CHICAGO — Uterine artery embolization appears to have a slight edge over myomectomy in terms of recovery after treatment of uterine fibroids, according to data presented during the annual meeting of the Radiological Society of North America.
Uterine artery embolization (UAE) was “superior in terms of adverse events, time off from work, time until the resumption of normal activities, and hospital stay,” said Scott C. Goodwin, M.D., who is the chief of imaging services at Greater Los Angeles Veterans Affairs Medical Center.
UAE was superior for hospital stay, time off, and time to resume activities by a roughly three to one margin.
In the prospective study, 149 patients underwent UAE and 60 underwent myomectomy. Embolization was performed with Contour PVA particles.
Patients were included in the study if they were older than 30 years and had symptomatic fibroids. Women in the UAE group did not desire to become pregnant. The researchers collected overall and fibroid specific quality of life scores (QOLs) before the procedures were undertaken.
Women in the UAE group were older, more likely to have been previously pregnant, and to have had longer periods than those in the myomectomy group. Myomectomy patients were more likely to have a miscellaneous pelvic abnormality or a tubal ligation and to have had more fibroids than UAE patients.
“In terms of the QOLs, we did not find an overall difference [between the two groups], though if you look specifically at the 36–40 age group, there were some differences in terms of sleep, mental health, and restricted activity in favor of the UAE group,” Dr. Goodwin said at the meeting.
There was also no significant difference in terms of reduction of uterine volume or in bleeding score reduction.
Though the major efficacy outcomes were similar between the two groups, the study was not powered sufficiently to determine whether there were actually any statistically significant differences between groups in terms of efficacy, Dr. Goodwin said.
The adverse event rate (UTI and vaginal discharge, among others) in the UAE group was 22%, compared with 40% in the myomectomy group (UTI, hemorrhage, and others).
The major adverse event rate was 4% in the UAE group, compared with 1.7% in the myomectomy group.
Major adverse events included significant postembolization syndrome—described as flu-like symptoms—enlargement of a multicystic adnexal mass, excessive vaginal discharge, and a ruptured appendix (not related to the procedure).
Due to study design, among the women in the UAE group, 19% were considered failures (including 4 patients who withdrew consent, 10 who were lost to follow-up, and 8 who failed to meet QOL criteria, among others).
In comparison, the failure rate was 25% in the myomectomy group (including five patients who failed to meet QOL criteria, one patient requiring a hysterectomy, and three patients who were lost to follow-up, among others).
Despite the findings, not all women are good candidates for UAE.
Dr. Goodwin does not recommend that women undergo the procedure if they are not symptomatic. Instead, he advises them to watch and wait, he told this newspaper.
Fertility is also a consideration. There is some risk of premature ovarian failure following embolization, though this varies with age.
He estimated that a woman under 35 years has very little chance of this occurring, while a woman under 40 has a roughly 1% chance. Over the age of 50 the risk goes up to 30%–40%.
“So if you have a 45-year-old woman—who has not had children—who is really trying to get her last shot at having a baby, she would probably be better served by a myomectomy,” Dr. Goodwin said.
Uterine artery embolization is also contraindicated in women with a severe allergy to the contrast dye used in imaging and in women who have poor renal function, he said.
The uterine artery is shown before UAE.
This angiogram shows the same artery after UAE. Photos courtesy Dr. Scott C. Goodwin