UTERINE FIBROID EMBOLIZATION (UFE) – Results
To date, there have been several hundred articles in the medical literature that have demonstrated the success of UFE in treating patients with symptomatic fibroids. The technical success rate, which is the ability of an interventional radiologist to successfully embolize the uterine arteries, is greater than 95% and has been shown to be higher at centers with significant experience with this procedure. Clinically, the success of UFE is best measured by its ability to address the symptoms experienced by our patients. These results have been consistent throughout the many studies evaluating this procedure, with 85-95% of patients citing significant improvement in either abnormal uterine bleeding or bulk-related symptoms such as abdominal distension, frequent urination, or pelvic pain. Most importantly, studies have demonstrated that UFE has been associated with improvements in health-related quality of life.
The success of UFE can also be measured in its ability to reduce the volume of the uterus and dominant fibroids. Most studies have shown an average decrease in uterine and fibroid volume of 40-65%. It is important to remember, however, that this procedure is best evaluated by its ability to address symptoms and not by its ability to reduce the size of the fibroids. The size reduction seen after UFE is somewhat variable and does not necessarily correlate with its ability to reduce symptoms and improve patient comfort. Recent data has suggested that the ability of UFE to completely devascularize a fibroid (eliminate its blood supply and destroy the tissue) may be the most important effect of UFE as it relates to long-term control of symptoms. If a fibroid has been successfully devascularized, it will demonstrate the signs of tissue death (infarction) on the post-procedure MRI, which is what we look for on the 6-month follow-up MRI that we routinely recommend for all of our patients.
When evaluating the results seen after UFE, it is important to remember that while 85-95% of patients receiving significant clinical benefit, there are 5-15% of patients that do not. Possible explanations for treatment failure include incomplete embolization, extremely large uterine fibroids, the presence of a uterine cancer (leiomyosarcoma) or coexisting disorder such as adenomyosis, and the persistence of alternative sources of blood for the fibroids (such as the ovarian artery and the round ligament artery). Many of these possible causes of treatment failure are actively sought out on images obtained before and during the procedure.
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