What is the place of uterine artery embolisation in the management of symptomatic uterine fibroids?

Hickey, Martha; Hammond, Ian

doi:10.1111/j.1479-828x.2008.00886.x

Cited by 11 publications

(9 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The side‐effects that occurred in both UPA and UAE groups in our study are similar to those reported previously. There is little information on the long‐term effects of UPA but, in a recent study, it was shown that repeated 3‐month courses of UPA provided effective long‐term treatment for symptomatic fibroids and that concerns about its negative influence on the endometrium were not confirmed.…”

Section: Discussionsupporting

confidence: 84%

Influence of ulipristal acetate therapy compared with uterine artery embolization on fibroid volume and vascularity indices assessed by three-dimensional ultrasound: prospective observational study

Czuczwar

Woźniak

Szkodziak

et al. 2015

Ultrasound Obstet Gynecol

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 84%

Influence of ulipristal acetate therapy compared with uterine artery embolization on fibroid volume and vascularity indices assessed by three-dimensional ultrasound: prospective observational study

Czuczwar

Woźniak

Szkodziak

et al. 2015

Ultrasound Obstet Gynecol

View full text Add to dashboard Cite

show abstract

“…These complications include post embolization syndrome (pain, nausea, vomiting and fever), persistent vaginal discharge, premature ovarian failure, vaginal expulsion of an infarcted fibroid, intrauterine infection, sepsis and death. Most of the observed complications are minor and occur during the first three months after UAE [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Predicting the results of uterine artery embolization: correlation between initial intramural fibroid volume and percentage volume decrease

Czuczwar¹,

Woźniak²,

Szkodziak³

et al. 2014

View full text Add to dashboard Cite

Introduction and objectiveUterine artery embolization (UAE) is a minimally invasive treatment option for symptomatic fibroids. Long-term follow-up studies have shown that at five-year follow-up after UAE, up to 30% of patients required a hysterectomy. Therefore, it seems of utmost importance to identify patients, who are unlikely to benefit from UAE. It has been postulated that the percentage volume reduction of fibroids may predict long-term UAE outcome. The results of available studies are equivocal, therefore it seemed of interest to investigate the correlation between the preinterventional intramural fibroid volume and imaging outcome of UAE in premenopausal patients.Material and methodsUterine artery embolization was performed in 65 premenopausal patients with symptomatic, intramural fibroids. Dominant fibroid volume was assessed using an integrated VOCAL (Virtual Organ Computer-aided AnaLysis) imaging program at baseline and 3 months after UAE. The percentage reduction of fibroid volume was calculated. The association between preinterventional fibroid volumes and percentage volume reductions was determined with the Spearman rank correlation test.ResultsBefore UAE, the median dominant fibroid volume was 101 cm3 (range 23.6-610). At three-month follow-up the median dominant leiomyoma volume decreased to 50.4 cm3 (range 6.9-193.9). Median percentage reduction of fibroid volume three months after UAE was calculated at 50.1% (range 2.7-93.5). The Spearman correlation test between the preinterventional dominant fibroid volume and percentage volume reduction showed a statistically significant, positive correlation (R = 0.33; p = 0.006).ConclusionsThe percentage volume reduction of intramural leiomyomas after UAE seems to be more pronounced in the case of larger tumors.

show abstract

“…Low‐level data from subgroup analyses of small studies suggest slightly improved outcomes with myomectomy (ie, lower rates of miscarriage and higher rates of live births) 45 . However, the quality of the evidence is low, with insufficient comparison between the two procedures to assess fertility outcomes, but it appears that UAE does not increase the risk of radiation‐associated cancer or radiation‐related infertility 46 , 50 …”

Section: Leiomyomasmentioning

confidence: 99%

“…49,50 Pregnancy concerns include intrauterine growth restriction, malpresentation, pre-term labour, uterine rupture, post-partum haemorrhage and increased risk of caesarean delivery. 46,50,51 While live births have been reported after the procedure, the evidence regarding the impact of UAE on fertility is poor. Low-level data from subgroup analyses of small studies suggest slightly improved outcomes with myomectomy (ie, lower rates of miscarriage and higher rates of live births).…”

Section: Minimally Invasive Managementmentioning

confidence: 99%

“…45 However, the quality of the evidence is low, with insufficient comparison between the two procedures to assess fertility outcomes, but it appears that UAE does not increase the risk of radiation-associated cancer or radiation-related infertility. 46,50 The rate of ovarian failure after UAE may be up to 7% and it most commonly occurs in women aged over 45 years. 52 A recent systematic review showed no significant difference in ovarian failure between UAE and hysterectomy or myomectomy, and current guidelines suggest that UAE should only be offered to symptomatic women wishing to preserve their fertility, after a full discussion about the potential impact of this procedure on fertility.…”

Section: Minimally Invasive Managementmentioning

confidence: 99%

See 1 more Smart Citation

Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas

Brennan

Hickey

2018

Medical Journal of Australia

Self Cite

View full text Add to dashboard Cite

Abnormal uterine bleeding refers to any change in the regularity, frequency, heaviness or length of menstruation. There are several potential causes for bleeding disturbance, the two most common being primary endometrial dysfunction and fibroids. Management of abnormal uterine bleeding involves both medical and surgical options and will largely depend on a patient's fertility plans. The use of levonorgestrel-releasing intrauterine devices for heavy menstrual bleeding is increasing in Australia, and they are considered first-line medical management for women accepting of hormonal therapies. Tranexamic acid, non-steroidal anti-inflammatory drugs, the combined oral contraceptive pill and oral progestins offer alternatives. Hysterectomy offers a definitive surgical approach to abnormal uterine bleeding and is associated with high levels of patient satisfaction. Women wishing to preserve their fertility, or avoid hysterectomy, may be offered myomectomy. Submucosal fibroids should be removed via hysteroscopy in symptomatic or infertile patients. Intramural and subserosal fibroids may be removed via an open or laparoscopic approach. There are several minimally invasive options, including uterine artery embolisation, magnetic resonance-guided focused ultrasound and endometrial ablation, but patients should be aware that there is insufficient evidence to ensure fertility preservation with these procedures and further research is needed. Areas for additional research include cost-effectiveness of treatments and quality of life comparisons between management options using patient reported outcome measures to evaluate patient satisfaction.

show abstract

What is the place of uterine artery embolisation in the management of symptomatic uterine fibroids?

Abstract: UAE should be considered as an alternative to surgical management of symptomatic uterine fibroids in carefully selected and informed patients.

Cited by 11 publications

References 41 publications

Influence of ulipristal acetate therapy compared with uterine artery embolization on fibroid volume and vascularity indices assessed by three-dimensional ultrasound: prospective observational study

Influence of ulipristal acetate therapy compared with uterine artery embolization on fibroid volume and vascularity indices assessed by three-dimensional ultrasound: prospective observational study

Predicting the results of uterine artery embolization: correlation between initial intramural fibroid volume and percentage volume decrease

Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas

Contact Info

Product

Resources

About