Uterine Artery Embolization For Treatment Research Articles

Contrast-Enhanced Ultrasound and High Sensitive Doppler for Monitoring Outcomes of Uterine Artery Embolization

To monitor fibroid microvascularity using contrast-enhanced ultrasound (CEUS) and a new high-sensitive Doppler mode (SMI) for assessment of uterine artery embolization (UAE) outcomes. Forty women with symptomatic uterine fibroids scheduled for UAE were enrolled in this Institutional Review Board-approved study. Subjects underwent three examinations (day 0, 15, and 90 post-UAE) with Color Doppler (CDI), power Doppler (PDI), color and monochrome SMI (cSMI and mSMI), and CEUS imaging of the fibroids. Clips were assessed by two radiologists classifying fibroids based on their vascularity. Fibroid fractional vascularity (FV; % of enhanced pixels within the fibroid) and flow intensity (as mean brightness level of the enhanced pixels) were quantified. Results were analyzed using repeated measures ANOVA and nonparametric Wilcoxon sign rank tests. Inter-reader agreement was assessed with κ-values. There was overall agreement between readers for all imaging modalities and examination times (P=.25; κ=0.70). The FV analysis showed statistically significant differences between CEUS and the Doppler imaging modes (CDI, PDI, cSMI, and mSMI) for the three examination times were compared (P<.0001). The comparison using CDI, PDI, and cSMI showed no statistically significant difference (P=.53). The flow intensity analysis comparison between the Doppler imaging modes (CDI, PDI, cSMI and mSMI) and examination times showed statistically significant differences between all the Doppler imaging modalities (P=.02), except for the 90days post-UAE (P=.34). When the comparison was made for CDI, PDI, and cSMI there was no statistically significant differences (P<.47). CEUS and SMI can accurately evaluate fibroid microvascularity, and therefore, can be a noninvasive and accurate method for monitoring outcomes following UAE treatment.

Uterine Artery Embolization in Treatment of Fibroid Uterus: A Case Series

Uterine Artery Embolization in Treatment of Fibroid Uterus: A Case Series

Ultrasound guided microwave ablation compared to uterine artery embolization treatment for uterine fibroids – a randomized controlled trial

Objective To evaluate the efficacy, feasibility and acceptability of microwave ablation (MWA) compared to uterine artery embolization (UAE) as treatment for uterine fibroids. Method A randomized controlled superiority trial, including premenopausal women 30–55 years, with symptomatic uterine fibroids without any single fibroid exceeding mean diameter of eight centimeters. Patients were randomized to receive microwave ablation, performed abdominally or vaginally, or to uterine artery embolization. The primary outcome was volume difference of the three largest fibroids at 6 months post treatment evaluated by magnetic resonance imaging (MRI) by a blinded radiologist analyzed by Mann–Whitney U-test. Secondary outcomes included symptom severity score (SSS), health related quality of life (HR-QoL), amount of menstrual bleeding, postoperative pain, length of hospitalization, need for additional treatment, adverse events and if patients would recommend the treatment to a friend. Results Patients were recruited from 30 January 2017 to 12 September 2019, with a total of 17 patients treated in each group from May 2017 to December 2019. Superiority of MWA could not be established. The volume reduction was 41.8% (Interquartile range, IQR, 14–63) in the MWA group compared to 62.2% (IQR 34.9–80.1) in the UAE group (p = 0.29). Effects on symptoms, HR-QoL and acceptability did not differ between groups. Days of hospitalization and sick leave were significantly fewer in the MWA group (p < 0.001 and p = 0.001). Conclusions Although superiority of MWA could not be established, it is a promising technique for treating uterine fibroids. It was well tolerated and associated with lower use of health care resources. Trial registration: NCT02942537, www.clincialtrials.gov

Comparative evaluation of combined and isolated applications of high-intensity focused ultrasound and super-selective uterine artery embolization in treatment of patients with uterine fibroids

