Opportunity and Responsibility: SCVIR's Role with Uterine Artery Embolization

Abstract

UTERINE artery embolization (UAE) for the treatment of symptomatic leiomyomata is an emerging minimally invasive procedure that represents a promising alternative to surgical interventions. The procedure was first performed for this indication in the United States 4 years ago with fewer than 30 procedures performed in 1996. As of September 1999, over 4000 UAE procedures had been performed by interventional radiologists in the United States (see Appendix). Symptomatic fibroids are a major health concern for women, with between 177,000 and 366,000 hysterectomies and approximately 35,000 myomectomies performed each year in the United States for this problem (1). In addition, many women receive medical treatment for fibroids and many others experience symptoms but never undergo treatment. Therefore, there is obvious potential for UAE to provide an important therapeutic alternative for thousands of women each year. Embolotherapy has been successfully used for several decades for the endovascular treatment of female genital tract bleeding of arterial origin. Successfully treated conditions include postpartum hemorrhage, arteriovenous malformations, and postsurgical bleeding. Embolization is a standard of interventional radiology (IR) practice, and UAE represents an innovation in that standard. Although our specialty thinks of UAE as an extension of IR practice, it is viewed by many other medical professionals as a new technology. Although many interventional radiologists and patients are eager to realize the promise of this procedure, we, as a professional medical society, recognize our obligation to introduce this procedure into broader IR practice in a responsible and accountable fashion. Ultimately, this entails collating the collective experience of interventional radiologists to demonstrate the procedure’s safety and efficacy. It also means that the Society of Cardiovascular & Interventional Radiology (SCVIR) must be looked to as a credible resource by patients, medical professionals, and payers. Establishing this procedure as a generally recognized option for the treatment of fibroids represents a considerable challenge, one that requires deployment of society volunteers, staff, and fiscal resources. In April 1999, SCVIR established a Uterine Fibroid Embolization Task Force to help guide Society policy and activities with regard to this procedure. The Task Force, chaired by Scott Goodwin, MD, comprises six work groups: research, registry, professional education, public information, economics, and standards. During the past 10 months, Task Force members and SCVIR staff have worked diligently and made significant progress. The Task Force developed a UAE research strategy, the goals of which are to establish the safety and efficacy of UAE and to compare UAE with other common surgical treatments for uterine fibroids. Recognizing the potential impact of UAE on IR practice and the need to develop the scientific evidence for this procedure, the Cardiovascular and Interventional Radiology Research and Education Foundation (CIRREF) awarded a grant to RAND Health to develop a research agenda for UAE. In this issue of JVIR, “An Agenda for Research into Uterine Artery Embolization: Results of an Expert Panel Conference” (2) describes the results of a multidisciplinary expert panel conference held in June 1999 and represents the consensus of a wide variety of experts. The purpose of the expert panel was to address immediate and long-term research goals for UAE. The panel discussed various study designs, including their strengths and weaknesses. From this discussion, four areas of UAE research were identified: a prospective registry, a quality-of-life instrument, a randomized controlled trial, and a cost study. This report is being used to guide research of UAE and may provide a working model for evaluating other promising technologies before they become widely adopted. Progress has been made in three of the four identified research ar