Outcomes and reinterventions following uterine artery embolization for the treatment of uterine leiomyomata

PurposeUterine leiomyomas are common benign tumors that arise from smooth muscle and can significantly impact quality of life. Over the past two decades, uterine artery embolization has risen as a minimally invasive alternative treatment to hysterectomy or myomectomy for the management of leiomyomas. While prior work has established the safety of this procedure, there exist few reports quantifying sequelae, notably rates of subsequent treatment and primary ovarian insufficiency. The purpose of this study is to demonstrate the efficacy of uterine artery embolization as well as to investigate the frequency of gynecologic reintervention and primary ovarian insufficiency following treatment. MethodsThe study cohort consisted of patients (n=199) who presented with symptoms concerning for uterine pathology and with leiomyoma(s) confirmed by MRI. This cohort underwent embolization between January 2013 and December 2018 at a single academic institution. Data was collected from retrospective chart review and included demographics, symptomology, imaging, procedural details, and follow-up care. This data was subsequently analyzed to quantify the frequencies of various outcomes at 4-10 years following embolization. ResultsOf 199 symptomatic patients with confirmed leiomyomas, all underwent technically successful uterine artery embolization. At the time of follow-up, information was available for 188 (94.5%) patients, of which 145 (77.1%) reported significant symptomatic improvement while 34 required additional intervention--either medical (9%) or surgical (9%). The most common secondary medical management involved hormone therapy, while the most common subsequent gynecologic procedure was a hysterectomy. Additionally, there were seven (3.7%) cases of amenorrhea following embolization. ConclusionGiven its minimally invasive nature, rapid recovery time, and uterine-sparing capability, uterine artery embolization should be considered a frontline therapy for symptomatic leiomyomas. This study supports an overall low complication rate, limited hospitalization time, near-complete resolution of symptoms, and low risk of ovarian dysfunction for a majority of patients. Following embolization, only 9% of patients required additional medical management, and only 9% required a second procedural intervention.