Uterine artery embolisation for the treatment of symptomatic uterine fibroids is a

minimally invasive procedure first described in 1994, then performed increasingly

often in many Western countries. The method is characterised by a high success rate

85%, capable of providing significant relief in women and characterised by

a low complication rate. Uterine fibroids, the most common type of benign tumour among women in

reproductive age, are associated with heavy menstrual bleeding, abdominal discomfort,

subfertility and a reduced quality of life. Not all women are willing to undergo

uterine removal surgery, current guidelines on the clinical management of ACOG

support the technique of uterine embolisation, which is therefore an answer for

those women who wish to preserve their uterus or who have not benefited from the

medical care.

As with any procedure, careful patient selection is crucial. Ideal candidates

for uterine artery embolisation include patients with symptomatic fibroids who wish to

preserve the uterus and/or avoid surgery. Symptoms of uterine fibroids may include

menorrhagia and/or metrorrhagia; pelvic mass symptoms manifesting as pelvic pain,

sense of weight or bloating, dyspareunia, severe cramps or urinary disorders. Absolute contraindications

include pregnancy, untreated active endometritis and suspected malignancy, unless

are not treated for palliative purposes or in addition to surgery, fibroma of less than 1 cm or fibroma

with pedunculated morphology, fibroma localised in the cervix. Allergy to contrast medium, the

coagulopathy, desire for future fertility and renal insufficiency are relative contraindications.

Appropriate counselling should be carried out for the potential risks associated with the technique,

including bleeding, infection, renal damage due to contrast administration

intravascular, impact on fertility and possibility of requiring surgery.

The technique consists of injecting small particles, such as tris-acrylic gelatin spheres (TAG),

non-spherical polyvinyl alcohol (PVA) and spherical PVA, in uterine arteries after selective catheterisation,

entry into the arterial system is usually achieved by unilateral or bilateral access

to the common femoral artery. For the procedure, anaesthesia in

sedation.

The expected results after uterine artery embolisation are excellent, the SIR guidelines indicate

that approximately 90% of women should experience a reduction in general symptoms and that more

of 90% should expect the elimination of abnormal uterine bleeding, a reduction of

50-60% of fibroid size and a 40-50% reduction in uterine size. For the

women with ideal procedure selection characteristics, it is possible to achieve a high rate

of symptom control, a satisfaction rate and an increase in the quality of life rate of up to

to 10 years after the procedure. Causes of failure include poor patient selection,

large fibroids, inability to catheterise uterine arteries or embolisation

incomplete artery, arterial spasm leading to poor flow of the embolic artery,

anatomical variants of the uterus or the recanalisation of embolised arteries.

Healthy pregnancies have been reported sporadically following embolisation of the artery

uterine, but the actual fertility rate after the procedure remains uncertain. In contrast, the low

at birth, miscarriage and prematurity have been associated with the technique. Despite the risks

inherent of possible fertility problems, the procedure remains an option for women with fibroids

clinically symptomatic people who wish to become pregnant. However, further

research on conception rates and obstetrical risks of infertility.

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References

Jonathan J Keung, Uterine artery embolization: A review of current concepts. Best Pract Res Clin

Obstet Gynaecol. 2018 Jan:46:66-73. doi: 10.1016/j.bpobgyn.2017.09.003. Epub 2017 Sep 29.

Michael Young, et al. Uterine Fibroid Embolization. Treasure Island (FL): StatPearls Publishing; 2024

Jan 2023 Jul 3.

Parker E Ludwig, et al. Pregnancy success and outcomes after uterine fibroid embolisation: updated

review of published literature.

Br J Radiol. 2020 Jan;93(1105):20190551. doi: 10.1259/bjr.20190551.

Epub 2019 Oct 8.