Uterine leiomyomas (fibroids): Treatment with uterine artery embolization
- Sanne M van der Kooij, MD, PhD
Sanne M van der Kooij, MD, PhD
- Academic Medical Centre Amsterdam
- Wouter JK Hehenkamp, MD, PhD
Wouter JK Hehenkamp, MD, PhD
- VU University Medical Center, Amsterdam
- Section Editors
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Uterine artery embolization (UAE) was introduced for the treatment of symptomatic uterine leiomyomas (fibroids) in 1995 [1,2]. UAE treatment of fibroids is performed worldwide. Fibroids are a common gynecologic problem and result in symptoms that impact quality of life and may result in anemia or other adverse effects. There are many options for treatment, including hormonal therapy, hysteroscopic or abdominal myomectomy, and hysterectomy. UAE provides a minimally invasive and uterine-sparing treatment option.
This topic reviews UAE for uterine fibroids. The diagnosis and general principles of management of fibroids are discussed in detail separately. (See "Uterine leiomyomas (fibroids): Epidemiology, clinical features, diagnosis, and natural history" and "Overview of treatment of uterine leiomyomas (fibroids)".)
The majority of the blood supply to the uterus derives from the uterine arteries, and there is also collateral perfusion from the ovarian arteries (figure 1). The uterine arteries originate from the anterior division of the internal iliac arteries in the retroperitoneum (figure 2). They may share a common origin with the obliterated umbilical artery, internal pudendal, or vaginal artery. The ovarian arteries arise from the abdominal aorta. The right ovarian vein returns to the inferior vena cava while the left ovarian vein returns to the left renal vein. (See "Surgical female pelvic anatomy", section on 'Vasculature'.)
Indications — Uterine artery embolization (UAE) is a treatment option for women with symptomatic uterine leiomyomas. There are many treatment options for uterine fibroids and the clinician must guide the patient through this choice. (See "Overview of treatment of uterine leiomyomas (fibroids)".)
Ideal candidates for UAE include women with all of the following characteristics [3-5]:
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- RELEVANT ANATOMY
- PATIENT SELECTION
- - Prognostic factors
- PREPROCEDURE EVALUATION
- History and physical examination
- Laboratory testing
- Pelvic imaging
- PREPROCEDURE PREPARATION
- Informed consent
- Antibiotic prophylaxis
- Procedure setting
- Catheter placement
- Early complications
- Late complications
- Need for subsequent treatment
- Uterine artery embolization versus surgery
- REPRODUCTIVE OUTCOMES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS