Society of Interventional Radiology
J Jia, E Nguyen, A Chuprin, T Geisbush, S Win, Z Billah, T Sherry, K Karani, I Lekht, Kaiser Permanente Southern California
To compare the rate of secondary interventions following uterine artery embolization (UAE) and myomectomy for treatment of symptomatic uterine fibroids.
This is a retrospective cohort study. Patients who underwent UAE or myomectomy between January 1, 2008 and December 31, 2014 for treatment of symptomatic uterine fibroids were included in this analysis. Patient data was collected between the time of their initial procedure and December 31, 2017. Data extraction and chart review for baseline characteristics, procedural data, complications, secondary procedures, post procedural hemoglobin levels, subsequent pregnancy, and pregnancy outcomes was performed. Statistical analysis was performed using SPSS (IBM, New York).
Nine hundred and fifty patients are included in this analysis, 475 patients in each treatment arm. The median follow-up for the UAE and myomectomy groups was 7.1 and 7.4 years respectively. The myomectomy group had a higher rate of postprocedural complications including a significantly higher rate of blood transfusion than the UAE group, 2.9% versus 1.1%, respectively (p= 0.04). The rates of secondary intervention which included UAE, myomectomy, and hysterectomy were not statistically significant between the two groups, 8.6% in the UAE group and 9.9% in the myomectomy group (p=0.5). Both groups demonstrated a significant increase in hemoglobin at 1-year following initial procedure with a mean difference of 2.5 g/dL in the UAE group (p<0.1) and 1.9 g/dL in the myomectomy group (p<0.1). Seventy-seven patients who received myomectomy had subsequent pregnancies following their procedure versus 8 in the UAE group. In both groups the majority of patients delivered via Cesarean section. There were comparable rates of spontaneous abortion.
UAE and myomectomy are both valuable tools in the treatment of patients with symptomatic uterine fibroids. The two interventions have comparable rates of secondary intervention and are associated with a statistically significant improvement in hemoglobin from baseline, however UAE resulted in a significant decrease in necessity of postprocedural blood transfusions.