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Uterine Artery Embolization in the Primary Treatment of Uterine Leiomyomas

Technical Features and Prospective Follow-Up with Clinical and Sonographic Examinations in 58 Patients

¹ Service de Radiologie Adultes (Pr Rouleau), Hôpital Bretonneau, CHRU Tours, F.37044 Tours, Cedex 01, France.
² Service de Neuroradiologie (Pr Herbreteau), Hôpital Bretonneau, Cedex 01, France.
³ Départment de Gynécologie-Obstétrique (Pr Lansac), Hôpital Bretonneau, Cedex 01, France.
⁴ Service de Médecine Nucléaire et Ultrasons (Pr Pourcelot), Hôpital Bretonneau, Cedex 01, France.

OBJECTIVE. The purpose of this study was to analyze the technical features of uterine artery embolization and to evaluate the effectiveness of this method as the primary treatment of uterine leiomyomas in a series of 58 patients monitored by clinical and sonographic examinations.

SUBJECTS AND METHODS. Fifty-eight women (age range, 33-65 years; mean age, 44.5 years) with symptoms caused by uterine leiomyomas (abnormal bleeding, bulk-related symptoms, pelvic pain) were included in this prospective study. We performed embolization with a single catheter using the single-femoral artery approach, injection of particles (150-250 mm), and an absorbable gelatin sponge. Postprocedural pain was assessed using a visual analog scale. Systematic follow-up included clinical and sonographic examinations at 3 months for 58 patients, at 6 months for 46 patients, at 1 year for 27 patients, and at 2 years for seven patients.

RESULTS. Embolization was performed without problems in 84% of the patients. Post-procedural pain control was excellent in 90% of the patients. In most patients, symptoms were improved or had resolved at 3 months (90%), 6 months (92%), and 1 year (93%), and all patients were symptom-free at 2 years. Clinical failure of treatment occurred in only two patients (3%). Progressive reduction in leiomyoma size was revealed during sonographic follow-up, and new leiomyomas were seen in one patient at 2 years.

CONCLUSION. Uterine artery embolization is an endovascular method for the treatment of uterine leiomyomas that is clinically effective in most patients and that induces a progressive reduction in the size of the largest leiomyomas.

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