title: Provision of a mobile uterine artery embolization service to medically underserved areas in Brazil.
abstract: OBJECTIVE
  To determine the feasibility, efficacy, and safety of a mobile uterine artery embolization (UAE) program for patients in medically underserved, socioeconomically deprived areas.
  
  
  METHODS
  One hundred women with symptomatic uterine leiomyomas were treated with UAE. A small truck containing a mobile c-arm and all needed supplies visited one hospital per week during a 6-month period. Four public hospitals were visited in rotation. Pre- and postprocedural magnetic resonance (MR) imaging and validated quality of life (QOL) questionnaires were obtained, and procedural details and complications were recorded.
  
  
  RESULTS
  Technical success was achieved in 97 of 100 women. Mean procedure time was 41 minutes (range, 15-140 min) and mean fluoroscopy time was 17 minutes (range, 6-45 min). Mean hospital stay was 1.03 days (range, 1-3 d) and mean time to resumption of normal activities was 8.2 days (range, 2-20 d). At 12 weeks, 88% of patients noted symptomatic improvement and 98% stated they would recommend the procedure to other women. Complete tumor ischemia was seen on postprocedural MR imaging in 92% of women, with a mean uterine volume reduction of 36.3% (range, -4.3% to 65%) and a mean tumor volume reduction of 57.1% (range, -23.4% to 95.8%). Health-related QOL scores increased from 41.4 points before UAE to 81.2 points at 12 weeks and 85.3 points at 1 year after UAE. Complications were recorded in seven women (7%): three puncture site hematomas, three readmissions for pain control, and one case of leiomyoma passage.
  
  
  CONCLUSIONS
  A mobile interventional radiology unit is a feasible, efficient, and safe method to provide UAE to an underserved patient community. Outcomes and complications are similar to published results from centers with conventional angiographic facilities.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil. kisilevn@uol.com.br
authors.forename: Nestor
authors.initials: N
authors.lastname: Kisilevzky
authors.forename: Henrique
authors.initials: H
authors.lastname: Elkis
mesh_terms: D000328:Adult; D001938:Brazil; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility; D006779:Hospitals, Public; D006801:Humans; D007889:Leiomyoma / Q000175:diagnosis / Q000628:therapy*; D007902:Length of Stay; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008507:Medically Underserved Area; D008875:Middle Aged; D008952:Mobile Health Units; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D011446:Prospective Studies; D011788:Quality of Life; D015641:Radiography, Interventional; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D055357:Uterine Artery Embolization / Q000009:adverse effects; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000628:therapy*