Transcatheter uterine artery embolization for leiomyoma: mid-term results and effects on outcome

Objective To evaluate the midterm result of transcathether uterine artery embolization (TUAE) in the treatment of uterine fibroids and its factors affecting outcome. Methods TUAE was performed in 78 cases of uterine fibroids. Mean patient age was 39.8 years (range, 29-48 years) .Of them, 71 patients presented with menstrual bleeding, lower abdominal and/or lumbago pain, and utinary irritation. There were intramural myomas in 72 patients and submucous in 6 patients. There were multiple myomas in 71 patients and single in 7 patients. The largerest dominant myomas diameter was ≤3 cm in 30 patients and 3 cm in 48 patients. Lipiodol-pingyangmycin emulsion (LPE) was used as embolic agent with amount of lipiodol ranged from 8-20 ml and pingyangmycin from 8-16 mg. Forty-six patients followed by embolization with Gelfoam sponge particles (GSP). Bilateral uterine arteries were embolized in 71 patients and unilateral in 7 patients (becausing of an absent uterine artery in 5 patients and technical failure in 2 patients). The follow-up period of all patients was over 3 years. Results Total improvement of symptoms occurred in 97.4%. The median reduction in the fibroid volum was 59.8% at 1 year, 62.7% at 2 years and 64.6% at 3 years, respectively. The mean uterine volume reduction rates was 50.1% at 1 year, 53.9% at 2 years, and 55.8% at 3 years, respectively. There was a much higher percentage reduction in the fibroid volume in the patients with the largerest dominant diameter ≤3 cm than in the patients with the largerest dominant diameter3 cm. A submucosal leiomyoma location was associated with a greater volume reduction. Embolization with combination of PLE and GSP had improved a percentage reduction in myomas volume, but increasing of dose of lipiodol and pingyangmycine did not improve a percentage reduction in myoma volume. Conclusion TUAE is associated with a good mid-term efficacy in treatment of uterine fibroids. The factors affecting results include tumor size and location, using of GSP, and performing of bilateral embolization.