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Uterine leiomyomas (fibroids): Treatment with uterine artery embolization

Authors
Sanne M van der Kooij, MD, PhD
Wouter JK Hehenkamp, MD, PhD
Section Editors
Deborah Levine, MD
Robert L Barbieri, MD
Deputy Editor
Sandy J Falk, MD, FACOG

INTRODUCTION

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)".)

RELEVANT ANATOMY

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'.)

PATIENT SELECTION

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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Literature review current through: Jul 2017. | This topic last updated: Jan 06, 2017.
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References
Top
  1. Silberzweig JE, Powell DK, Matsumoto AH, Spies JB. Management of Uterine Fibroids: A Focus on Uterine-sparing Interventional Techniques. Radiology 2016; 280:675.
  2. Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolisation to treat uterine myomata. Lancet 1995; 346:671.
  3. Volkers NA, Hehenkamp WJ, Birnie E, et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial. Am J Obstet Gynecol 2007; 196:519.e1.
  4. Hehenkamp WJ, Volkers NA, Birnie E, et al. Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy--results from the randomized clinical Embolisation versus Hysterectomy (EMMY) Trial. Radiology 2008; 246:823.
  5. Moss JG, Cooper KG, Khaund A, et al. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG 2011; 118:936.
  6. van der Kooij SM, Bipat S, Hehenkamp WJ, et al. Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol 2011; 205:317.e1.
  7. Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev 2014; :CD005073.
  8. de Bruijn AM, Ankum WM, Reekers JA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol 2016; 215:745.e1.
  9. Spies JB, Ascher SA, Roth AR, et al. Uterine artery embolization for leiomyomata. Obstet Gynecol 2001; 98:29.
  10. Walker WJ, Pelage JP. Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG 2002; 109:1262.
  11. Lohle PN, Voogt MJ, De Vries J, et al. Long-term outcome of uterine artery embolization for symptomatic uterine leiomyomas. J Vasc Interv Radiol 2008; 19:319.
  12. Scheurig-Muenkler C, Koesters C, Powerski MJ, et al. Clinical long-term outcome after uterine artery embolization: sustained symptom control and improvement of quality of life. J Vasc Interv Radiol 2013; 24:765.
  13. Popovic M, Puchner S, Berzaczy D, et al. Uterine artery embolization for the treatment of adenomyosis: a review. J Vasc Interv Radiol 2011; 22:901.
  14. Spies JB, Myers ER, Worthington-Kirsch R, et al. The FIBROID Registry: symptom and quality-of-life status 1 year after therapy. Obstet Gynecol 2005; 106:1309.
  15. Isonishi S, Coleman RL, Hirama M, et al. Analysis of prognostic factors for patients with leiomyoma treated with uterine arterial embolization. Am J Obstet Gynecol 2008; 198:270.e1.
  16. Marret H, Cottier JP, Alonso AM, et al. Predictive factors for fibroids recurrence after uterine artery embolisation. BJOG 2005; 112:461.
  17. Gabriel-Cox K, Jacobson GF, Armstrong MA, et al. Predictors of hysterectomy after uterine artery embolization for leiomyoma. Am J Obstet Gynecol 2007; 196:588.e1.
  18. American College of Obstetricians and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol 2008; 112:387.
  19. Homer H, Saridogan E. Uterine artery embolization for fibroids is associated with an increased risk of miscarriage. Fertil Steril 2010; 94:324.
  20. Mara M, Maskova J, Fucikova Z, et al. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008; 31:73.
  21. Smeets AJ, Nijenhuis RJ, Boekkooi PF, et al. Safety and effectiveness of uterine artery embolization in patients with pedunculated fibroids. J Vasc Interv Radiol 2009; 20:1172.
  22. Smeets AJ, Nijenhuis RJ, van Rooij WJ, et al. Uterine artery embolization in patients with a large fibroid burden: long-term clinical and MR follow-up. Cardiovasc Intervent Radiol 2010; 33:943.
  23. Munro MG, Critchley HO, Fraser IS, FIGO Menstrual Disorders Working Group. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril 2011; 95:2204.
  24. Dueholm M, Lundorf E, Hansen ES, et al. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol 2002; 186:409.
