June 8, 2008
Uterine Artery Embolisation or Hysterectomy For the Treatment of Symptomatic Uterine Fibroids
Uterine artery embolization is a relatively non-invasive procedure to stop the blood supply to the existing uterine fibroids in order to eliminate them. It involves a catheter through the artery and lasts for about an hour, but after the procedure, the uterus is intact. The fibroids do not have blood to feed them, so they disappear. But is it really a better solution than the hysterectomy, given that the symptomatic uterine fibroids may return within a year or two, and that with hysterectomy they cannot return because the uterus isn’t there any more?
Here’s a comparative study, with the full name of
Uterine artery embolisation or hysterectomy for the treatment of symptomatic uterine fibroids: a cost-utility analysis of the HOPEFUL study
by Wu, O. and Briggs, A.H. and Dutton, S. and Hirst, A. and Maresh, M. and Nicholson, A. and McPherson, K. (2007), and published in BJOG: An International Journal of Obstetrics and Gynaecology 114(11):pp. 1352-1362.
They wanted to see which procedure should be favourized from the standpoint of UK NHS. There were 649 women who underwent UAE (Uterine Artery Embolisation) and were followed for the 8.6 years in average, while there were 459 women with hysterectomy, which were followed for up to 4.6 in average.
Two main measures were the Costs of procedures and complications, and Quality Adjusted Life Years (QALY) UAE had the lower cost, £2536 versus £3282, small reduction in quality of life (8.203 versus 8.241 QALYs) when compared with hysterectomy. However, when the quality of life associated with the conservation of the uterus was incorporated in the model, UAE was shown to be the dominant strategy—lower costs and greater QALYs.
The result of the study is that simply more women should be allowed to UAE instead of going directly to hysterectomy. This is especially important if the woman wants to preserve her uterus.
The abstract of the Uterine Artery Embolisation or Hysterectomy For the Treatment of Symptomatic Uterine Fibroids study is published by the University of Glasgow.
Filed under Hysterectomy, Hysterectomy News, Laparoscopy, Reiki, Uterine Artery Embolization, Uterine Fibroids, Uterus by Dusko Savic
Comments on Uterine Artery Embolisation or Hysterectomy For the Treatment of Symptomatic Uterine Fibroids »
A hysterectomy is never needed for fibroids unless you have the wrong doctor. Myomectomy (surgical removal of fibroids leaving the uterus intact) can be performed regardless of the number, location, and size of fibrods, if the doctor has the skill. If the gynecologist doesn’t have the skill, they can’t perform a myomectomy. Rather than tell women they lack the necessary skill to perform a myomectomy many doctors tell women it’s not possible for them to have a myomectomy because their fibroids are too large, in a bad location in the uterus or pelvis, or they have too many of them.
Uterine artery embolization (UAE, sometimes called uterine fibroid embolization (UFE) has left many women with serious, permanent problems including migration of the embolic material to other organs and other parts of the vascular system including the lungs, vagina, labia, clitoris, bladder, bowel, buttocks, and kidney, chronic pain in the legs making walking difficult or impossible, infertility, cessation of menstruation, infection requiring removal of the uterus and ovaries, and death.
In addition to the study recommended on this blog there are several informative articles including:
Fibroid Embolisation: A Technique Not Without Significant Complications
A. Vashisht, J.W.W. Studd, A.H. Carey, J. McCall, P.R. Burn, J.C. Healy and J.R. Smith
British Journal of Obstetrics and Gynecology
September 2000; 107: p.1166-1170
Fatal Sepsis after Uterine Artery Embolization with Microspheres
Sjoerd de Blok, MD, PhD, Cees de Vries, MD, Helma M. Prinssen, MD, Hans L.G. Blaauwgeers, MD and Lorine B. Jorna-Meijer, MD
Journal of Vascular and Interventional Radiology
Vol. 14 No. 6 June 2003: p.779-783
Fatal Septicaemia after Fibroid Embolisation
Arvind Vashisht, John Studd, Adam Carey, Paul Bum
The Lancet
July 24, 1999; 354 (9175): p.307-308
Pelvic Sepsis Complicating Embolization of a Uterine Fibroid
Stephen Robson, Kay Wilson, David Munday and Ruben Sebben
The Austrailan and New Zealand Journal of Obstetrics and Gynaecology
1999; 39: 4: p. 516-7
Buttock Necrosis After Uterine Artery Embolization
Danielle M. Dietz, MD, Kurt R. Stahlfeld, MD, Surendra K. Bansal, MD, and Wayne A. Christopherson, MD
Obstetrics & Gynecology
November 2004; Vol. 104, No. 5, Part 2: p.1159-1161
Uterine Necrosis after Uterine Artery Embolization for Leiomyoma
Claire D. Godfrey, MD and Edward A. Zbella, MD
Obstetrics and Gynecology
November 2001; 98(5 Part 2): p.950-952
Uterine Necrosis After Arterial Embolization for Postpartum Hemorrhage
J.P. Cottier, MD, A. Fignon, MD, F. Tranquart, MD, PhD, and D. Herbreteau, MD
Obstetrics and Gynecology
Vol. 100 No. 5, Part 2, November 2002: p.1074-7
Labial Necrosis After Uterine Artery Embolization for Leiomyomata
Thomas J. Yeagley, Jay Goldberg, Thomas A. Klein, and Joseph Bonn
Obstetrics and Gynecology
2002; 100:881-2
Massive vault necrosis with bladder fistula after uterine artery embolisation
Amr H. El-Shalakany, Mohammad H. Nasr El-Din, Gamal A. Wafa, Mohammad E. Azzam, Ahmad El-Dorry
British Journal of Gynecology
February 2003, Vol. 110 pp. 215-216
Ischemic Uterine Rupture and Hysterectomy 3 Months after Uterine Artery Embolization
Abraham R. Shashoua, M.D., Nelson H. Stringer, M.D., Julie B. Pearlman, M.D., Behnaz Behmaram, M.D.
