[Clinical 3-year follow-up of uterine fibroid embolization]

Abstract

Purpose: The purpose of this study was to evaluate the clinical long-term success of uterine artery embolization (UAE) in patients with symptomatic fibroids using spherical particles (Embosphere).

Materials and methods: 34 consecutive patients treated with UAE were initially enrolled in the study which had the following study goals 1) 1-year follow-up MRI evaluation of the fibroid behavior and 2) clinical long-term success due to standardized assessment of the main fibroid-related symptoms (hypermenorrhoea, dysmenorrhoea and dysuria) of the patients' individual overall health status and their therapy satisfaction at 1-year, 2- year and 3-year intervals after UAE.

Results: Technical success was achieved in all procedures. Four patients had to be excluded from the long-term evaluation schedule: one because of a hysterectomy due to bleeding after 6 weeks, 3 patients were not available for the designated minimum follow-up interval. The preinterventional severe hypermenorrhoea (n = 27) with a score of 4.4 +/- 0.7 (5 = extreme menstrual bleeding) decreased after one year to 2.1 +/- 0.5 (p = 0.0001), after two years to 1.7 +/- 0.5 (p = 0.0042) and after three years to 1.3 +/- 0.6 (p = 0.0001). The preinterventional dysmenorrhoea (n = 15) with a score of 3.1 +/- 1.5 (3 = distinctly increased dysmenorrhoea) decreased after one year to 1.1 +/- 0.3 (p = 0.0001), after two years to 1.2 +/- 0.2 and after three years to 1.2 +/- 0.4 (p = 0.148). The pretreatment dysuria (n = 12) with a preinterventional score of 3.1 +/- 1.5 (3 = distinctly increased dysuria) decreased after one year to 1.1 +/- 0.3 (p = 0.0069) and remained after two years at 1.1 +/- 0.2 and after three years at 1.2 +/- 0.4 (p = 0.905). The initial overall health status was 54.7 +/- 20.1 (maximal value 100). After one year it rised to 90.5 +/- 15.4 (p = 0.0001), was 91.8 +/- 5.6 after two years and was 91.3 +/- 8.5 (p = 0.8578) after three years. The satisfaction with the therapy was 2.9 +/- 0.2 after one year, 2.6 +/- 0.3 after two years and 2.7 +/- 0.5 (3 = extremely satisfied) after three years. We observed 12 minor and 3 major complications (one hysterectomy, one fibroid expulsion associated with a short bleeding episode and one transient amenorrhoea for three months). All patients benefited clinically from the procedure and a clinical benefit was achieved in all cases.

Conclusion: Under controlled study conditions, flow-guided UAE with spherical embolization particles achieves high clinical success for all relevant clinical symptoms without negative changes during follow-up after at least 3 years. Accordingly, patient therapy satisfaction remained extraordinarily high even 3 years after UAE.