Uterine Artery Embolization for Management of Symptomatic Fibroids

Abstract

Abstract

Uterine leiomyomata (i.e., fibroids) are common benign tumors that have traditionally been managed surgically (i.e., myomectomy or hysterectomy). Fibroids are the most common indication for hysterectomy in the United States. Medical therapy with gonadotropin-releasing hormone agonists is limited and generally used prior to surgical treatment.

The technique of uterine artery embolization, introduced in 1995, is a minimally invasive nonsurgical therapeutic option used in the management of women with symptomatic fibroids. Indications for transcatheter embolotherapy include (1) heavy menstrual bleeding (e.g., anemia) and (2) “bulk” symptoms to include pelvic fullness resulting in urinary tract symptoms (e.g., urgency and frequency), gastrointestinal symptoms (e.g., constipation), and low back pain secondary to pressure.

Because the long-term effect of uterine artery embolization on the menstrual cycle and capacity for reproduction are not fully known, the procedure is generally not recommended for women desiring future fertility. However, more recent reports describe women who have had normal full-term infants after uterine artery embolization.

This comprehensive article will review the clinical, imaging, and catheter—based technical aspects of the uterine artery embolization procedure. Anatomy complications, outcomes and radiation doses will be described. The importance of imaging studies in the pre and post procedure evaluation of the patient will be emphasized. The reader will hopefully gain a greater understanding of the role of this rapidly evolving nonsurgical technique used in treating women with significant fibroid-related symptoms.