Uterine Artery Embolization in the Management of Symptomatic Uterine Fibroids: An Overview of Complications and Follow-up

Abstract

Uterine artery embolization (UAE) evolved as a treatment for symptomatic uterine fibroids in the early 1990s, after initially being used as a temporizing measure prior to hysterectomy or myomectomy. Since that time, over 100,000 UAEs have been performed. Technical success rates have been quoted ranging from 94 to 99%. The overall incidence of major complications associated with the procedure is low, the majority of which can be prevented. Knowledge of the potential complications and the measures that can be taken to avoid these complications is essential. Furthermore, because UAE is a relatively new procedure, no standardized recommendations for patient follow-up exist. Common practice for patient follow-up includes both clinic visits at increasing time intervals postprocedure, as well as telephone follow-up, and imaging follow-up when necessary. As symptomatic improvement is subjective, some institutions have developed standardized questionnaires to better assess patient improvement postprocedure. Aggressive pain control is a crucial component of follow-up, as uncontrolled pain can result in readmission and patient dissatisfaction.

Keywords: Uterine artery embolization; fibroids; leiomyomata.

Figure 1

(A–C) Axial T1-weighted postcontrast and sagittal short inversion time (STIR) images demonstrate a fluid-filled, dilated, enhancing right fallopian tube, compatible with tubo-ovarian abscess, in a patient who was treated with uterine artery embolization 3 months prior.

Figure 2

(A) Sagittal short inversion time (STIR) image demonstrates a 10-cm submucosal fibroid prior to treatment. (B) Sagittal STIR image demonstrates involution of the submucosal fibroid 9 months after uterine artery embolization.

Figure 3

(A) Sagittal T2-weighted magnetic resonance image (MRI) demonstrates uterine fibroids in the posterior uterine wall and fundus in a patient with adenomyosis. (B) Sagittal short inversion time (STIR) image postuterine artery embolization demonstrates involution of the uterine fibroids in the posterior uterine wall, with persistent fundal fibroid. Failure rate is reported to be higher in patients with adenomyosis.