1493 Preoperative Uterine Artery Embolization Prior to the Surgical Management of Fibroids: An Institutional Case Series

Abstract

Study Objective Uterine artery embolization (UAE) can be used as a preoperative adjunct for the surgical management of fibroids. Few, small studies have reported that preoperative UAE may reduce blood loss or facilitate a laparoscopic approach for myomectomies. We assessed outcomes at our institution with preoperative UAE prior to surgical management of fibroids from 7/1/2013 through 8/1/2018. Design Case series Setting Academic medical center Patients or Participants Patients who underwent preoperative UAE prior to surgical management of fibroids Interventions Preoperative UAE followed by myomectomy/hysterectomy Measurements and Main Results Eight patients underwent planned UAE immediately prior to surgery: 2 myomectomies and 6 hysterectomies. One myomectomy was laparoscopic; 22 week size uterus, 3 fibroids removed (largest 11 cm), specimen weight 903g, estimated blood loss (EBL) 300cc with intraop vasopressin use. The other myomectomy was abdominal; 22 week size uterus, 23 fibroids removed (largest 11 cm), specimen weight 1723g, EBL 500cc, with intraoperative vasopressin and misoprostol used. Of the hysterectomy cases, 3 were abdominal and 3 were laparoscopic. A notable open case was a supracervical hysterectomy of a 32 week size uterus; EBL 200cc, specimen weight 5150g. Among the laparoscopic hysterectomy cases, the mean uterine size was 19 weeks (range 17-21 weeks; mean specimen weight 1328g), average EBL 350cc (range minimal-500cc). There were no complications from the UAE and no perioperative surgical complications (conversion to laparotomy, blood transfusions, fever/infection, bleeding, reoperations). All minimally invasive cases were discharged on postoperative day 0. Conclusion Preoperative UAE for surgical management of fibroids appears to be a safe adjunct to myomectomy or hysterectomy with respect to control of EBL, reduced need for transfusions, and maintaining a laparoscopic approach (when applicable). Future larger studies, likely with pooled data from multiple sites, are needed to further evaluate the safety and efficacy of preoperative UAE in this setting.