BACKGROUND: Uterine fibroids are a benign tumor found in two out of three women of reproductive age. The most modern methods of organ preserving treatment of uterine fibroids are uterine artery embolization, which is a minimally invasive procedure, and high intensity focused ultrasound (HIFU) ablation, which is a non-invasive procedure. According to the literature and our own experience, uterine artery embolization is ineffective in 17.1% of cases and HIFU ablation in 16% of cases, mainly due to the peculiarities of blood supply to myomatous nodes.&#x0D; AIM: The aim of this study was to compare the effectiveness of the treatment of uterine fibroids using an isolated HIFU ablation technique and combined sequential application of selective embolization of uterine artery supplying the myomatous node and HIFU ablation.&#x0D; MATERIALS AND METHODS: This study included two groups of patients with symptomatic uterine fibroids. Group 1 consisted of 133 patients treated using the isolated HIFU ablation, and group 2 comprised 90 patients treated sequentially using supplying the myomatous node and HIFU ablation. Age and clinical manifestations of the disease (menometrorrhagia, pain syndrome, impaired function of adjacent organs, anemia) did not differ in the both groups.&#x0D; RESULTS: The following parameters were different in the study groups: the duration of ultrasound ablation (p 0.005) and the decrease in the volume of myomatous nodes in one, six and 12 months after surgery (p 0.001). The duration of ultrasound ablation was 610.84 (56.26) minutes in group 1 and 215.28 (70.57) minutes in group 2. In group 1, the decrease in the volume of myomatous nodes was 12.2% in one month and 58.97% in 12 months after surgery, compared to the initial value. In group 2, the decrease was 42.9% and 67.5%, respectively.&#x0D; CONCLUSIONS: The combined treatment of uterine fibroids using supplying the myomatous node and FUVI ablation techniques allowed for reducing the duration of the FUVI ablation operation three times and the volume of the node by 67.5% within one year compared to group 1 (58.97%).

Assessment of Post Therapeutic Response of Uterine Artery Embolization for Treatment of Uterine Fibroids

Background: Uterine fibroids are the most common benign gynecological tumors with an incidence rate reaching approximately 70% of women in their reproductive age and may cause serious complications in more than 50% of the patients, including vaginal bleeding, anemia, chronic pelvic pain, dyspareunia, infertility as well as secondary pressure manifestations. Uterine artery embolization (UAE) is an effective and widely used modality in managing uterine fibroids given that it is minimally invasive in managing the condition and its associated serious complications. Methods: A retrospective assessment of 41 patients who underwent UAE in a 4-year period (2016- 2020) was performed. The study evaluated the value of this new technique in the Kingdom of Bahrain, King Hamad University Hospital and included a follow up of its therapeutic response by monitoring the symptomatic status and confirmation by quantitative volumetric measurement by pre and post procedure multi parametric MRI. Results: Post-embolization MRI fibroid findings revealed an overall volume reduction rate (VRR) of 19.3% with statistically significant reduction in all outcome variables. Complete resolution of symptoms was reported by 80% of the patients. Conclusion: Uterine artery embolization is an effective treatment option for uterine fibroids. Keywords: Interventional radiology; MRI; Uterine artery embolization; Uterine fibroids; Uterine bleeding.

Transradial versus transfemoral arterial access in the uterine artery embolization of fibroids.

Transradial arterial access has become more popular in body interventional procedures but has not been ubiquitously adapted. This retrospective study assesses the efficacy of this approach in uterine artery embolization. Aim of the study was to compare transradial to transfemoral arterial access in patients undergoing uterine artery embolization for the treatment of fibroids. A total of 172 patients underwent uterine artery embolization procedures at our institute from October 2014 to June 2020. Of these, 76 patients had their operations performed via transfemoral access while 96 underwent transradial access. The peak radiation dose, fluoroscopy time, procedure time, total contrast volume, and equipment cost for each procedure were all reviewed to evaluate for statistical differences between the 2 groups. All cases were technically successful without major complications. The average peak skin dose was 2281 mGy,with no statistical difference between the transradial or transfemoral cohorts. Average fluoroscopy time was 25 minutes, also with no statistical difference between the subsets. Mean procedure time was 100 min, and mean contrast volume usage was 138 mL with no statistical differences. Similarly, the average equipment cost was $2204, with no significant differences found between transradial and transfemoral access. With respect to many pertinent radiation parameters, transradial access was evaluated as being an equally efficacious alternative to transfemoral access in uterine artery embolization procedures. The results of this study suggest that transradial access should be considered more often, whenever viable, as an option in the uterine artery embolization treatment of fibroids.

