Practice Essentials

Uterine leiomyomas, better known as uterine fibroids, are benign smooth muscle tumors of the uterus.The most common tumor found in the female reproductive system, uterine fibroids are seen in 50-60% of women (rising to 70% by 50 years of age) and, in 30% of cases, cause morbidity due to abnormal uterine bleeding and pelvic pressure. African-American women have a greater chance of being affected by uterine fibroids, particularly at an earlier age than either white or Asian women.^[1] Uterine fibroids can occur at any time between menarche and menopause but are most common in women 35-49 years of age. They typically resolve after menopause.

Before performing uterine fibroid embolization (UFE), it is important to document the presence of fibroids, usually either by pelvic ultrasound or by MRI. MRI is preferred because of its greater ability to demonstrate individual fibroids and denote their size, location, and number within the uterus. ^{[1, 2, 3, 4, 5]} It has been estimated that 13,000-14,000 UFE procedures are performed annually in the United States.^[6]

In light of the success of embolization in reducing solid tumors and diminishing associated symptoms, uterine fibroid embolization (UFE) is performed to reduce uterine as well as fibroid volume and their associated symptoms.^{[7, 8, 9, 10, 11]}

(Scans of uterine fibroids are shown in the images below.)

Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016 Nov. 22 (6):665-686. [QxMD MEDLINE Link]. [Full Text].
Chapiro J, Duran R, Lin M, Werner JD, Wang Z, Schernthaner R, et al. Three-Dimensional Quantitative Assessment of Uterine Fibroid Response after Uterine Artery Embolization Using Contrast-Enhanced MR Imaging. J Vasc Interv Radiol. 2015 May. 26 (5):670-678.e2. [QxMD MEDLINE Link].
Kong CY, Meng L, Omer ZB, Swan JS, Srouji S, Gazelle GS, et al. MRI-guided focused ultrasound surgery for uterine fibroid treatment: a cost-effectiveness analysis. AJR Am J Roentgenol. 2014 Aug. 203 (2):361-71. [QxMD MEDLINE Link].
Kirpalani A, Chong J, Yang N, Jenkins SJ, Nisenbaum R, Prabhudesai V, et al. Diffusion-weighted imaging properties of uterine fibroids pre- and post-uterine fibroid embolisation. Eur J Radiol. 2014 Sep. 83 (9):1620-5. [QxMD MEDLINE Link].
De La Cruz MS, Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017 Jan 15. 95 (2):100-107. [QxMD MEDLINE Link]. [Full Text].
Society of Interventional Radiology. Uterine Fibroid Symptoms, Diagnosis and Treatment. Society of Interventional Radiology. Available at https://www.sirweb.org/patients/uterine-fibroids. Accessed: : May 6, 2009.
Popovic M, Puchner S, Berzaczy D, Lammer J, Bucek RA. Uterine artery embolization for the treatment of adenomyosis: a review. J Vasc Interv Radiol. 2011 Jul. 22(7):901-9. [QxMD MEDLINE Link].
Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007 Jan 25. 356(4):360-70. [QxMD MEDLINE Link].
van der Kooij SM, Bipat S, Hehenkamp WJ, Ankum WM, Reekers JA. Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011 Mar 16. [QxMD MEDLINE Link].
Barton PP, Waneck RE, Karnel FJ, Ritschl P, Kramer J, Lechner GL. Embolization of bone metastases. J Vasc Interv Radiol. 1996 Jan-Feb. 7 (1):81-8. [QxMD MEDLINE Link].
Brown KT, Nevins AB, Getrajdman GI, Brody LA, Kurtz RC, Fong Y, et al. Particle embolization for hepatocellular carcinoma. J Vasc Interv Radiol. 1998 Sep-Oct. 9 (5):822-8. [QxMD MEDLINE Link].
[Guideline] Expert Panel on Interventional Radiology:., Knuttinen MG, Stark G, Hohenwalter EJ, Bradley LD, Braun AR, et al. ACR Appropriateness Criteria^® Radiologic Management of Uterine Leiomyomas. J Am Coll Radiol. 2018 May. 15 (5S):S160-S170. [QxMD MEDLINE Link]. [Full Text].
Kirby JM, Burrows D, Haider E, Maizlin Z, Midia M. Utility of MRI Before and After Uterine Fibroid Embolization: Why to Do It and What to Look For. Cardiovasc Intervent Radiol. 2010 Nov 18. [QxMD MEDLINE Link].
Smeets AJ, Nijenhuis RJ, van Rooij WJ, Weimar EA, Boekkooi PF, Lampmann LE, et al. Uterine artery embolization in patients with a large fibroid burden: long-term clinical and MR follow-up. Cardiovasc Intervent Radiol. 2010 Oct. 33(5):943-8. [QxMD MEDLINE Link]. [Full Text].
Siddiqui N, Nikolaidis P, Hammond N, Miller FH. Uterine artery embolization: pre- and post-procedural evaluation using magnetic resonance imaging. Abdom Imaging. 2013 Oct. 38(5):1161-77. [QxMD MEDLINE Link].
Jacobs MA, Nasser F, Zlotnik E, Messina Mde L, Baroni RH. Endometrium evaluation with high-field (3-Tesla) magnetic resonance imaging in patients submitted to uterine leiomyoma embolization. Einstein (Sao Paulo). 2013 Jan-Mar. 11(1):58-62. [QxMD MEDLINE Link].
Park MJ, Kim YS, Rhim H, Lim HK. Safety and therapeutic efficacy of complete or near-complete ablation of symptomatic uterine fibroid tumors by MR imaging-guided high-intensity focused US therapy. J Vasc Interv Radiol. 2014 Feb. 25 (2):231-9. [QxMD MEDLINE Link].
