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World
Experience of Uterine Artery Embolisation
So far the world experience of uterine artery embolisation for fibroids would indicate a success rate of over 85%. Till
recently we only had short and medium term follow up but now long term follow up
data is available (31,32). UAE is now widely established particularly in the US and recently Condoleezza Rice's UAE was
widely reported in the US press. The procedure kills all the fibroids at one session with a very low
recurrence rate i.e. the cure appeared to be permanent in the majority of cases. The main complication of the
procedure is infection leading to hysterectomy and this has an incidence of <0.5%. The second important
complication is ovarian failure (i.e. a premature menopause). Again, the incidence of this complication is
extremely low (approximately 1% of patients under the age of forty-five) and when it does occur does not appear
to affect satisfaction rates. Like hysterectomy fibroid embolisation carries a mortality rate but this is extremely low.
To our knowledge there have been 5 mortalities in the world experience of
more than 30,000 embolisations of which 2 were from
pulmonary emboli (which is more common after hysterectomy and myomectomy) and 3 from infective/infarctive complications.
A survey by the Society of
Cardiovascular & Interventional Radiology in the United States in 1999 of 10,500 procedures revealed less than 1% of
serious complications requiring emergent surgery after embolisation and one death i.e. a mortality rate of one
in 10,000 (28) From this data it would appear that fibroid embolisation has a significantly lower complication rate
than hysterectomy which has a serious complication rate of 4-6% and a mortality rate for hysterectomy for fibroids
of one in 1,000 - 1,500 (24,25)
Kundu et al (33) compared 312 patients undergoing
surgery (total abdominal hysterectomy, myomectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy)
for fibroids with 65 women undergoing UFE. In the surgery group there were 20 cases of major complication and one death.
There were no major complications in the UFE group. Also 3 patients suffered pulmonary embolism in the surgery group and
27 cases of infection related to surgery but none in the UFE group. |