Uterine artery Embolization: Interventional Radiologist's Perspective in Management of Uncontrolled Obstetric Hemorrhage.

To study the efficacy and safety of uterine artery embolization in treatment of obstetric hemorrhage. This ethically approved prospective study was conducted between November 2017 and October 2019, and written informed consent was obtained from all patients. Consecutive patients presenting with uncontrolled obstetric hemorrhage were evaluated. Fifty-three patients with uncontrolled bleeding underwent uterine artery embolization (UAE) and were followed up. Spectrum of patients encountered in this study was arteriovenous malformations (AVMs) (n = 25), retained products of conception (RPOC) (n = 16), RPOC with secondary AVMs (n = 5), ectopic pregnancy (n = 5) and iatrogenic trauma to cervix or vagina (n = 2). A total of 57 UAE procedures were performed in these 53 patients as repeat sessions were required in four patients. Most common embolic agent used was polyvinyl alcohol (PVA) particles with gelfoam followed by cyanoacrylate glue as second most common agent. Technical success was achieved in 57 (100%) of 57 UAE procedures. Primary clinical success was achieved in 49 (92%) of 53 patients and secondary clinical success in 52 (98%) patients. Clinical failure was observed in one patient who underwent hysterectomy. Uterine artery embolization is a safe and effective procedure in the management of uncontrolled obstetric hemorrhage.

Efficacy of Uterine Artery Embolization for Treatment of Anticoagulant-Associated Abnormal Uterine Bleeding

Data regarding uterine artery embolization (UAE) to specifically treat anticoagulant-associated iatrogenic abnormal uterine bleeding (AUB-I) are sparse. This manuscript aimed to quantify the effectiveness of UAE in treating this subset of patients. Retrospective case series. Academic hospital serving a large minority-majority population. Twenty-four patients with AUB-I that was provoked or aggravated by the initiation of anticoagulation therapy. Treatment of anticoagulant-associated AUB-I that failed medical management or was acute with UAE rather than inferior vena cava filter placement and hysterectomy. An imaging database search was performed to identify patients who underwent UAE for anticoagulant-associated AUB-I from May 2011 to July 2020. Medical and radiologic records were reviewed. Short- and long-term outcomes were obtained to date, ranging from 10 months to 10 years after the procedure. In total, 24 patients were identified, ranging in age from 35 to 54 (mean 44.9) years. Venous thromboembolic disease was the most common (92%) indication for anticoagulation. At presentation, 14 patients (58%) were anticipated to require lifelong anticoagulation. Most UAE procedures (54%) occurred within 10 days of anticoagulation initiation. Before UAE, 17 patients (71%) attempted and failed medical management, myomectomy, or endometrial ablation to control bleeding. After UAE, 21 patients (88%) experienced substantial improvement or resolution of AUB and continued anticoagulation therapy. Three patients (14%) did not experience improvement and were treated with hysterectomy. Amenorrhea immediately after UAE occurred in 1 patient at age 45. UAE was an effective tool in the management of anticoagulant associated AUB-I in this cohort, resulting in decreased bleeding while allowing the continuation of anticoagulation therapy, with high rates of uterine preservation and preserved menses.

Can pre-procedural MRI signal intensity ratio predict the success of uterine artery embolization in treatment of myomas?

