Pre-operative uterine artery embolization before hysterectomy or myomectomy: a single-center review of 53 patients

Dhara J Kinariwala; Minhaj S Khaja; Sara McCann; Daniel Sheeran; Auh Whan Park; Luke R Wilkins; Alan H Matsumoto; Dana L Redick

doi:10.1016/j.clinimag.2023.06.003

Pre-operative uterine artery embolization before hysterectomy or myomectomy: a single-center review of 53 patients

Clin Imaging. 2023 Sep:101:121-125. doi: 10.1016/j.clinimag.2023.06.003. Epub 2023 Jun 9.

Authors

Dhara J Kinariwala¹, Minhaj S Khaja², Sara McCann¹, Daniel Sheeran¹, Auh Whan Park¹, Luke R Wilkins¹, Alan H Matsumoto¹, Dana L Redick³

Affiliations

¹ Department of Radiology and Medical Imaging, University of Virginia Health, 1215 Lee St, Charlottesville, VA 22903, United States of America.
² Department of Radiology and Medical Imaging, University of Virginia Health, 1215 Lee St, Charlottesville, VA 22903, United States of America. Electronic address: mkhaja@umich.edu.
³ Department of Obstetrics and Gynecology, University of Virginia Health, 1215 Lee St, Charlottesville, VA 22903, United States of America.

PMID: 37329639
DOI: 10.1016/j.clinimag.2023.06.003

Abstract

Purpose: To assess outcomes of planned pre-operative uterine artery embolization (UAE) in patients with uterine fibroids at high risk for bleeding prior to hysterectomy or myomectomy.

Materials & methods: A retrospective review of 53 consecutive patients who underwent planned UAE followed by surgery from 2004 to 2019 was performed in a subset of patients deemed high risk for bleeding by the referring surgeon due to bulky fibroids and/or adhesions. Characteristics of the largest fibroid, total number of fibroids, embolic agents, estimated blood loss (EBL), complications, and other factors were collected.

Results: 53 patients (mean age = 41) had an elective UAE prior to a hysterectomy 24 (45%) or myomectomy 29 (55%). Median interval between UAE & surgery was 21.6 h (range 1.75 h-57 days). Of the myomectomies, 13 (45%) were open, 15 (52%) hysteroscopic and 1 laparoscopic. Mean number of fibroids/patient was 4.1 (SD 1.3), mean fibroid volume was 328 cm³ (range 11-741), and the mean fibroid diameter in longest dimension was 7.4 cm (range 3.2-15). Mean EBL was 90 (SD 99.5 mL). Three (10%) myomectomy patients required blood transfusion. All hysterectomies were via a laparotomy. Mean fibroid volume was 1699 cm³ (range 93-9099 cm³) with a mean maximum diameter of 16.2 cm (range 6.5-29.6) and an average of 2.4 (SD 1.7) fibroids. Mean EBL was 352 (SD 220 mL). Four (17%) hysterectomy patients required an intra- or post-operative blood transfusion. At a mean 1-year follow-up (range 1 month-14 years), 70% of UAE-myomectomy patients and 74% of UAE-hysterectomy patients reported symptom resolution. Three (6%) patients were readmitted: one for osteodiscitis, one wound dehiscence, and one for an infected retained fibroid after myomectomy.

Conclusion: Planned pre-operative UAE resulted in intraoperative blood loss similar to "all-comer" myomectomy and hysterectomy patients in the literature. Further studies may elucidate which patients would be the best candidates for this staged treatment paradigm.

Keywords: Artery; Embolization; Endovascular; Fibroid; Pelvic; Uterine.

MeSH terms

Adult
Female
Humans
Hysterectomy
Leiomyoma* / diagnostic imaging
Leiomyoma* / surgery
Retrospective Studies
Treatment Outcome
Uterine Artery Embolization* / adverse effects
Uterine Artery Embolization* / methods
Uterine Myomectomy*
Uterine Neoplasms* / diagnostic imaging
Uterine Neoplasms* / surgery