRT

Hormone replacement therapy

LH

Luteinizing hormone

MRI

Magnetic resonance imaging

NSAID

Non-steroidal anti-inflammatory drugs

PVA

Polyvinyl alcohol

SD

Standard deviation

UFE

Uterine fibroid embolization

VAS

Visual analogue scale

Notes

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Alessandro Cina, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise. The study is on human subjects.

Informed consent

Written informed consent was not required by the Institutional Review Board for this study because it is a retrospective study.

Ethical approval

Institutional Review Board approval was not required because is a retrospective study.

Methodology

Retrospective, observational, performed at one institution.

References

  1. 1.
    Pron G et al (2003) Tolerance, hospital stay, and recovery after uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial. JVIR 14(10):1234–1250CrossRefGoogle Scholar
  2. 2.
    Goodwin SC et al (2001) Uterine artery embolization for uterine fibroids: a radiologist’s perspective. Clin Obstet Gynecol 44(1):412–424CrossRefPubMedGoogle Scholar
  3. 3.
    Bruno J et al (2004) Recovery after uterine artery embolization for leiomyomas: a detailed analysis of its duration and severity. JVIR 15:801–807CrossRefPubMedGoogle Scholar
  4. 4.
    Edwards RD et al (2007) Committee of the Randomized Trial of Embolization versus Surgical Treatment for Fibroids. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 356(4):360–370CrossRefPubMedGoogle Scholar
  5. 5.
    Spies JB et al (2001) Uterine artery embolization for leiomyomata. Obstet Gynecol 98:29–34PubMedGoogle Scholar
  6. 6.
    Worthington-Kirsch R et al (2005) The Fibroid Registry for outcomes data (FIBROID) for uterine embolization short-term outcomes. Obstet Gynecol 106(1):52–59CrossRefPubMedGoogle Scholar
  7. 7.
    Goodwin SC et al (2006) Uterine artery embolization versus myomectomy: a multicenter comparative study. Fertil Steril 85:14–20CrossRefPubMedGoogle Scholar
  8. 8.
    Farquhar CM et al (2002) Hysterectomy rates in the United States 1990–1997. Obstet Gynecol 99(2):229–234PubMedGoogle Scholar
  9. 9.
    Levy BS (2008) Modern management of uterine fibroids. Acta Obstet Gynecol Scand 87(8):812–823CrossRefPubMedGoogle Scholar
  10. 10.
    McLucas B et al (2001) Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids. J Am Coll Surg 192:95–105CrossRefPubMedGoogle Scholar
  11. 11.
    Walker WJ, Pelage JP (2002) Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow-up. Br J Obstet Gynecol 109:1263–1272CrossRefGoogle Scholar
  12. 12.
    Pron G et al (2003) The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertil Steril 79:120–127CrossRefPubMedGoogle Scholar
  13. 13.
    Spies JB et al (2005) The FIBROID Registry: symptom and quality-of-life status 1 year after therapy. Obstet Gynecol 106:1309–1318CrossRefPubMedGoogle Scholar
  14. 14.
    Badawy SZ et al (2001) Uterine artery embolization: the role in obstetrics and gynecology. Clin Imaging 25:288–295CrossRefPubMedGoogle Scholar
  15. 15.
    Hutchins FL Jr et al (1999) Selective uterine artery embolization as primary treatment for symptomatic leiomyomata uteri. J Am Assoc Gynecol Laparosc 6:279–284CrossRefPubMedGoogle Scholar
  16. 16.
    Huang JY et al (2006) Failure of uterine fibroid embolization. Fertil Steril 85(1):30–35CrossRefPubMedGoogle Scholar
  17. 17.
