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Uterine fibroid embolization: where are we and where should we go?

Since the first reports of its use as a treatment option for women with symptomatic uterine fibroids, uterine artery embolization (UtAE) has become increasingly accepted as a key therapy for this patient population. The method of uterine fibroid embolization (UFE) has been extensively described in the literature1–6. In essence it involves the placement of a catheter into the uterine arteries and injection of embolization particles into the uterine arteries to achieve fibroid devascularization and progressive shrinkage1–6. Non-spherical polyvinyl alcohol (PVA) particles were the first embolization agents used for UFE1–6. Spherical embolization particles, such as tris-acryl microspheres, have been developed to address some of the disadvantages of non-spherical particles (such as unpredictable level of arterial occlusion) and thus allow a more targeted fibroid devascularization whilst sparing normal myometrium7,8. With the increasing frequency of use of UtAE to treat uterine fibroids there has been a greater understanding of patient selection, preand postprocedural imaging, indications, results and potential risks associated with the procedure. The scientific evidence of the procedure’s effectiveness has also greatly improved. Evaluation of UFE results has mainly included determination of clinical success and complication rates and uterine/fibroid volume reduction. Recovery time, change in quality of life and patient acceptance are other important considerations. UFE is a highly effective, minimally invasive alternative to hysterectomy and is now widely accepted for the management of fibroid-related symptoms. However, there are still some questions regarding the use of UFE as an alternative to myomectomy in women desiring future fertility and in women with adenomyosis.