OC102: Assessment and embolization of uterine fibroids

Although embolization has been increasingly employed by radiologists since the 1970 for many differing conditions, fibroid embolization is comparatively new, despite fibroids being a logical target for embolization. Before fibroid embolization is carried out it is particularly important that the radiologist and gynaecologist are confident in the diagnosis. Embolization should be offered only to symptomatic women complaining of heavy menstrual bleeding, pelvic pain or bulk-related symptoms. Preprocedure imaging should provide precise information on the number, type and size of fibroids with special attention paid to pedunculated subserosal and submucosal fibroids. Associated conditions such as adenomyosis or adnexal abnormality should be excluded. Results of embolization are generally similar with a success rate of over 85% for control of menorrhagia or bulk-related symptoms. The volume reduction of the dominant fibroid is larger than uterine volume reduction and varies between 40 to 70% for the fibroid and 25 to 50% for the whole uterus. Serious complications are mainly infections which have led to hysterectomy in approximately 5:1000 patients. Infective complications are more likely with large sub-mucosal or pedunculated subserosal fibroids. Four deaths have occurred following embolization, two from pulmonary emboli and two due to infection in approximately 40 000 cases (0.1:1000). A further documented complication of fibroid embolization is ovarian failure. This complication occurs mainly in women (3%) over the age of 45. From an economical point of view, embolization is a valuable alternative to surgery mainly because of a shorter hospital stay and faster recovery. A sufficient number of fibroid embolizations have been carried out and the results published to date strongly indicate that this is a viable alternative to hysterectomy and multiple myomectomy for symptomatic women.