UTERINE ARTERY EMBOLIZATION AS AN EFFICACIOUS STAND-ALONE TECHNIQUE IN MANAGEMENT OF SYMPTOMATIC UTERINE LEIOMYOMATA

Background: Uterine artery embolization is now evolving to be the first-line therapy for symptomatic uterine leiomyoma alongside elder conventional alternatives comprising hysterectomy and myomectomy whether surgical or endoscopic. Many clinical trials have confronted UAE and surgical therapies as regard safety and efficacy in treatment of symptomatic leiomyomas where UAE exhibited comparable short and mid-term clinical outcomes, encompassing symptomatic amelioration, better quality of life and psychological satisfaction benefiting from uterine preservation.
Aim of the Work: to emphasize the role of the trans-catheter uterine artery embolization as an effective stand-alone technique in treating the symptoms attributable to uterine leiomyomata.
Patients and Methods: This study included 30 patients with uterine fibroids referred from gynecology clinic to interventional radiology unit to be counseled for UAE.
Results: Follow-up symptomatic assessment was done for all patients at 1 and 3 months. Most patients confirmed symptomatic amelioration at 1 months persisting or continue at 3-month follow-up visit. Among 21 patients presented with bleeding, 90.5% of patients reported symptomatic improvement at 1 month post-procedurally continued to increase to reach 95.2% at 3 months follow-up visit, however, no significant symptomatic change was noted between 3, 6 months follow up. Fourteen patients complained from pressure symptoms. At 1-month follow-up, 71.44% of patients stated improvement, 14.29% had stationary course with similar percentage exhibited slightly worse response. Contrariwise, 85.71% of patients reported symptomatic amelioration at 3 month and 14.3% had no change. Indifferent from bleeding, a highly statistically significant time improvement between 1, 3 months follow up is notable. Of 13 patients admitted with pelvic pain, 53.9% get improved, 30.77% showed no change, 15.38 % gave slightly worse response in comparison to 84.7%, 7.69%, 7.69% at 1, 3 months follow-up clinical assessment visits. There is clinical reduction of pain between 1, 3 months however it didn’t reach clinical significance. Among three patients presented with infertility, one gets pregnant at 3 months follow up with no significant change between 1, 3 months follow up. On MRI, the mean uterine volume was reduced by 30% 6 months after treatment. Similarly, mean dominant leiomyoma volume was reduced by 44 % after 6 months. There was highly statistically reduction of volume between 1 and 6 months follow up. Conclusion: Although limited by small sample size however we might conclude that UAE is associated with considerable cumulative reduction of leiomyoma volume that parallels patients’ symptomatic amelioration and psychological satisfaction and should be considered among first lines of management of symptomatic leiomyoma particularly in child-bearing age.