Updates on Uterine Artery Embolization

Abstract

Uterine fibroids (leiomyomas) are the most common benign neoplasm of the female pelvis and have a lifetime prevalence exceeding 80% among African American women and approaching 70% among Caucasian women. Approximately 50% of women with fibroids experience symptoms which may include menorrhagia that may result in anemia, bulk symptoms with bladder and bowel dysfunction and abdominal protrusion, dysmenorrhea, and infertility. Hysterectomy remains the most common treatment option for fibroids and concerns have been raised about the overuse of this procedure. Uterine artery embolization (UAE) is now a well-established uterine preserving and minimally invasive therapy for symptomatic fibroids. Since its introduction, strong evidence for safety and efficacy of UAE has been generated with low rates of complications. This review will discuss UAE for the management of symptomatic uterine fibroids with special focus on emerging technical approaches and novel periprocedural patient care.

Minimally invasive surgery for uterine fibroids

“…It may be an alternative to traditional treatment, especially for women with multiple fibroids, very large fibroids, restricted operability, or a history of multiple operative procedures in the abdomen [41]. UAE has some contraindications, including viable pregnancy, active infection, and suspected uterine, cervical, or adnexal malignancy [42]. However, UAE has many advantages, such as less blood loss, shorter operative times, and shorter hospital stays [43].…”

Uterine artery embolization in the treatment of symptomatic fibroids – state of the art 2018

“…Fibroid-related bleeding in postmenopausal women may also occur and should be very carefully diagnosed prior to UAE. Underlying malignancy or endometrial hyperplasia should be considered and first-line biopsy is recommended [6]. It is also important to assess the risk of sarcoma, although this may be very challenging preoperatively [15].…”

“…demonstrated that regardless of the embolic material used, pedunculated serosal fibroids were less likely to infarct than transmural tumours [23]. Thus, while the embolization of pedunculated fibroids may be safe, the chance of successful treatment may be lower compared with fibroids in other uterine locations [6].…”

“…Infection is potentially the most serious complication after UAE [25]. The presence of an intrauterine device (IUD) may be considered a risk factor for post-procedural infection and it was recommended before to remove the IUD prior to UAE [6]. The combination of a foreign body within the uterine cavity and necrotic fibroid tissue following UAE was thought to increase the rate of infection [26].…”

“…Our review will focus on the novel updates on UAE in symptomatic fibroids management. Since its introduction, strong evidence for safety and efficacy of UAE with low rates of complications has been published [6]. In this review we present the current state of knowledge about UAE as a well-established uterine preserving and minimally invasive therapy for symptomatic fibroids.…”