Uterine Artery Embolization as an Efficacious Stand-Alone Technique in Management of Symptomatic Uterine Leiomyomata

Abstract

U terine artery embolization is now evolving to be the first-line therapy for symptomatic uterine leiomyoma alongside elder conventional alternatives comprising hysterectomy and myomectomy whether surgical or endoscopic. Many clinical trials have confronted UAE and surgical therapies as regard safety and efficacy in treatment of symptomatic leiomyomas where UAE exhibited comparable short and mid-term clinical outcomes, encompassing symptomatic amelioration, better quality of life and psychological satisfaction benefiting from uterine preservation. Our study is a prospective cohort study that included 30 patients with mean age of 34.2 (31-45 years) that underwent UAE after adequate patient preparation and pelvic MRI with contrast. The uterine, dominant leiomyoma volumes were calculated in cm3 pre-procedural as a baseline and 6 months post-procedural. Descriptive data obtained was the procedure parameters, uterine and leiomyoma volume changes, and questionnaire responses. As baseline parameters, the patient’s age, most annoying symptom, the uterine and dominant fibroid volumes, sum of leiomyomata, and site of dominant leiomyoma were all gathered. Among 21 patients presented with bleeding, 90.5% of patients reported symptomatic improvement at 1 month post-procedure continued to increase to reach 95.2% at 3 months. Fourteen patients complained from pressure symptoms. At 1-month follow-up, 71.44% of them stated improvement, 14.28% had stationary course with similar percentage exhibited slightly worse response. Contrariwise, 85.71% of patients reported symptomatic amelioration at 3 months and 14.3% had no change. Of 13 patients admitted with pelvic pain, 53.8% get improved, 30.8% showed no change, 15.4% gave slightly worse response in comparison to 84.6%, 7.7%, 7.7% at 1, 3 months follow-up clinical assessment visits. Among three patients presented with infertility, one got pregnant at 3 months follow up. Patient satisfaction was analogous to improvement on clinical scale. Nineteen patients (63.3%) were satisfied at 1 month follow up which increased up to 25 patients (83.3 %) at 3 months. Preprocedural analysis of MRI showed mean of uterine as well as dominant leiomyoma volumes of 783.33 (range: 333-1165 cm3) and 279.6 (Range: 77-486 cm3) respectively. The mean uterine volume was reduced by 30% (standard deviation [SD] 0.03) 6 months after treatment. Similarly, mean dominant leiomyoma volume was reduced by 44 % (SD 0.06) after 6 months.