Long-term Outcome of Uterine Artery Embolization for Symptomatic Uterine Leiomyomas
Received 30 March 2007; received in revised form 4 October 2007; accepted 8 October 2007.
Purpose
To evaluate long-term outcomes and factors associated with treatment failure after uterine artery embolization (UAE) in women with symptomatic uterine leiomyomas.
Materials and Methods
One hundred consecutive women treated with UAE for symptomatic uterine leiomyomas participated. Clinical outcome data (ie, changes in symptoms, menstrual status, subsequent therapies) and satisfaction data were collected. Treatment failure was defined by subsequent major surgery (ie, hysterectomy or myomectomy), a second embolization, or a lack of symptom improvement at the patient’s final follow-up interval. Possible predictors of failure were age, clinical baseline characteristics (ie, bleeding, pain, and bulk), and imaging results (eg, percent volume reduction of the dominant tumor). Cox proportional-hazards analysis was used to determine factors associated with failure.
Results
Follow-up was available in 93 women (median follow-up, 54 months; range, 45–87 y). Continued symptom relief was observed in 72% of patients (n = 67). Among the 26 women with treatment failure (28%), 11 (42%) underwent hysterectomy, four (15%) myomectomy, and eight (31%) repeat embolization. Three (12%) reported no improvement. In women without any additional surgery (n = 70), heavy menstrual bleeding, pain, and bulk-related symptoms improved in 97%, 93%, and 92%. Ninety percent of all women (n = 93) were satisfied or very satisfied at final follow-up. Predictors of failure were a lack of improvement in bleeding (hazard ratio [HR], 9.0; 95% CI, 3.1–26.3; P < .001) or pain (HR, 7.4; 95% CI, 2.2–24.4; P < .001) at 1 year after UAE and the percent reduction in dominant tumor volume (HR, 0.97; 95% CI, 0.95–0.99; P = .007).
Conclusions
UAE in women with symptomatic leiomyomas leads to long-term symptom improvement. Predictors of failure were a lack of improvement in bleeding or pain at 1 year and the percent reduction in dominant tumor volume.
aDepartment of Radiology, St. Elisabeth Ziekenhuis, Tilburg University, Tilburg, The Netherlands
bDepartment of Obstetrics and Gynecology, St. Elisabeth Ziekenhuis, Tilburg University, Tilburg, The Netherlands
cDepartment of Medical Psychology and Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
Address correspondence to P.N.M.L., Department of Radiology, St. Elisabeth Ziekenhuis, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
P.N.M.L. is a consultant to Biosphere Medical (Roissy, France), the maker of one the embolic materials used in this study, but did not receive any support from the company. None of the other authors have identified a conflict of interest.
ABSTRACT