Background/aim Magnetic resonance (MR) images, signal intensity ratios calculated using region of interests (ROI) in T2W images by proportioning the dominant myoma to iliac muscle can aid patient selection and, thus, in achieving better outcomes with the uterine artery embolization (UAE) procedure. The present study investigates the association between the success of UAE treatment with signal intensity (SI) ratio of the dominant myoma to the iliac muscle in MR imaging performed prior to the procedure.Materials and methods This is a retrospective study and included 30 patients who admitted to our clinic between February 2017 and July 2019 due to symptoms associated with myoma and who underwent MR imaging before and after UAE treatment. All patients, MR images obtained before UAE treatment and at the 12th month after the procedure were evaluated. In MRI, SI values were calculated by proportioning the dominant myoma to the iliac muscle using circular ROI in T1 weighted (W), T2W, and post-contrast T1W images. In the present study, 50% or more volumetric regression of the myoma with infarction of fibroids (loss of enhancement) at the 12-month follow-up MRI after the procedure was considered a successful procedure. Results Myoma volumes calculated in MR images showed significant differences between the MRI performed before UAE procedure and the MRI performed at the 12th month after the procedure (p < 0.0001). SI ratio calculated from pre-procedure T2W MR images was found to be a significant determinant of 50% or more volumetric regression in the myoma after UAE procedure (p = 0.017), T1W, post-contrast T1W images were not statistically significant (p = 0.211).Conclusion Our results indicate that SI ratio of the dominant myoma to the iliac muscle calculated using ROI in T2W images of MR studies performed before UAE procedure can predict the success of the procedure.

The Diagnostic Value of Superb Microvascular Imaging in Prediction of Uterine Artery Embolization Treatment Response in Uterine Leiomyomas.

We aimed to determine if superb microvascular imaging (SMI) can predict response to uterine artery embolization (UAE) as compared with power Doppler ultrasound. The blood flow and the volume of the dominant leiomyoma was evaluated by power Doppler ultrasonography (PDUS) and SMI 1 day before and 3 months after the UAE procedure. SMI and PDUS blood flow were classified to 4 grades of vascularity. The change in fibroid volume in Grades 0-2 (hypovascular group) was compared to the hypervascular Grade 3 group. Twenty-eight women (mean age, 40.9 years; range, 33-53 years) were examined with PDUS and SMI before and 3 months after UAE. The volume reduction was statistically significantly higher hypervascular group (P < .05). When we accept 30% or more volume reduction as a good response to UAE, the positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of SMI were 100, 64, 73.6, 100, and 82.1%, respectively. There was excellent agreement between the two blinded observers in SMI measurements. SMI, with its high reproducibility, provides further microvessel information than PDUS in uterine fibroids. It may be a useful tool in prediction of response to UAE treatment and improve counseling and patient selection for UAE versus medical or surgical treatment options.

Long-term durability of uterine artery embolisation for treatment of symptomatic adenomyosis.

BackgroundFailing conservative therapies, uterine artery embolisation (UAE) has been proposed as a uterine‐sparing option for treatment of symptomatic adenomyosis. UAE appears effective at short‐term; however long‐term durability is less well established.AimsTo evaluate the long‐term clinical efficacy of UAE for treatment of adenomyosis.Materials and MethodsOne hundred and four women with initial clinical success following UAE for adenomyosis (results previously published) were further followed with a two‐part online survey. Part one inquired about menopause, symptom recurrence, need for further intervention and overall satisfaction. Part two comprised the Uterine Fibroid Symptom and health‐related Quality of Life (UFS‐QOL) questionnaire. Maintenance of clinical success was defined as remaining ‘happy’ or ‘very happy’ with overall outcome, no recurrence of symptoms, or need for further intervention.ResultsOf those women with initial success, 91/104 (88%) participated in this long‐term study at mean 52 months following UAE. Maintenance of clinical success was demonstrated in 82/91 (90%) women. For the remaining 9/91 (10%) women, mean time to failure was 31 months. There were 53/91 (58%) women who reached menopause at mean age of 51.5 years, occurring at mean 30 months post‐UAE. UFS‐QOL demonstrated significant decrease in symptom severity from 58.9 to 20.0 (P < 0.001); and significant increase in QOL from 40.3 to 86.3 (P < 0.001).ConclusionsLong‐term durability of UAE for treatment of adenomyosis was demonstrated, with cumulative success rate of 80% at mean 52 months. UAE did not appear to bring forward menopause. UAE should be considered as an alternative to hysterectomy to treat adenomyosis.

