At Georgetown University, we have treated nearly 600 patients with uterine embolization for fibroids. Beginning as a research protocol, embolization is now established as an accepted alternative to surgical management of fibroids. We have completed a number of studies on this procedure. Perhaps the most important is our recent report of our experience in 200 consecutive patients treated and followed for a minimum of 12 months. In this section, we will discuss those results in some depth.

Uterine Artery Embolization for Leiomyomata
Authors: Spies JB, Ascher SA, Roth AR, Kim J, Levy EB, Gomez-Jorge J.
Obstetrics and Gynecology 2001;98:29-34.

A total of 200 patients were treated between July 1997 and December 1999. The procedure was technically successful on both uterine arteries in 99% (n=198) of patients.

The large majority of patients (93%) had an overnight (23 hour) admission to the hospital. An additional 4% were discharged the day of the procedure. Admission for more than one night was required in 3% of patients. The average days until return to normal activity was 8, including weekend days.

The mean duration of study participation was 21 months and ranged from 12 to 36 months. Follow-up questionnaires were obtained from 91% of patients at three months, 82% at six months, 92% at one year and 69% at two years. Each patient in the study had a minimum of 12 months interval from the procedure.

Table 1 provides a summary of the symptom outcome from therapy. The majority of patients had improvement in symptoms by three months post-procedure and the symptom control persisted in most patients for up to two years of follow-up. Patient satisfaction paralleled the symptom change.

Table 1
Summary of symptom change

	Heavy Menstrual Bleeding
	3 months n=181	6 months n=158	1 year n=167
Improved Unchanged Worse	87 10 3	89 5 5	90 8 2
	Bulk Symptoms (%)
	3 months	6 months	1 year
Improved Unchanged Worse	93 4 3	92 5 3	91 7 2
	Satisfaction with symptom change (%)
	3 months	6 months	1 year
Improved Unchanged Worse	93 4 3	93 2 5	92 2 6
Questionaire Response Rate	95.5%	85%	90.5%

The imaging follow-up was obtained in 174 patients at 3 months and 116 at 12 months after treatment. The mean uterine volume reduced by 27% (std. dev. 29) 3 months post-treatment and further reduced by a mean of 38% (std. dev. 31) by 12 months after treatment. The mean dominant fibroid volume reduced by 44% (std. dev. 27) after 3 months and 58% (std. dev. 29) after 12 months. The data revealed a progressive reduction in both uterine and dominant leiomyoma mean volume from baseline to one year after treatment. There was a significant time effect for the percent reduction in uterine volume (F=26.26, df = 1, p<0.001).

There were 13 minor complications (6.5%), all treated with nominal therapy. The majority of these complications were for additional pain management (N=7). One major complication occurred. A patient developed a pulmonary embolus within 36 hours of the procedure. Her pulmonary embolus was diagnosed 2 days after discharge, prompting readmission for 4 days for anticoagulation.

Eleven patients were amenorrheic 3 months after embolization. The majority of these resumed normal menses within the subsequent 3 months, with only 4 patients made permanently amenorrheic by the procedure.

Subsequent gynecologic interventions or readmission occurred in 10.5% of patients. Most gynecologic procedures occurred months after the procedure. In our experience dilatation and curettage or hysteroscopic resection were the most common interventions for acute gynecologic problems related to the treated leiomyomata. During follow-up, 5 of the subsequent interventions were for endometrial infection, fibroid tissue passage, or severe bleeding; 2.5% of the study group.

Nine hysterectomies were performed, none for complications of the procedure. Seven patients underwent hysterectomy for failure of symptoms to improve sufficiently. Two patients had incidental hysterectomies for other conditions

The conclusion from this study is that uterine embolization is safe, with remarkably few complications. It also appears to be effective in the large majority of patients, with approximately 90% improved.