  25. Kirby JM, Burrows D, Haider E, et al. Utility of MRI before and after uterine fibroid embolization: why to do it and what to look for. Cardiovasc Intervent Radiol 2011; 34:705.
  26. Siddiqui N, Nikolaidis P, Hammond N, Miller FH. Uterine artery embolization: pre- and post-procedural evaluation using magnetic resonance imaging. Abdom Imaging 2013; 38:1161.
  27. Lee MS, Kim MD, Lee M, et al. Contrast-enhanced MR angiography of uterine arteries for the prediction of ovarian artery embolization in 349 patients. J Vasc Interv Radiol 2012; 23:1174.
  28. Mori K, Saida T, Shibuya Y, et al. Assessment of uterine and ovarian arteries before uterine artery embolization: advantages conferred by unenhanced MR angiography. Radiology 2010; 255:467.
  29. Clinical recommendations on the use of uterine artery embolization (UAE) in the management of fibroids, 3rd ed, Royal College of Obstetricians and Gynaecologists, London 2013. https://www.rcog.org.uk/globalassets/documents/guidelines/23-12-2013_rcog_rcr_uae.pdf (Accessed on January 06, 2017).
  30. SELDINGER SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta radiol 1953; 39:368.
  31. Goodwin SC, Spies JB. Uterine fibroid embolization. N Engl J Med 2009; 361:690.
  32. Costantino M, Lee J, McCullough M, et al. Bilateral versus unilateral femoral access for uterine artery embolization: results of a randomized comparative trial. J Vasc Interv Radiol 2010; 21:829.
  33. Edwards RD, Moss JG, Lumsden MA, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 2007; 356:360.
  34. Das R, Champaneria R, Daniels JP, Belli AM. Comparison of embolic agents used in uterine artery embolisation: a systematic review and meta-analysis. Cardiovasc Intervent Radiol 2014; 37:1179.
  35. Vashisht A, Studd J, Carey A, Burn P. Fatal septicaemia after fibroid embolisation. Lancet 1999; 354:307.
  36. Brown KT. Fatal pulmonary complications after arterial embolization with 40-120- micro m tris-acryl gelatin microspheres. J Vasc Interv Radiol 2004; 15:197.
  37. Czeyda-Pommersheim F, Magee ST, Cooper C, et al. Venous thromboembolism after uterine fibroid embolization. Cardiovasc Intervent Radiol 2006; 29:1136.
  38. Fatal nontarget embolization via an intrafibroid arterial venous fistula during uterine fibroid embolization. J Vasc Interv Radiol 2009; 20:419.
  39. Hehenkamp WJ, Volkers NA, Birnie E, et al. Pain and return to daily activities after uterine artery embolization and hysterectomy in the treatment of symptomatic uterine fibroids: results from the randomized EMMY trial. Cardiovasc Intervent Radiol 2006; 29:179.
  40. Spencer EB, Stratil P, Mizones H. Clinical and periprocedural pain management for uterine artery embolization. Semin Intervent Radiol 2013; 30:354.
  41. Kim SY, Koo BN, Shin CS, et al. The effects of single-dose dexamethasone on inflammatory response and pain after uterine artery embolisation for symptomatic fibroids or adenomyosis: a randomised controlled study. BJOG 2016; 123:580.
  42. Worthington-Kirsch R, Spies JB, Myers ER, et al. The Fibroid Registry for outcomes data (FIBROID) for uterine embolization: short-term outcomes. Obstet Gynecol 2005; 106:52.
  43. Kaump GR, Spies JB. The impact of uterine artery embolization on ovarian function. J Vasc Interv Radiol 2013; 24:459.
  44. Hehenkamp WJ, Volkers NA, Broekmans FJ, et al. Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy. Hum Reprod 2007; 22:1996.
  45. Kim CW, Shim HS, Jang H, Song YG. The effects of uterine artery embolization on ovarian reserve. Eur J Obstet Gynecol Reprod Biol 2016; 206:172.
  46. Spies JB. Current evidence on uterine embolization for fibroids. Semin Intervent Radiol 2013; 30:340.
  47. van der Kooij SM, Hehenkamp WJ, Volkers NA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial. Am J Obstet Gynecol 2010; 203:105.e1.
  48. Pron G, Bennett J, Common A, et al. The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertil Steril 2003; 79:120.
  49. Kroencke TJ, Scheurig C, Poellinger A, et al. Uterine artery embolization for leiomyomas: percentage of infarction predicts clinical outcome. Radiology 2010; 255:834.