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[The percutaneous treatment of uterine fibromas by means of transcatheter arterial embolization].

INTRODUCTION
We report our preliminary experience with arterial embolization of uterine fibroids in seven women, focusing on the technical aspects of the procedure and the clinical and morphological results during the follow-up.


MATERIAL AND METHODS
February to December 1999 seven women (mean age 47) underwent transcatheter arterial embolization of both uterine arteries as a permanent treatment for fibroids. We included in this study single or multiple, bleeding and/or large fibroids, symptomatic on compression, contraindicated for myomectomy because of high surgical or anesthesiologic risks or myomata in which myomectomy could probably be converted into hysterectomy. Fibroids enlarging the uterus to the size of 25 weeks' pregnancy or more, pedunculated myomata or small submucous fibroids--smaller than 5 cm--were excluded. Uterine arterial embolization was performed bilaterally, till a total blockage of flow, by injecting permanent embolization material: polyvinyl-alcohol (PVA) particles of increasing size from 150 to 500 mu and in varying amounts from 10 to 24 mL, depending on fibroid size and degree of vascularization.


RESULTS
A technical success was achieved in all cases and no late complications were seen. At 6-month clinical follow-up all compressive symptoms had disappeared; regular menses had returned in 57% of patients, milder hyper-dysmenorrhea was present in 28% compared to pretreatment symptoms; only in one case (14%) was permanent amenorrhea observed. The 3-month and 6-month US follow-up studies showed an average 40.7% (range 10-50%) and 51% (range 25-83%) reduction in the fibroid size, respectively. All the small myomata (about 2 cm in size) were unidentifiable at 6-month US follow-up. In no cases did new fibroids appear.


DISCUSSION
Surgery is the traditional treatment for symptomatic uterine fibroids (hysterectomy, myomectomy). More recently, hormone therapy and operative endoscopy (laparoscopy and hysteroscopy) have been introduced as alternatives, together with uterine embolization previously applied preoperatively in extensive bleeding neoplasms or to control post-partum hemorrhage. Transcatheter embolization of the uterine arteries feeding large fibroids is a minimally invasive technique which could be safely used as an alternative to surgery, and a valuable in the definitive treatment of symptomatic, large or multiple, intramural or submucosal fibroids. In agreement with literature findings, in the present series symptoms resolved completely in over 85% of cases after embolization, with an average reduction in fibroid size over 50% at 6-month follow-up in large fibroids, whereas smaller size myomata were no longer detectable at US and no new fibroids had formed.


CONCLUSIONS
Our preliminary experience confirms that arterial embolization is a promising alternative to surgery in the definitive treatment of fibroids, thanks to its high efficacy and safety, also reducing patient hospitalization and costs.