Uterine artery embolization shortens hospital stay but increases minor complications

Compared to traditional surgery for uterine fibroids, a new minimally invasive procedure leads to shorter hospitalization and a quicker return to everyday activities, researchers report.

But the procedure - uterine artery embolization, or UAE - does not achieve significantly higher patient satisfaction compared to traditional surgery involving direct removal of the fibroids or of the uterus itself. Also, UAE patients have a higher rate of minor complications rate after discharge, and long-term data for this relatively new procedure is scarce.

The review, based on three previous studies comprising 297 women, appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The review, led by Dr. Janesh Gupta of the University of Birmingham, Birmingham Women's Hospital in England, looked at two studies comparing UAE to abdominal hysterectomy. The third study compared UAE with myomectomy, or surgical removal of the fibroids, in women wishing to preserve their fertility.

Up to 40 percent of women age 40 and older have fibroids, with the incidence dropping after menopause, according to the study background information. Fibroids are benign tumors that can cause heavy bleeding, pain and lowered fertility.

In uterine artery embolization, an interventional radiologist makes a tiny incision in the groin area and inserts a catheter into an artery to the uterus. Through the catheter, the physician injects tiny plastic particles, which block the flow of blood to the fibroid, causing it to shrink or eventually disappear.

Uterine artery embolization of fibroid tumors is successful for about 85 percent of the women who choose this treatment. Most women can return to normal activities after one week, compared with six weeks or more after hysterectomy.

Clinical success is measured by improvement in fibroid-related symptoms such as heavy bleeding and fibroid volume, which UAE decreased by 30 percent to 46 percent in two trials.

But UAE was associated with a higher rate of minor complications following the procedure, such as vaginal discharge, bruising at the puncture site, pain, fever, nausea and vomiting. Women who underwent UAE had more unscheduled clinical visits and higher hospital readmission rates after discharge compared with hysterectomy. But there were no statistically significant differences in rates of major complications between the two groups.

American College of Obstetrics and Gynecology spokesman Howard Sharp, M.D., said, “The important information that this study provides, is that, though UAE appears to be relatively safe compared to hysterectomy and myomectomy, we do not have high-quality, long-term outcome data as to how well UAE holds up over time. How many patients with UAE will have a hysterectomy at five years? How does UAE affect pregnancy and fertility?”

Sharp, who is also chief of obstetrics and gynecology at the University of Utah School of Medicine, said that the primary conclusion of the review about the benefits of UAE compared to surgery, “does not give us new information. It confirms the obvious: the out-patient, minimally invasive UAE results in a shorter hospital stay, and a quicker return to work when compared to the inpatient, more invasive hysterectomy or myomectomy.”

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