New study evaluates effectiveness of elective unilateral uterine artery embolization (UAE) in women whose fibroids are limited to one side of the uterus and supplied by only one uterine artery.
While indications for unilateral embolization are uncommon, in the rare case when unilateral fibroid disease is present and arterial supply to the fibroids is from a single uterine artery, intentional unilateral embolization may be effective, suggests a study presented at the 35th Annual Scientific Meeting of the Society of Interventional radiology in Tampa, USA.
Luke E Stall, Georgetown University Hospital, Washington DC, USA, who presented the study, said analysis had shown that select patients could effectively be treated by elective UAE. He added that patients undergoing such a procedure experienced less post-procedure pain and that unilateral embolization could provide a greater margin of safety.
Stall quoted from the literature (Ravina et al. Arterial embolisation to treat uterine myomata. The Lancet. 1995 Sep; 346: 671-672) to highlight that there was a common perception that bilateral embolization was required for success regardless of fibroid burden or blood supply, and concern that the fibroids would not completely infarct without bilateral embolization .
Stall told delegates that an earlier study by Bratby and Walker (Outcomes after unilateral uterine artery embolization. Cardiovasc Intervent Radiol 2008; 31: 254-259) was the first to report elective unilateral uterine artery embolization. Bratby et al reported better clinical and imaging outcomes with the elective (30 patients) vs. failed catheterisation (12 pts). They concluded that “unilateral UAE can achieve a positive clinical result in the group of patients where there is a dominant unilateral artery supplying the fibroid(s), in contrast to the poor results seen following technical failure.”
The Georgetown University Hospital investigators carried out a retrospective review of 1290 patients treated with uterine artery embolization for symptomatic leiomyomata from September 2004 through July 2009. The study identified 75 patients who underwent unilateral uterine artery embolization. Most of these patients had an absent uterine artery and some had a failure of catheterisation of one uterine artery. However, 28 had intentional embolization of a single uterine artery because of unilateral fibroid disease on MRI and arterial supply to the fibroids from only the ipsilateral uterine artery on angiography. In all cases, routine embolization using micro-catheters and bilateral femoral puncture was performed.
Stall said outcome measures included peri-procedural pain, fluoroscopy time, clinical and post-procedure MR imaging outcomes. Twenty-five patients returned for three month clinical and imaging follow-up. Improvement in their symptoms was evaluated with a standard post-procedure questionnaire. Their outcomes were compared to a randomly selected control group of patients undergoing routine bilateral embolization.
Results of the Georgetown University Hospital study found that in the immediate post-embolization period, there was less pain among those with unilateral embolization versus routine bilateral embolization (VAS score 3.7 unilateral embolization vs 5.7 for bilateral embolization, p = 0.003) and they required less morphine for pain management.Unilateral emoblization also required less fluoroscopy time than bilateral (10.9 minutes vs 13.4 minutes, p = 0.013). Imaging follow-up showed that 23 of 25 patients (92%) who returned for post-embolization contrast enhanced MRI had complete infarction of their fibroids. Two of 25 patients (8%) had incomplete infarction of fibroids, with neither having greater than 25% residual enhancement. Twenty-five patients completed three-month clinical follow-up. Of these patients, six were very satisfied, sixteen patients were satisfied, two patients were neutral, and one patient reported dissatisfaction with the procedure. There were no other differences in the outcomes of these patients between the two groups.
Stall said, “Symptom resolution in these unilateral embolization patients was similar to that seen in previously published studies of patients undergoing bilateral uterine artery embolization.”