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Uterine artery embolization for the treatment of symptomatic fibroid disease

September 2001 Uterine leiomyomas (fibroids) are the most common gynecological tumors in women, occurring in 20% to 25% of women of childbearing age. They are three times more common in the AfricanAmerican population than in the white population. Although asymptomatic in the majority of women, fibroids are a common cause of heavy prolonged menstrual bleeding (menorrhagia), intermenstrual bleeding (menometrorrhagia), urinary frequency, stress incontinence, and pelvic pain in approximately 25% of women with fibroids. Although patients may experience these symptoms during their 20s, women usually do not manifest severe symptoms until their late 30s or 40s. Fibroid disease is responsible for the loss of 5 to 10 million persondays, for 900,000 hospital days, and a direct cost of more than $1 billion in the United States annually. Transcatheter uterine artery embolization (UAE) is a rapidly emerging alternative to conventional medical and surgical therapy in the treatment of symptomatic uterine leiomyomas. The technique of pelvic vessel embolization is well recognized as an effective treatment for acute pelvic hemorrhage, with the first successful uterine artery embolization for this indication reported in 1979. Embolization has been used successfully in cases of postpartum hemorrhage, trauma, postsurgical bleeding, ectopic pregnancy, placenta accreta, cervical pregnancy, and vascular malformation. In 1994, Ravina et al described uterine artery embolization as an adjunct to surgery in the treatment of fibroids and a year later described it as a primary therapy.