    Volkers NA et al (2007) Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years’ outcome from the randomized EMMY trial. Am J Obstet Gynecol 196(6):519.e1–519.e11CrossRefGoogle Scholar
  18. 18.
    Park HR et al (2005) Uterine restoration after repeated sloughing of fibroids or vaginal expulsion following uterine artery embolization. Eur Radiol 15:1850–1854CrossRefPubMedGoogle Scholar
  19. 19.
    Spies JB et al (2005) Long-term outcome of uterine artery embolization of leiomyomas. Obstet Gynecol 106:933–939CrossRefPubMedGoogle Scholar
  20. 20.
    Katsumori T et al (2006) Long-term outcomes of uterine artery embolization using gelatine sponge particles alone for symptomatic fibroids. AJR 186:848–854CrossRefPubMedGoogle Scholar
  21. 21.
    Goodwin SC et al (2008) Uterine artery embolization for treatment of leiomyomata. Long-term outcomes from the FIBROID Registry. Obstet Gynecol 111:22–33CrossRefPubMedGoogle Scholar
  22. 22.
    van der Kooij SM et al (2010) Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial. Am J Obstet Gynecol 203(2):105.e1–105.e13CrossRefGoogle Scholar
  23. 23.
    Spies JB et al (2002) Complications after uterine artery embolization for leiomyomas. Obstet Gynecol 100(5):874–880Google Scholar
  24. 24.
    Marret H et al (2003) Leiomyoma recurrence after uterine artery embolization. J Vasc Interv Radiol 14:1395–1400CrossRefPubMedGoogle Scholar
  25. 25.
    Pelage JP et al (2004) Uterine fibroid tumors: long-term MR imaging outcome after embolization. Radiology 230(3):803–809CrossRefPubMedGoogle Scholar
  26. 26.
    Spies JB et al (2002) Leiomyomata treated with uterine artery embolization: factors associated with successful symptom and imaging outcome. Radiology 222(1):45–52CrossRefPubMedGoogle Scholar
  27. 27.
    Marret H et al (2005) Predictive factors for fibroids recurrence after uterine artery embolisation. BJOG 112(4):461–465CrossRefPubMedGoogle Scholar
  28. 28.
    Huang JY et al (2006) Failure of uterine fibroid embolization. Fertil Steril 85:30–35CrossRefPubMedGoogle Scholar
  29. 29.
    Gabriel-Cox K et al (2007) Predictors of hysterectomy after uterine artery embolization for leiomyoma. Am J Obstet Gynecol 196:588.e1–588.e16CrossRefGoogle Scholar
  30. 30.
    Lohle PN et al (2008) Long-term outcome of uterine artery embolization for symptomatic uterine leiomyomas. J Vasc Interv Radiol 19(3):319–326CrossRefPubMedGoogle Scholar
  31. 31.
    Toor SS et al (2008) Clinical failure after uterine artery embolization: evaluation of patient and MR imaging characteristics. J Vasc Interv Radiol 19(5):662–667CrossRefPubMedGoogle Scholar
  32. 32.
    Bonney V (1931) The tecnique and results of myomectomy. Lancet 220:171–173CrossRefGoogle Scholar
  33. 33.
    Yoo EH et al (2007) Predictors of leiomyomata recurrence after laparoscopic myomectomy. J Minim Invasive Gynecol 14(6):690–697CrossRefPubMedGoogle Scholar
  34. 34.
    Reed SD et al (2006) The incidence of repeat uterine surgery following myomectomy. J Womens Health 15(9):1046–1052CrossRefGoogle Scholar
  35. 35.
    Goodwin S et al (1999) Uterine artery embolization for the treatment of uterine leiomyomata: mid-term results. J Vasc Inter Radiol 10:1159–1165CrossRefGoogle Scholar
  36. 36.
    Pelage JP et al (2005) Uterine fibroid vascularization and clinical relevance to uterine fibroid embolization. Radiographics 25(Suppl 1):S99–S117CrossRefPubMedGoogle Scholar
  37. 37.
