Uterine artery embolisation for uterine leiomyomas

Background. Many forms of minimally invasive treatment have gained substantial popularity, both with the medical fraternity and the public. With the correct clinical indications and in skilled hands, uterine artery embolisation (UAE) has been accepted internationally as part of the standard of care that should be offered to patients with symptomatic uterine leiomyomas (fibroids). Objectives. To introduce UAE as an effective and safe treatment option in patients with symptomatic fibroids in the Western Cape Provincial Service, South Africa. Methods. Setting: Groote Schuur and Tygerberg hospitals, Western Cape. Design: Prospective observational multi-centre study. Methods: 36 women (mean age 38 years, range 30 - 47 years) with symptomatic fibroids were treated with UAE between November 2009 and February 2012. Pre-procedure magnetic resonance imaging (MRI) followed by a 6-month clinical follow-up plus MRI or an ultrasound scan were performed. Results. The presenting symptoms were menorrhagia, dysmenorrhoea, pressure symptoms and intermenstrual bleeding. Three women were treated for primary infertility. Uterine artery sub-selection and embolisation was successful in all patients. Complications included low-grade pyrexia (3/36, 8.3%) and readmission (1/36, 2.8%). The average reduction in uterine volume at 6 months was 50%. At followup (mean 15 months, range 7 - 32), 91.7% (33/36) had complete symptomatic resolution and 83.3% (30/36) were ‘completely satisfied’. Participants treated for primary infertility and concurrent adenomyosis did not receive any benefit from UAE. Conclusion. Uterine artery embolisation is associated with a high clinical success rate. This study suggests that UAE should be offered as an attractive alternative to surgery in our practice.