Comparison of anxiety level in patients under uterine fibroid treatment by myomectomy and uterine artery embolization (UAE) and its relationship with pain and duration of postoperative hospitalization in Ahvaz educational hospitals in 2018

Introduction:Uterine fibroids are the most common benign tumors in women. Preoperative anxiety is due to concerns about the consequences of surgery and prevents recovery and high prevalence of postoperative pain and increases the length of stay in the hospital. In this study, we tried to investigate the level of anxiety in patients who are candidates for uterine artery embolization (UAE) and myomectomy surgery and its relationship with the length of hospitalization and postoperative pain.Methods:The present descriptive-analytical study was performed on candidates for uterine fibrinoid treatment referred to Ahvaz educational hospitals in 2018. A total of 41 candidates for uterine fibroid treatment were segmented into two groups of 24 candidates for myomectomy surgery and 17 for UAE treatment considering the inclusion and exclusion criteria after informed consent. Data were analyzed by SPSS VER 20 software using Mann–Whitney test, multiple regression, and Chi-square.Results:Myomectomy surgery group recorded more overt and covert anxiety, followed by a longer hospital stay and more postoperative pain (P < 0.05). The demographic criterion of age was significantly associated with overt and covert anxiety (P < 0.05). The level of education was significantly associated with overt anxiety (P < 0.05) and marital status and BMI were not significantly associated with overt and covert anxiety levels (P > 0.05).Conclusion:According to the results of the study, overt and covert preoperative anxiety in women undergoing myomectomy surgery for symptomatic uterine fibroids is longer than in UAE treatment. And have more pain after surgery.

Contrast-enhanced ultrasound in uterine artery embolization treatment of cesarean scar pregnancy.

ObjectiveThe current study aimed to investigate the application of contrast-enhanced ultrasound (CEUS) in diagnosis and treatment of cesarean scar pregnancy (CSP).MethodsA retrospective study was performed in 35 patients with clinically suspected CSP who requested termination of pregnancy and underwent contrast-enhanced ultrasound (CEUS). The patients were classified into two groups on the basis of whether they received uterine artery embolization (UAE). The CEUS characteristics of the two groups were reviewed.ResultsCEUS features of CSP were early enhancement of the cesarean scar and continuous infusion of contrast agent between the gestational sac and cesarean scar. Myometrial thickness in the cesarean scar was thinner in the UAE group than in the non-UAE group by CEUS and transvaginal ultrasound. Myometrial thickness measured by CEUS was thinner than that measured by transvaginal ultrasound in both groups. The parameters of the time-intensity curve in the UAE group were characterized by a faster arrival time, shorter time to peak, higher peak intensity, and greater enhancement rate compared with the non-UAE group.ConclusionsCEUS may be a novel supplementary method to diagnose and assess CSP, and to help evaluate whether UAE is required.

Clinical assessment of uterine artery embolization combined with curettage when treating patients with cesarean scar pregnancy: A retrospective study of 169 cases.

