Analysis of presurgical uterine artery embolization (PUAE) for very large uterus myomatosus; patient’s desire to preserve the uterus; case series and literature review

Abstract

Purpose Purpose of this paper to present results of a group of 21 consecutive patients who underwent uterine artery embolization (UAE) immediately before myomectomy. Surgical myomectomy can lead to a substantial blood loss in case of large or multiple tumors due to the hypervascularization of the tumors. This may lead to multiple blood transfusion or hysterectomy. In cases were the preservation of the uterus is demanded, pre-operative embolization could reduce the risk of substantial bleeding.

Materials and Methods Between January 2011 and March 2016, 21 patients underwent UAE 24 hours before myomectomy. All patients were asked by questionnaire about post-surgical follow-up, complications, the length of the scar, satisfaction and improvement of symptoms. Data of the operation and embolization were retrospectively assessed.

Results UAE could be performed in all patients without complications. Mean diameter of the largest myoma was 12.7 ± 3.2 cm, primary preservation of the uterus succeeded in all cases. In none of the cases a perioperative blood transfusion was necessary. One patient underwent hysterectomy in another hospital after primary successful resection, one patient received transfusion of 2 bags of red blood cell concentrate during her stay in hospital.

11 of 21 patients responded to the questionnaire. 10 of 11 had subjective symptom improvement. Mean inability to work was 31 days, the mean self-measured length was 12 cm. 9 of 11 patients would recommend the procedure, one patient was in the second trimester of pregnancy.

Conclusion Preoperative uterine artery embolization facilitates a safe and uterus-preserving myomectomy in patients with very large or multiple fibroids.

Key Points 

• Uterus-preserving myomectomy can be used in cases of large uteri or with multiple fibroids with low amount of blood loss.

• The combination of preoperative embolization and subsequent myomectomy may be a therapeutic option in cases of infertility due to a fibroid-induced uterine deformation.

• Good interdisciplinary cooperation is essential for sustainable results in this complex group of patients.

Citation Format

• Schnapauff D, Russ M, Kröncke T et al. Analysis of presurgical uterine artery embolization (PUAE) for very large uterus myomatosus; patient’s desire to preserve the uterus; case series and literature review. Fortschr Röntgenstr 2018; 190: 616 – 622

Key words

embolization - fibroids - preoperative embolization - fertility

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