Uterine Artery Catheterisation and Selective Leiomyoma Embolization: Patient Acceptance and Clinical Outcome

Abstract

Objective: To evaluate the patient acceptance and clinical outcome after selective uterine leiomyoma embolization. Materials and Methods: Twenty-four women with symptomatic uterine fibroid were recruited for this study. Selective uterine leiomyoma embolization proceeded until complete vascular occlusion was achieved. The main outcome measure was the decrease in the leiomyoma volume and factors that predict it. Pearson correlation analysis and linear regression analysis were performed to identify possible correlates and predictors of decrease in leiomyoma volume. Patient satisfaction was assessed by asking the subjects to indicate their degree of satisfaction on a five-point scale. Results: The mean age of the patients was 41.5 +/- 4.9 (Range: 28-52). The mean leiomyoma volume before the procedure was 157 +/- 214 cm(3) which was calculated to be 44 +/- 66 cm3 with a 76 +/- 17% (Range: 30-99%) decrease in the mean leiomyoma volume at the end of one year. Correlation analysis revealed that only preoperative estradiol level was positively correlated with the extent of decrease in the leiomyoma volume (r=0.54, p=0.005). This was also proved in the regression analysis (beta=0.25, p=0.01). During the follow-up 17 (70.8%) patients had complete remission of the symptoms, 5 (20.8%) had partial remission and 2 (8.3%) had no clinically significant change. Twenty patients (83.3%) were completely satisfied, 2 were satisfied and 2 were dissatisfied with the leiomyoma embolization procedure. Discussion: There is a positive correlation between the preoperative estradiol level and the extent of the decrease in the leiomyoma volume after the embolization procedure. As leiomyoma is a hormone dependent tumor, the shrinkage of the leiomyoma seems also dependent on the estradiol levels before the precedure besides the incurred ischemic necrosis secondary to arterial embolization.