Uterine Artery Embolization in Women with Symptomatic Cervical Leiomyomata: Efficacy and Safety

Abstract

Purpose: To perform an evaluation on safety and efficacy of uterine artery embolization (UAE) in the patients with symptomatic cervical leiomyomata.

Methods: Patients with symptomatic cervical leiomyomata who underwent UAE in one specialized hospital were retrospectively analyzed, both clinically and with MR imaging. The 3-month outcomes were assessed with MR imaging and a validated questionnaire. Long-term follow-up was assessed by direct contact or file review. To determine the efficacy of UAE for cervical leiomyomata, the primary objective was to assess the clinical outcome with the UFS-QOL questionnaire, containing the health-related quality of life (HRQOL) and symptom severity score (SSS). To assess safety, the secondary objective included leiomyomata volume reduction, the infarction/complication rate and secondary interventions were needed.

Results: Between 2006 and 2017, eight of 1180 patients underwent UAE and were eligible for inclusion. All embolizations were technically successful (n = 8). At 3 months, all patients showed cervical leiomyomata volume reduction with a median reduction of 41.5% (38.8 cm³) compared to baseline (p = 0.012). No complications occurred. At a median follow-up of 3 months (range 1-7, n = 7), the HRQOL and SSS improved with a median difference of 13 points (range - 5 to 60, p = 0.063) and - 13 points (range - 79 to 3, p = 0.046), respectively. Long-term follow-up showed two secondary interventions (median of 43.5 months). Six patients reported no symptom recurrence.

Conclusion: UAE in women with symptomatic cervical leiomyomata is effective and safe with significant improvement in symptoms and quality of life. UAE is a valuable option for women seeking a non-surgical solution.

Keywords: Cervical leiomyomata; Health-related quality of life (HRQOL); Uterine artery embolization.

Fig. 1

Overview of afferent branching arteries to cervical leiomyomata as identified during UAE. Note Boxes type 1, 2.1 and 2.2 are the locations of the catheters as used per subtype. Subtype 1 with a plexus of feeding branches to the cervical leiomyomata. Subtype 2.1 with a proximal single branch from uterine artery to the cervical leiomyomata. Subtype 2.2 with a distal single branch from uterine artery to the cervical leiomyomata. Type 2 cases were, when possible, super-selectively catheterized

Fig. 2

Median cervical leiomyomata volume reduction (cm³) until 3 months of follow-up compared to baseline

Fig. 3

MRI (SAG T1 − TSE − HR contrast +) imaging of cervical leiomyomatas in combination with uterine body fibroids. Note Patient no. 6, MR images (sagittal T1 − TSE − HR + contrast) of leiomyomata in the uterine body and cervix. A Both the cervical leiomyomata (106 cm³) and the uterine body leiomyomata demonstrated full enhancement prior to UAE. B Follow-up imaging 3 months after UAE with 5% enhancement of the leiomyomata in the uterine body and no enhancement of the cervical leiomyomata, as a result of complete infarction after bilateral UAE (2cc700 µm, 4cc900 µm and 4cc1200 µm microspheres, Embozene™). The cervical leiomyomata volume 3 months after UAE was 77 cm³ with a volume reduction of 27%

Fig. 4

MRI (SAG T1 − TSE − HR contrast +) imaging of a solitary cervical leiomyomata. Note Patient no. 2, MR images (sagittal T1 − TSE − HR + contrast) of a single cervical leiomyomata in a 37-year-old patient with heavy menstrual blood loss and a wish to conceive. Cervix with a broad-based leiomyomata on the left. A The cervical leiomyomata (106 cm³) with full enhancement prior to UAE. B MR imaging 3 months after UAE showed 95% infarction with an irregular enhancing rim. Unilateral left-side UAE with 2cc500, 2cc700 and 3cc900 µm microspheres Embozene™; 47% volume reduction (56.4 cm³)

Fig. 5

Total quality of life and symptoms severity scores at baseline and 3 months of follow-up