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Uterine Artery Embolization Versus Laparoscopic Uterine Artery Occlusion: The Outcomes of a Prospective, Nonrandomized Clinical Trial

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Abstract

Purpose

To compare outcomes of two different types of occlusive therapy of uterine fibroids.

Methods

Women with fibroid(s) unsuitable for laparoscopic myomectomy (LM) were treated with uterine artery embolization (UAE) or laparoscopic uterine artery occlusion (LUAO).

Results

Before the procedure, patients treated with UAE (n = 100) had a dominant fibroid greater in size (68 vs. 48 mm) and a mean age lower (33.1 vs. 34.9 years) than surgically treated patients (n = 100). After 6 months, mean shrinkage of fibroid volume was 53 % after UAE and 39 % after LUAO (p = 0.063); 82 % of women after UAE, but only 23 % after LUAO, had complete myoma infarction (p = 0.001). Women treated with UAE had more complications (31 vs. 11 cases, p = 0.006) and greater incidence of hysteroscopically verified intrauterine necrosis (31 vs. 3 %, p = 0.001). Both groups were comparable in markers of ovarian functions and number of nonelective reinterventions. The groups did not differ in pregnancy (69 % after UAE vs. 67 % after LUAO), delivery (50 vs. 46 %), or abortion (34 vs. 33 %) rates. The mean birth weight of neonates was greater (3270 vs. 2768 g, p = 0.013) and the incidence of intrauterine growth restriction lower (13 vs. 38 %, p = 0.046) in post-UAE patients.

Conclusion

Both methods are effective in the treatment of women with future reproductive plans and fibroids not suitable for LM. UAE is more effective in causing complete ischemia of fibroids, but it is associated with greater risk of intrauterine necrosis. Both methods have low rate of serious complications (except for a high abortion rate).

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Acknowledgments

The authors thank Alena Dohnalova for statistical consultations and analysis of the results and Pavel Dundr for histopathological examinations of all excised myomas. The study was supported by a grant from the Internal Grant Agency of Ministry of Health of the Czech Republic (Grant No. NS 9798-4).

Conflict of interest

All authors state that they have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty of Charles University, Prague 2, 128 00, Czech Republic

    Michal Mara, Kristyna Kubinova, Petr Horak & David Kuzel

  2. Department of Radiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK

    Jana Maskova

  3. Department of Radiology, Central Military Hospital, Prague 6, 169 02, Czech Republic

    Tomas Belsan

Authors
  1. Michal Mara
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  2. Kristyna Kubinova
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Correspondence to Kristyna Kubinova.

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Mara, M., Kubinova, K., Maskova, J. et al. Uterine Artery Embolization Versus Laparoscopic Uterine Artery Occlusion: The Outcomes of a Prospective, Nonrandomized Clinical Trial. Cardiovasc Intervent Radiol 35, 1041–1052 (2012). https://doi.org/10.1007/s00270-012-0388-y

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