The Journal of the American Association of Gynecologic Laparoscopists
May 2002; 9(2): p.217-220
Massive Vaginal Hemorrhage after Uterine Fibroid Embolization
Robert K. Kerlan Jr, James O. Coffey, Marilyn S. Milkman, Jeanne M. LaBerge, Mark W. Wilson, Kristen A. Cea Wolanske, and Roy L. Gordon
Journal of Vascular & Interventional Radiology
2003; 14:1465-1467
Sexual Dysfunction after Uterine Artery Embolization
A.C. Lai, S.C. Goodwin, S.M. Bonilla, A.P. Lai, T. Yegul, S. Vott, and M. DeLeon
Journal of Vascular & Interventional Radiology
June 2000; 11(6): p.755-8
Vesicouterine fistula after uterine artery embolization: A case report
Carmen J. Sultana, MD, Jay Goldnerg, MD, Laura Aizenman, MD, and Joanna K. Chon, MD
American Journal of Obstetrics and Gynecology
2002; 187(6): p.1726-7
Ovarian Failure after Uterine Artery Embolization for Treatment of Myomas
N.H. Stringer, T. Grant, J. Park, and L. Oldham
Journal American Association of Gynecologist Laparoscopists
August 2000; 7(3): p.395-400
Embolic Microspheres Within Ovarian Arterial Vasculature After Uterine artery Embolization
John F. Payne, MD, Stanley J. Robboy, MD, and A. F. Haney, MD
Obstetrics & Gynecology
Vol. 100, No. 5, Part 1 November 2002: p.883-6
The Vascular Impact of Uterine Artery Embolization: Prospective Sonographic Assessment of Ovarian Arterial Circulation
Robert K. Ryu, MD, Howard B. Chrisman, MD, Reed A. Omary, MD, MS, Simka Miljkovic, RDMS, Albert A. Nemcek, Jr, MD, Mark B. Saker, MD, Scott Resnick, MD, James Carr, MD, and Robert L. Vogelzang, MD
Journal of Vascular and Interventional Radiology
September 2001; 12(9): p.1071-1074
The Future Interventional Radiologist: Clinician or Hired Gun?
Mark O. Baerlocher, BSc, and Murray R. Asch, MD, FRCPC
Journal of Vascular & Interventional Radiology
December 2004; 15:1385-1390
Transarterial Embolization of the Uterine Arteries: Patient Reactions and Effects on Uterine Vasculature
Adel Aziz, Oswald M. Petrucco, Satoru Makinoda, Gunnar Wikholm, Paul Svendsen, Mats Brannstrom and Per Olof Janson
Acta Obstetricia et Gynecologica of Scandinavica
March 1998; 77(3): p.334-340
Pathologic Features of Uteri and Leiomyomas Following Uterine Artery Embolization for Leiomyomas
Terence J. Colgan, Gaylene Pron, Eva J. M. Mocarski, John D. Bennett, Murray R. Asch, and Andrew Common
The American Journal of Surgical Pathology
27(2); 167-177, 2003
Patient Radiation Dose Associated With Uterine Artery Embolization
B. Nikolic, J.B. Spies, M.J. Lundsten, and S. Abbara
Radiology
Jan. 2000, 214(1): p.121-125
Influence of Radiographic Technique and Equipment on Absorbed Ovarian Dose Associated with Uterine Artery Embolization
B. Nikolic, S. Abbara, E. Levy, I. Imaoka, M.L. Lundsten, R.C. Jha, and J.B. Spies
Journal of Vascular & Interventional Radiology
October 2000; 11(9): p.1173-1178
Permanent amenorrhea associated with endometrial atrophy after uterine artery embolization for symptomatic uterine fibroids
Giovanna Tropeano, MD et al
Fertility and Sterility
January 2003 Vol. 79, No. 1
Embolization of the Internal Iliac Artery: Still More to Learn
Michael C. Soulen, Ronald M. Fairman and Richard Baum
Journal of Vascular & Interventional Radiology
May 2000;11(5): p.543-545
The Positive Effect of Targeted Marketing on an Existing Uterine Fibroid Embolization Practice
Howard B. Chrisman, MD, MBA, Pat Auveek Basu, MD, MBA, and Reed A. Omary, MD
Journal of Vascular Interventional Radiology
March 2006; 17:577-581
Let the reader beware.
Thank you for this list of official reports on UAE. A very interesting list for anyone considering this procedure!
thanks for useful information and the citations. approximately 230,000 hysterectomies for fibroids are done annually in the USA alone. However other alternative treatments exist and some are successfully based on the fibroids. A full report in the WSJ about a minimally invasive technique that uses heat energy to ablate the fibroid tissue laparoscopically. A phase 3 clinical trial is underway at 7 sites to test the efficacy of this treatment. More details on the sites, the procedure and how to enroll are provided at the link above. Hope this is helpful