1Abdullah Muharib,1Radhi Alshehri, 1Radhi Alshehri, 1Najeeb Ghanem, 1Salem Bauones

1King Fahad Medical City

Introduction(s):

Uterine leiomyomas (fibroids) are the most common gynecological tumors. Approximately 20–40 % of women are affected in their reproductive age. The vast majority of fibroids present no symptoms and are incidental findings during routine gynecological examinations. Asymptomatic uterine fibroids require no medical management beyond observation, whereas symptomatic fibroids are indicated for medical treatment. Surgery remains a first-line treatment of symptomatic uterine fibroids; however, minimally invasive techniques and pharmacological management have become more available and popular. Among minimally invasive techniques uterine artery embolization (UAE) is the most well-established uterine preserving treatment.

In our study, we are going to determine the safety and efficacy of uterine artery embolization in the treatment of patients with symptomatic fibroids in a single tertiary hospital at king Fahad medical city, Riyadh, Saudi Arabia. We are going to determine its safety by determining what are the complications related to the procedure and how frequent they are. Also, we are going to determine its efficacy by assessing the improvement in the imaging findings in the follow up with MRI.

Material(s) and Method(s):

It is a retrospective cohort study including all patients who underwent uterine artery embolization for the treatment of symptomatic fibroids who had baseline and follow up MRI at King Fahad Medical City, Riyadh, Saudi Arabia between the period of 1 January 2016 to 1 January 2021. A total of 28 female patients were found.

The outcomes included: The dominant fibroid volume before and after UAE, presence or absence of infarction in MRI, and early and delayed complications.

Result(s):

In this study, the ages of the patients ranged from 32 to 51 years, with an average of 40.7 years. 8 (28%) patients have single fibroid while 20 (72%) patients have multiple fibroids ranging from 2 to more than 10 fibroids. Radial access was used in 8 (28%) patients while the remaining 20 (72%) patients, common femoral access was used. Beads block was the embolizing agent that was used in all patients.  Technical success achieved in all patients without immediate complication. The mean MRI follow up period after UAE was 9.3 months. Only one patient (3.6%) had progression in the fibroid volume after UAE by 64 % with absence of infarction attributed to ovarian artery parasitization. The rest of the patients (96.4%) had significant volume reduction with mean of 57.6 (12.6%-99.6%), P value less than 0.001, 95% confidence interval is 69.20, 207.39. The patients with solitary fibroids had mean of fibroid volume reduction of 79.6% compared to 54.3% in patients with multiple fibroids, P value is less than 0.001.

Post discharge complications seen only in one patient (3.6%) who had postembolization syndrome. No major complications encountered.

Conclusion(s):

UAE is a safe, technically successful and effective treatment for symptomatic fibroids which could be a good alternative for surgery. All patients with symptomatic uterine fibroids considering hysterectomy and myomectomy should be counseled about UAE by an interventional radiologist. Selection of patients is important to optimize the benefits.