Hans van Overhagen and Jim A Reekers from The Netherlands have authored the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) Standard of Practice guidelines for transcatheter uterine artery embolisation (UAE) for symptomatic leiomyomata (fibroids) and these have been published in Cardiovascular and Interventional Radiology (CVIR). The authors urge that every symptomatic patient with uterine myomas (fibroids) should be offered embolisation as alternative treatment to hysterectomy/myomectomy. "UAE should be incorported in the (national) gynaecological guidelines." they report.
The authors write that Uterine Artery Embolisation (UAE) is a true alternative to hysterectomy in women who want to preserve their uterus, a statement that is backed by level one evidence. Further, they find that the highest quality of evidence shows that the five-year outcome in quality of life is equal in groups treated either by hysterectomy or by UAE, with no difference in major complications. In the short term, UAE had lower blood loss, shorter hospital stay and quicker return to work. The authors further conclude that the risk for ovarian dysfunction after UAE seems over-estimated in women less than 40 years of age.
The indications for Uterine Artery Embolisation are heavy menstrual bleeding, mechanical complaints, such as pain, pressure, dyspareunia, urinary urgency and frequency. The authors emphasise that all possible candidates for UAE should undergo assessment by a gynaecologist wtih training and experience. All candidates should also undergo assessment by the attending interventional radiologist in order to be informed about the procedure, clinical success rate, complications and follow-up".
The authors make it clear that the effect of UAE on fertility has not been well investigated and that preservation of fertility is not assured from the current literature. However, uncomplicated pregnancies and normal deliveries have been reported after Uterine Artery Embolisation.
With regard to complications, as reported in CVIR, major complications of both hysterectomy and UAE are rare and equal in terms in the randomised trials.
The full article can be read here