    Payne JF et al (2003) Serious complications after uterine embolization for conservative treatment of fibroids. Fertil Steril 79(1):128–131CrossRefPubMedGoogle Scholar
  38. 38.
    Sawin SW et al (2000) Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol 183:1448–1455CrossRefPubMedGoogle Scholar
  39. 39.
    Marret H et al (2004) Late leiomyoma expulsion after uterine artery embolization. J Vasc Interv Radiol 15:1483–1485CrossRefPubMedGoogle Scholar
  40. 40.
    Are F (2008) Fibroids that become endocavitary after uterine artery embolization necessarily a complication? AJR Am J Roentgenol 190(5):1227–1230CrossRefGoogle Scholar
  41. 41.
    Radeleff B et al (2010) Expulsion of dominant submucosal fibroids after uterine artery embolization. Eur J Radiol 75:e57–e63CrossRefPubMedGoogle Scholar
  42. 42.
    Andrews RT et al (2004) Patient care and uterine artery embolization for leiomyomata. J Vasc Interv Radiol 15:115–120CrossRefPubMedGoogle Scholar
  43. 43.
    Katsumori T et al (2005) Uterine artery embolization for pedunculated subserosal fibroids. AJR Am J Roentgenol 184:399–402CrossRefPubMedGoogle Scholar
  44. 44.
    Margau R et al (2008) Outcomes after uterine artery embolization for pedunculated subserosal leiomyomas. J Vasc Interv Radiol 19:657–661CrossRefPubMedGoogle Scholar
  45. 45.
    Smeets AJ et al (2009) Safety and effectiveness of uterine artery embolization in patients with pedunculated fibroids. JVIR 20:1172–1175CrossRefPubMedGoogle Scholar
  46. 46.
    Andrews RT, Brown PH (2000) Uterine arterial embolization: factors influencing patient radiation exposure. Radiology 217:713–722CrossRefPubMedGoogle Scholar
  47. 47.
    White AM et al (2007) Patient radiation exposure during uterine fibroid embolization and the dose attributable to aortography. J Vasc Interv Radiol 18:573–576CrossRefPubMedGoogle Scholar
  48. 48.
    Nikolic B et al (2000) Patient radiation dose associated with uterine artery embolization. Radiology 214:121–125CrossRefPubMedGoogle Scholar
  49. 49.
    Tse G, Spies JB (2010) Radiation exposure and uterine artery embolization: current risks and risk reduction. Tech Vasc Interv Radiol. 13(3):148–153CrossRefPubMedGoogle Scholar
  50. 50.
    Nishizawa K et al (2008) Surface dose measurement in patients and physicians and effective dose estimation in patients during uterine artery embolisation. Radiat Prot Dosim 128:343–350CrossRefGoogle Scholar
  51. 51.
    Spies JB et al (2001) Ovarian function after uterine artery embolization for leiomyomata: assessment with use of serum follicle stimulating hormone assay. J Vasc Interv Radiol 12:437–442CrossRefPubMedGoogle Scholar
  52. 52.
    McLucas B et al (2001) Pregnancy following uterine fibroid embolization. Int J Gynaecol Obstet 74:1–7CrossRefPubMedGoogle Scholar
  53. 53.
    Chrisman HB et al (2000) The impact of uterine fibroid embolization on resumption of menses and ovarian function. J Vasc Interv Radiol 11:699–703CrossRefPubMedGoogle Scholar
  54. 54.
    Tulandi T et al (2002) Ovarian reserve after uterine artery embolization for leiomyomata. Fertil Steril 78:197–198CrossRefPubMedGoogle Scholar
  55. 55.
    Payne JF et al (2002) Embolic microspheres within ovarian arterial vasculature after uterine artery embolization. Obstet Gynecol 100(5 Pt 1):883–886PubMedGoogle Scholar
  56. 56.
    Ahmad A et al (2002) Uterine artery embolization treatment of uterine fibroids: effect on ovarian function in younger women. J Vasc Interv Radiol 13:1017–1020CrossRefPubMedGoogle Scholar