Recent years have witnessed an elevated incidence of cesarean scar pregnancy (CSP). However, the clinical complications and consequences of uterine artery embolization (UAE) and curettage treatment for CSP patients are not clear. We aimed to assess menstrual recovery and other clinically pertinent factors after UAE and curettage treatment in CSP patients. A total of 169 CSP patients who underwent UAE combined with curettage between August 2013 and August 2017 were enrolled in this study. The menstruation recovery was recorded, and the factors that potentially affected menstrual blood volume (MBV) were analyzed. Among the 169 CSP cases, 36 had asymptomatics (21.3%), 133 vaginal hemorrhage (78.7%) and 19 lower abdominal pain (11.2%). The success rate of treatment was 96.4% with six patients undergoing further treatment. The follow-up assessment was performed in 139 of 169 patients. About 83 of 139 (59.7%) patients had reduced MBV, and 2 patients (1.4%) had amenorrhea. There was a significant difference in numbers of abortions between the decreased and normal MBV group (P = 0.0276). Importantly, 16 of 42 cases who were planning on having babies became pregnant, with 8 from the decreased (8/27) and normal MBV (8/15) group each. UAE combined with curettage treatment in CSP patients demonstrates a favorable success rate, which can also reduce MBV and proceeding pregnancy rate.

Asherman syndrome in adenomyosis treated with uterine artery embolization: incidence predictive factors

To investigate Asherman syndrome (AS) related to potential factors during uterine artery embolization (UAE) treatment of adenomyosis. This is a retrospective analysis of 195 women with adenomyosis who underwent UAE treatment from 2009 to 2016. All preoperative and intraoperative risk-related potential factors of AS were recorded. And AS events were carefully monitored during follow-up (range, 0-15months). Potential risk-related factors of AS events were determined via univariate and multivariate logistic regression analyses. The rate of AS events after UAE for adenomyosis was 12.82% (25/195). The univariate and multivariate analyses revealed the association of low vascularity with a significant risk for AS (P = 0.019). Patients with low vascularity of adenomyosis at the time of UAE are more likely to have AS. And adenomyosis patients with low vascularity should be carefully selected to undergo UAE treatment.

Frequency of performing uterine artery embolization for treatment of the totally retained placenta

Frequency of performing uterine artery embolization for treatment of the totally retained placenta

Outcomes After Uterine Artery Embolization and Other Treatment Modalities for Uterine Arteriovenous Malformation: A Multicenter Review from the Society of Gynecologic Surgeons Fellows Pelvic Research Network

Study Objective To compare treatment outcomes between women managed with uterine artery embolization (UAE) and women treated with other modalities for uterine arteriovenous malformations (AVM) Design Retrospective cohort Setting Five academic centers participating in the Fellows’ Pelvic Research Network (FPRN) Patients or Participants Women 18 years or older with pelvic ultrasound or other imaging diagnosis of uterine AVM between January 2006 and December 2013 Interventions Patients received either UAE or other conservative treatment options, which varied based on provider preference. Other treatment options included expectant management, hormones, methylergonovine, dilation and curettage (D&C), tranexamic acid. Women who underwent hysterectomy as first-line treatment were excluded. Measurements and Main Results Chart review was performed to gather data. Preliminary data analysis of 23 patients who met inclusion criteria at 3 different sites was performed. Twenty-one women (91.3%) underwent ultrasound and 6 (26.1%) ultimately had angiography while one patient had magnetic resonance angiography (MRA) performed. Of the 7 patients who had angiography or MRA, 5 confirmed a true uterine AVM. The majority of women presented with abnormal bleeding (82.6%). For first-line treatment, 5 patients underwent UAE, 14 had expectant management, 3 were given methylergonovine (1 patient was administered IV conjugated estrogen concurrently), 3 were given oral contraceptive pills, 2 underwent D&C, 1 patient underwent hysteroscopic resection, 1 received tranexamic acid and 1 patient received medroxyprogesterone acetate. Five patients were managed with a second-line treatment, 13 did not require additional treatment and 5 patients were lost to follow up. Fourteen patients had documented resolution. Conclusion Uterine AVM occur very infrequently but should be considered in the differential diagnosis of abnormal uterine bleeding. Although initial imaging showed concern for a uterine AVM, at least 2 of 7 patients who underwent subsequent angiography did not confirm the diagnosis. In women with concern for AVM, confirmatory imaging should be performed prior to any treatment that may affect future fertility.

