Failure of uterine fibroid embolization

Objective

To assess the outcomes of patients who underwent uterine fibroid embolization (UFE) and to evaluate factors associated with failure of UFE.

Design

Retrospective study.

Setting

University teaching hospital.

Patient(s)

Two hundred thirty-three consecutive patients who underwent UFE from November 1997 to February 2004.

Intervention(s)

Uterine fibroid embolizations were performed by three interventional radiologists using 355–500-μ polyvinyl alcohol particles.

Main Outcome Measure(s)

Hysterectomy rate, myomectomy rate, and repeat UFE rate.

Result(s)

With a mean follow-up of 13 months, a total of 22 patients underwent surgery after UFE (9.4%); 16 had hysterectomies (6.9%), and 6 had myomectomies (2.6%). This included 3 patients who underwent repeat UFE and subsequently required surgical intervention. The mean (± SEM) time interval between UFE and subsequent treatment was 12.5 ± 2.0 months. Among patients who required surgery, 13 (59.1%) presented with recurrent menorrhagia, and 5 (22.7%) complained of persistent abdominal pain. Histopathologic examination revelead concomitant findings of adenomyosis in 25% of hysterectomy specimens. Patients who failed UFE were more likely to have had a previous myomectomy (13% vs. 2.4%) and significant reduction in the uterine size 6 months after UFE (57.1% vs. 25.2%).

Conclusion(s)

The overall failure rate of UFE is 9.4%. Failure is mainly due to persistent menorrhagia and abdominal pain. Shrinkage of the uterus after UFE does not necessarily correlate with long-term success of UFE.

Key Words:  Uterine fibroid embolization , uterine artery embolization , fibroids , leiomyoma , menorrhagia , complications , polyvinyl alcohol , failure rate