Embolization for the treatment of large, complex fibroids in an outpatient setting: A report of 2 cases

Abstract

Uterine leiomyomas are the most common benign pelvic tumors in premenopausal women, causing significant morbidity. Uterine fibroid embolization is a minimally invasive alternative to traditional open or laparoscopic surgeries for the management of symptomatic uterine leiomyoma. For large fibroids, hospitalization after treatment is often required. However, there are limited data on patients with large, complex uterine leiomyomas treated by embolization. This report of 2 cases describes 2 females with large, complex fibroids causing pain and decreased quality of life who were evaluated and treated with embolization in the outpatient setting. Each patient underwent transradial cannulation and uterine artery embolization under local anesthesia or conscious sedation and returned home without complication. For women wishing to preserve their uterus, uterine fibroid embolization is an effective nonsurgical alternative to hysterectomy and myomectomy in an outpatient setting. If standard protocols are followed, embolization by way of transradial artery catheterization is safe for the treatment of large, complex, symptomatic fibroids in the outpatient setting; however, additional studies with larger cohorts are warranted. Accessing the uterine arteries transradially reduces the risk of intra- and post-operative complications for patients, reduces their time spent in a hospital, and minimizes operating costs.

Keywords: Endovascular embolization; Fibroid embolization; Minimally invasive; Uterine fibroid embolization; Uterine fibroids; Uterine leiomyoma.

Fig. 1

Arteriography of the dominant left fibroid in Case 1. (a) Left arteriography off the left uterine artery with a very large subserosal fibroid before embolization. (b) Left uterine artery arteriogram after embolization of the large subserosal fibroid.

Fig. 2

Duplex ultrasonography from Case 2 prior to treatment. (a) Ultrasonography of the uterus. (b) Fibroid 1 with x and y dimensions measured. (c) Fibroid 2 with x and y dimensions measured on the left and z dimensions measure on the right. (d) Fibroid 3 with x and y dimensions measured on the left and z dimensions measure on the right.

Fig. 3

Arteriography of the left uterine artery in Case 2. (a) Fluoroscopic imaging of the left uterine artery before embolization. (b) Right uterine artery after embolization.

Fig. 4

Duplex ultrasonography from Case 2 Post-op day 1 of fibroid 1. (a) Fibroid 1 with x and y dimensions measured on the left and z dimensions measure on the right.