Uterine Artery Embolization (UAE) for Fibroid Treatment – Results of the 7th Radiological Gynecological Expert Meeting

Uterine artery embolization (UAE) is a safe and effective organ sparing treatment for fibroid-related symptoms based on a broad range of published evidence including randomized-controlled trials. Indication for treatment by means of UAE are symptomatic uterine fibroids. UAE is an alternative to surgical and medical treatment for uterine fibroids as well treatment by MRgFUS. This consensus paper covers the structural prerequisites, the criteria for technical and clinical success, contraindications, side effects and complications as well as the role of UAE treatment in women wishing to conceive and gives guidance on radiation safety measures and clinical follow-up. KEY POINTS:: · The therapeutic aim of UAE for fibroids is the improvement (alleviation) or disappearance of fibroid-related symptoms. · The indication for UAE treatment is based on a gynecological examination incl. ultrasound performed by a specialist. · UAE is an alternative to surgical or medical therapy of fibroids as well as fibroid treatment by means of MRgFUS, independently of the size and number of fibroids (leiomyoma) or previous surgery. · The decision to offer UAE should be based on the wish of the patient and having regard to treatment alternatives, their success rates, limitations and side effects. · For women with uterine fibroids who wish to conceive the role of UAE as a treatment options is still not clarified based on the current state of knowledge. CITATION FORMAT: · Kröncke T, David M. Uterine Artery Embolization (UAE) forFibroid Treatment: Results of the 7th Radiological Gynecological Expert Meeting. Fortschr Röntgenstr 2019; 191: 630 - 634.

Uterine Artery Embolization (UAE) for Fibroid Treatment – Results of the 7th Radiological Gynecological Expert Meeting

Uterine artery embolization (UAE) is a safe and effective organ sparing treatment for fibroid-related symptoms based on a broad range of published evidence including randomized-controlled trials. Indication for treatment by means of UAE are symptomatic uterine fibroids. UAE is an alternative to surgical and medical treatment for uterine fibroids as well as treatment by MRgFUS. This consensus paper covers the structural prerequisites, the criteria for technical and clinical success, contraindications, side effects and complications as well as the role of UAE treatment in women wishing to conceive and gives guidance on radiation safety measures and clinical follow-up.

Outcome of Uterine Artery Embolization in the Treatment of Uterine Leiomyomas in Mongolia

Objective: To evaluate and determine treatment efficacy of uterine artery embolization versus uterine myomectomy in treating uterine leiomyomas. Methods: In 2010-2013, 94 women between the ages of 23-50 years were recruited in the study. They were divided into 2 treatment groups: uterine artery embolization and myomectomy (control) group and were followed up for two consecutive years. Results: After uterine artery embolization, the volume of leiomyomas decreased 56%-91% (p&lt;0.05). Menorrhagia in the uterine artery embolization versus myomectomy group was 95.2% and 92.8% (p&gt;0.05), anemia 87.5% and 85.7% (p&gt;0.05), pain subsided 72.2% versus 86.8% and "bulk" symptoms 87.5% versus 100% respectively (p&gt;0.05). Overall health-related quality of life score +27.6 versus +17.1 and SS score -34.0 versus -32.8, patient satisfaction 89.4% versus 72.3% (p=0.001). Re-growth after uterine artery embolization 2.1% versus myomectomy 23.4% (p=0.0001), Post-treatment conception 25.5% versus 31.9% and cesarean delivery rate 88.9% versus 90% respectively (p&gt;0.05). Duration of the procedure 38.9±4.8 minutes versus 54.0±26.3 minutes (p=0.0001), length of hospital stay 2.4±0.9 days versus 6.9±2.3 days (p=0.0001), days to recovery 10.6±3.0 versus 26.2±17.9 (p=0.0001). Conclusion: Uterine artery embolization treatment effectively decreases the size of leiomyomas (p=0.015), it particularly improves menorrhagia. The quality of life and patient satisfaction scores after uterine artery embolization are better (p=0.001). There was no statistically significant difference with regard to conception rate or the need for cesarean delivery (p&gt;0.05).