Use of Uterine Artery Embolization for the Treatment of Uterine Fibroids: A Comparative Review of Major National Guidelines.

Abstract

Fibroids cause significant morbidity, including anemia, pelvic pain, and infertility. It is imperative that healthcare providers are well-versed on the varying treatments available for fibroids. Specifically, uterine artery embolization (UAE) is a treatment that improves anemia, pelvic pain, and quality of life. The purpose of this article is to compare international guidelines on UAE to offer best practices to healthcare providers. Guidelines from the American College of Obstetrics and Gynecology (ACOG), The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Radiologists, National College of French Gynecologists and Obstetricians (CNGOF), The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the National Institute for Health and Care Excellence (NICE) were reviewed alongside peer-reviewed PubMed articles. A comparative review of major international guidelines was conducted to encompass potential geographical, cultural, and societal variances with UAE. Review of data revealed guidelines agree with many constituents surrounding treatment of fibroids with UAE. Guidelines diverge regarding offering UAE for small fibroids, intracavitary/submucosal fibroids, and pedunculated serosal fibroids with variations on suggested imaging. Most agree that an experienced care team including a gynecologist and interventional radiologist should be included. Preoperative antibiotics and IUD removal may be recommended. UAE for patients who desire fertility remains an option after counseling within most guidelines. UAE is a safe, efficacious, and cost-effective alternative to hysterectomy and myomectomy. Including UAE as a treatment option during the patient counseling process is critical. Guidelines vary based on data interpretation and are based on clinical research and expert opinion. Due to mixed data and lack of randomized controlled trials, organizations differ when offering UAE to patients who wish to preserve fertility. It is vital to note emerging studies supporting the safety of UAE for subsequent pregnancy.