Failure of uterine fibroid embolization

Abstract

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-mu 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 revealed 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.