  57. 57.
    Healey S et al (2004) Ovarian function after uterine artery embolization and hysterectomy. J Am Assoc Gynecol Laparosc 11:348–352CrossRefPubMedGoogle Scholar
  58. 58.
    Hovsepian DM et al (2006) A prospective comparison of the impact of uterine artery embolization, myomectomy, and hysterectomy on ovarian function. J Vasc Interv Radiol 17:1111–1115CrossRefPubMedGoogle Scholar
  59. 59.
    Hehenkamp WJ et al (2007) Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy. Hum Reprod 22:1996–2005CrossRefPubMedGoogle Scholar
  60. 60.
    Tropeano G et al (2010) Long-term effects of uterine fibroid embolization on ovarian reserve: a prospective cohort study. Fertil Steril 94(6):2296–2300CrossRefPubMedGoogle Scholar
  61. 61.
    Tropeano G et al (2011) The timing of natural menopause after uterine fibroid embolization: a prospective cohort study. Fertil Steril 96(4):980–984CrossRefPubMedGoogle Scholar
  62. 62.
    Tropeano G et al (2003) Permanent amenorrhea associated with endometrial atrophy after uterine artery embolization for symptomatic fibroids. Fertil Steril 79(1):132–135CrossRefPubMedGoogle Scholar
  63. 63.
    Davies C et al (2002) Amenorrhea secondary to endometrial ablation and Asherman’s syndrome following uterine artery embolization. Clin Radiol 54:317–318CrossRefGoogle Scholar
  64. 64.
    Mara M et al (2007) Hysteroscopy after uterine fibroid embolization in women of fertile age. J Obstet Gynaecol Res 33:316–324CrossRefPubMedGoogle Scholar
  65. 65.
    Mara M et al (2012) Hysteroscopy after uterine fibroid embolization: evaluation of intrauterine findings in 127 patients. J Obstet Gynaecol Res 38:823–831CrossRefPubMedGoogle Scholar
  66. 66.
    Ravina JH et al (2000) Pregnancy after embolization of uterine myoma: report of 12 cases. Fertil Steril 73(1241):1243Google Scholar
  67. 67.
    Pron G, Ontario UFE Collaborative Group et al (2005) Pregnancy after uterine artery embolization for leiomyomata: the Ontario multicenter trial. Obstet Gynecol 105(67):76Google Scholar
  68. 68.
    Walker WJ, McDowell SJ (2006) Pregnancy after uterine artery embolization for leiomyomata: a series of 56 completed pregnancies. Am J Obstet Gynecol 195:1266–1271CrossRefPubMedGoogle Scholar
  69. 69.
    Holub Z et al (2008) Pregnancy outcomes after uterine artery occlusion: prospective multicentric study. Fertil Steril 90(5):1886–1891CrossRefPubMedGoogle Scholar
  70. 70.
    Pabon PI et al (2008) Pregnancy after uterine fibroid embolization: follow-up of 100 patients embolized using tris-acryl gelatin microspheres. Fertil Steril 90(6):2356–2360CrossRefGoogle Scholar
  71. 71.
    Pisco JM et al (2011) Pregnancy after uterine fibroid embolization. Fertil Steril 95(3):1121.e5–1121.e8.  https://doi.org/10.1016/j.fertnstert.2010.08.032 (epub 2010 Sep 25) CrossRefGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  1. 1.Interventional Radiology, Department of Bioimaging, Policlinico Agostino GemelliCatholic University of Sacred HeartRomeItaly
  2. 2.Gynecology, Department of Women Health, Policlinico Agostino GemelliCatholic University of Sacred HeartRomeItaly
  3. 3.Diagnostic and Interventional Radiology, Department of Bioimaging, Policlinico Agostino GemelliCatholic University of Sacred HeartRomeItaly
  4. 4.Department of Bioimaging, Policlinico Agostino GemelliCatholic University of Sacred HeartRomeItaly

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