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The Re-intervention Rate

There have been some statements made by gynaecologists that fibroid embolisation has an unacceptable or high re-intervention rate. This is incorrect. There have been some articles published which have shown a high rate of further intervention but these are were in the early days where inexperienced interventional radiologists were performing the procedure with high and unacceptable technical failure rates and with a lack of experience and training.

Our re-intervention rate in those days was about 10% or 12% as reported in our major long-term study of more than five years follow up. But there is another highly significant point with regard to this; certain types of fibroid eg sub-mucous fibroids, may come away from the wall of the uterus after fibroid embolisation and require hysteroscopic resection. However, this is not really a complication, although it is usually included as such in statistics: you can argue that treating large sub-mucous fibroids by embolisation followed by hysteroscopic resection, where appropriate, is a method of treatment and the hysteroscopic resection is not a complication of the procedure but complementary to it.

Most of these patients end up with an entirely normal uterus after the hysteroscopic resection. Therefore, even a figure of 12% can be pared down and the real success rate of fibroid embolisation, when carried out by an experienced operator, should be around 95% for most cases except extreme examples e.g. fibroid sizes over 30 weeks pregnancy size where the situation is more complex and fibroid embolisation is normally performed with hysterectomy down the line.

In those rare difficult cases, the embolisation is carried out to shrink the fibroids down to such a size where for example instead of having an unsightly and longitudinal incision which can cause a number of problems to patients as well as the cosmetic one, the fibroid mass can be removed through a transverse incision.

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