Moss J, Christie A. Uterine artery embolization for heavy menstrual bleeding. Womens Health (Lond). 2016 Jan. 12 (1):71-7. [QxMD MEDLINE Link]. [Full Text].
Song YG, Jang H, Park KD, Kim MD, Kim CW. Non spherical polyvinyl alcohol versus gelatin sponge particles for uterine artery embolization for symptomatic fibroids. Minim Invasive Ther Allied Technol. 2013 Sep 1. [QxMD MEDLINE Link].
Chua KJC, McLucas B. Pregnancy after uterine artery embolization using Gelfoam™. Minim Invasive Ther Allied Technol. 2018 Aug. 27 (4):246-248. [QxMD MEDLINE Link].
Goodwin SC, Spies JB, Worthington-Kirsch R, Peterson E, Pron G, Li S, et al. Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID Registry. Obstet Gynecol. 2008 Jan. 111 (1):22-33. [QxMD MEDLINE Link].
Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2014 Dec 26. CD005073. [QxMD MEDLINE Link].
Dutton S, Hirst A, McPherson K, Nicholson T, Maresh M. A UK multicentre retrospective cohort study comparing hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids (HOPEFUL study): main results on medium-term safety and efficacy. BJOG. 2007 Nov. 114(11):1340-51. [QxMD MEDLINE Link].
Wu O, Briggs A, Dutton S, Hirst A, Maresh M, Nicholson A, et al. Uterine artery embolisation or hysterectomy for the treatment of symptomatic uterine fibroids: a cost-utility analysis of the HOPEFUL study. BJOG. 2007 Nov. 114(11):1352-62. [QxMD MEDLINE Link].
Hehenkamp WJ, Volkers NA, Birnie E, Reekers JA, Ankum WM. Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy--results from the randomized clinical Embolisation versus Hysterectomy (EMMY) Trial. Radiology. 2008 Mar. 246(3):823-32. [QxMD MEDLINE Link].
Gabriel-Cox K, Jacobson GF, Armstrong MA, Hung YY, Learman LA. Predictors of hysterectomy after uterine artery embolization for leiomyoma. Am J Obstet Gynecol. 2007 Jun. 196(6):588.e1-6. [QxMD MEDLINE Link].
Lanocita R, Frigerio LF, Patelli G. A fatal complication of percutaneous transcatheter embolization for treatment of uterine fibroids. Paper presented at: Society of Minimally Invasive Therapy Meeting;. September 1999. Boston, MA.
Hehenkamp WJ, Volkers NA, Broekmans FJ, de Jong FH, Themmen AP, Birnie E, et al. Loss of ovarian reserve after uterine artery embolization: a randomized comparison with hysterectomy. Hum Reprod. 2007 Jul. 22(7):1996-2005. [QxMD MEDLINE Link]. [Full Text].
Holub Z, Mara M, Kuzel D, Jabor A, Maskova J, Eim J. Pregnancy outcomes after uterine artery occlusion: prospective multicentric study. Fertil Steril. 2008 Nov. 90(5):1886-91. [QxMD MEDLINE Link].
Zupi E, Centini G, Sabbioni L, Lazzeri L, Argay IM, Petraglia F. Nonsurgical Alternatives for Uterine Fibroids. Best Pract Res Clin Obstet Gynaecol. 2016 Jul. 34:122-31. [QxMD MEDLINE Link].
Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol. 2008 Jan-Feb. 31(1):73-85. [QxMD MEDLINE Link].
Fischer K, McDannold NJ, Tempany CM, Jolesz FA, Fennessy FM. Potential of minimally invasive procedures in the treatment of uterine fibroids: a focus on magnetic resonance-guided focused ultrasound therapy. Int J Womens Health. 2015. 7:901-12. [QxMD MEDLINE Link]. [Full Text].
Stewart EA, Gostout B, Rabinovici J, Kim HS, Regan L, Tempany CM. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol. 2007 Aug. 110(2 Pt 1):279-87. [QxMD MEDLINE Link].
Jacoby VL, Kohi MP, Poder L, Jacoby A, Lager J, Schembri M, et al. PROMISe trial: a pilot, randomized, placebo-controlled trial of magnetic resonance guided focused ultrasound for uterine fibroids. Fertil Steril. 2016 Mar. 105 (3):773-780. [QxMD MEDLINE Link].
Kim YS, Lim HK, Park MJ, Rhim H, Jung SH, Sohn I, et al. Screening Magnetic Resonance Imaging-Based Prediction Model for Assessing Immediate Therapeutic Response to Magnetic Resonance Imaging-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids. Invest Radiol. 2016 Jan. 51 (1):15-24. [QxMD MEDLINE Link].
U.S. Food and Drug Administration. FDA Approves New Device to Treat Uterine Fibroids. FDA: U.S. Food and Drug Administration. Food and Drug Administration. Available at https://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01319.html. Accessed: : February 20, 2009.
Spies JB, Cornell C, Worthington-Kirsch R, Lipman JC, Benenati JF. Long-term outcome from uterine fibroid embolization with tris-acryl gelatin microspheres: results of a multicenter study. J Vasc Interv Radiol. 2007 Feb. 18 (2):203-7. [QxMD MEDLINE Link].

Media Gallery

Nonselective pelvic angiogram demonstrating the tortuous and dilated uterine arteries supplying a hypervascular uterine fibroid.
Selective angiogram of the left uterine artery prior to embolization.
Selective angiogram of the right uterine artery prior to embolization.
Nonselective angiogram of the pelvis after embolization demonstrating occlusion of both the right and left uterine arteries.

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