Fibroid-related menorrhagia: treatment with superselective embolization of the uterine arteries and midterm follow-up.
OBJECTIVE
To prospectively evaluate the effectiveness and safety of selective embolization of the uterine arteries in the management of symptomatic uterine leiomyoma.


METHODS
Eighty consecutive women (mean age, 44.7 years) with symptomatic uterine leiomyoma, none of whom desired future pregnancy, underwent superselective embolization of the uterine arteries with polyvinyl alcohol particles. In all women, arterial embolization was performed because of persistent, fibroid-related menorrhagia after failure of hormonal therapy. Follow-up consisted of office visits at 2, 6, 12, and 24 months and of ultrasonography at 2 and 6 months after the procedure.


RESULTS
Bilateral embolization of the uterine arteries was performed in 76 women; unilateral embolization, in four women. Menorrhagia disappeared in 72 (90%) women. In five (6%) women (including three women with unilateral embolization), clinical improvement was not observed, and myomectomy was needed. In one woman with a large submucosal uterine leiomyoma, hysterectomy was needed because of septic uterine necrosis. Normal menstruation resumed in all but six women. Full-term pregnancy occurred in three women after the procedure.


CONCLUSIONS
Superselective arterial embolization of the uterine arteries is an effective means of controlling symptomatic uterine leiomyoma. However, the ideal embolic regimen remains to be determined.
Pelage
J P
JP
Departments of Body and Vascular Imaging, Lariboisière Hospital-Public Assistance Hospital of Paris, 2 rue Ambroise Paré, 75475. jean-pierre.pelage@lrb.ap-hop-paris.fr
Le Dref
O
O
Soyer
P
P
Kardache
M
M
Dahan
H
H
Abitbol
M
M
Merland
J J
JJ
Ravina
J H
JH
Rymer
R
R
D000328:Adult; D000568:Amenorrhea / Q000209:etiology; D015901:Angiography, Digital Subtraction; D001158:Arteries; D003287:Contrast Media / Q000008:administration & dosage; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D007044:Hysterectomy; D007472:Iohexol / Q000008:administration & dosage; D007889:Leiomyoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D008595:Menorrhagia / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D008598:Menstruation / Q000502:physiology; D008875:Middle Aged; D009215:Myometrium / Q000601:surgery; D009336:Necrosis; D011142:Polyvinyl Alcohol / Q000008:administration & dosage; D011247:Pregnancy; D011372:Progestins / Q000627:therapeutic use; D011446:Prospective Studies; D012449:Safety; D017211:Treatment Failure; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D014599:Uterus / Q000098:blood supply*
D003287:Contrast Media; D006490:Hemostatics; D011372:Progestins; D007987:Gonadotropin-Releasing Hormone; D007472:Iohexol; D011142:Polyvinyl Alcohol