Re: Leiomyoma Recurrence after Uterine Artery Embolization

Abstract

Editor: We read with interest the recent report by Marret et al (1Marret H Alonso AM Cottier JP Tranquart F Herbreteau D Body G Leiomyoma recurrence after uterine artery embolization.J Vasc Interv Radiol. 2003; 14: 1395-1399Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar) on recurrence after uterine artery embolization (UAE). Some comments appear to be indicated. First, we note the case of technical failure. We have reported on success treating these patients after 2 weeks from the time of unilateral embolization (2McLucas B Reed RA Goodwin S et al.Outcomes following unilateral uterine artery embolisation.Br J Radiol. 2002; 75: 122-126Crossref PubMed Scopus (26) Google Scholar). Concerning endometrial cancer in an embolized patient; we would recommend that all women planning to undergo embolization also undergo diagnostic screening of the endometrium to avoid such an unfortunate occurrence (3McLucas B Adler L Perrella R Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids.J Am Coll Surg. 2001; 192: 95-105Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar). Should investigators use the techniques recommended by our group, adenomyosis could be identified before embolization and a lower success rate given to patients (3McLucas B Adler L Perrella R Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids.J Am Coll Surg. 2001; 192: 95-105Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar). Of the eight late failures (eight of 85 procedures; 9%), we submit that this is not unlike the failure rates given by the earliest articles on UAE (4Ravina J Herbreteau D Ciraru-Vigneron N et al.Arterial embolisation to treat uterine myomata.Lancet. 1995; 346: 671-672Abstract PubMed Google Scholar). Progression of known myomata and development of new myomata both indicate that these myomata are continuing to receive a blood supply. This impression would have been in line with the pathology report showing degeneration, but not infarction (1Marret H Alonso AM Cottier JP Tranquart F Herbreteau D Body G Leiomyoma recurrence after uterine artery embolization.J Vasc Interv Radiol. 2003; 14: 1395-1399Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar). We do not believe that expulsion of necrotic submucous myomata should represent failure. We remove such myomata vaginally in an outpatient procedure (5McLucas B Results of uterine artery embolization.in: Tulandi T Uterine fibroids: embolization and other treatments. 14. Cambridge University Press, Cambridge2003: 101-110Google Scholar). In addition, we now offer patients a combination embolization followed by laparoscopic myomectomy or myomectomy by laparotomy for pedunculated subserous myomata and extremely large uteri (>20 weeks), respectively (5McLucas B Results of uterine artery embolization.in: Tulandi T Uterine fibroids: embolization and other treatments. 14. Cambridge University Press, Cambridge2003: 101-110Google Scholar). Last, we have successfully offered many patients whose results indicated continued growth, a repeat procedure, in which the ovarian artery will be identified and embolized if indicated, and re-embolization of the uterine arteries performed (5McLucas B Results of uterine artery embolization.in: Tulandi T Uterine fibroids: embolization and other treatments. 14. Cambridge University Press, Cambridge2003: 101-110Google Scholar). Results of such repeat procedures are encouraging and will be published soon.