Interest of uterine artery embolization with gelatin sponge particles prior to myomectomy for large and/or multiple fibroids.
OBJECTIVE
To evaluate the efficacy of pre-myomectomy uterine artery embolization with gelatin sponge particles to reduce operative blood loss and facilitate removal of fibroids.


METHODS
This retrospective study included 33 women (mean age, 36 years; range, 24-45 years), of whom at least 18 wished to preserve fertility. They presented with at least one large myoma (mean diameter, 90 mm; range, 50-150 mm) and had undergone preoperative uterine artery embolization with resorbable gelatin sponge by unilateral femoral approach between December 2001 and November 2008. Clinical, radiological and surgical data were available for all patients. Mean haemoglobin levels before and after surgery were compared with Student's t-test.


RESULTS
No complication or technical failure of embolization occurred. The myomectomies were performed during laparotomy (25 cases) or laparoscopy (8 cases). Dissection of fibroids was easier (mean, 3 per patient; range, 1-11), with a mean operating time of 108±50 min (range, 30-260 min). Bloodless surgery was the rule with a mean estimated peroperative blood loss of 147±249 mL (range, 0-800 mL). Mean pre-(12.9±1.3g/dL) and post-therapeutic (11.4±1.2g/dL) haemoglobin levels were not statistically different (p>0.05). There was no need for blood transfusion. None of the patients required hysterectomy. The mean duration of hospital stay was 7.5±1.3 days (range, 3-12 days).


CONCLUSIONS
Preoperative uterine artery embolization is effective in reducing intraoperative blood loss and improves the chances of performing conservative surgery. It should be considered a useful adjunct to myomectomy in women at high hemorrhagic risk or who refuse blood transfusion.
Butori
Noémie
N
Department of Vascular and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, 2 bd du Maréchal de Lattre de Tassigny, BP 77908, 21079 Dijon Cedex, France.
Tixier
Hervé
H
Filipuzzi
Laurence
L
Mutamba
William
W
Guiu
Boris
B
Cercueil
Jean-Pierre
JP
Douvier
Serge
S
Sagot
Paul
P
Krausé
Denis
D
Loffroy
Romaric
R
D000328:Adult; D003287:Contrast Media; D003952:Diagnostic Imaging; D005260:Female; D005471:Fluoroscopy; D005781:Gelatin Sponge, Absorbable; D006801:Humans; D007889:Leiomyoma / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome; D055357:Uterine Artery Embolization; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*
D003287:Contrast Media