Fibroids treatment UFE World Experience

So far the world experience of uterine fibroid embolisation for fibroids would indicate a success rate of over 90%.

So far the world experience of uterine fibroid embolisation for fibroids would indicate a success rate of over 90%. Until recently we only had short and medium term follow up but now long term follow up data is available(2,5). UFE is now widely established particularly in the US and latterly Condoleezza Rice's UFE was widely reported in the US press. Hundreds of thousands of patients have had UFE worldwide. The procedure kills all the fibroids at one session with a very low recurrence rate i.e. the cure is permanent in the overwhelming majority of cases. The two major complications of the procedure are infection leading to hysterectomy and this has an incidence of <0.5% and ovarian failure (ie a premature menopause). Again, the incidence of this complication is extremely low (less than 1% of patients under the age of 45) and when it does occur does not appear to affect satisfaction rates.

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 emergency surgery after embolisation and one death i.e. a mortality rate of one in 10,000(37). From this data and numerous other papers (see table below) in this contect it would appear that fibroid embolisation has a much 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(27,34).

Kundu et al(4) 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.

Table of fibroid embolisation -v- myomectomy & hysterectomy

Author (year)	Study design	Procedures (No of pts at procedure	Months of follow-up (No of patients)
Broder et al (2002)	Retrosp	UAE 59 AM 38	46 (N=51) 49 (N=30)
Edwards et al (2007)	RCT	UAE 106 Surg 51	12 (N=95) 12 (N=45)
Goodwin et al (2006)	Retrosp	UAE 149 AM 60	6 (N=121) 6 (N=45)
Hehenkamp et al (2005)	RCT	UAE 88 H 89	1.5 (N=81) 1.5 (N=81)
Pinto et al (2003)	RCT	UAE 38 AH 19	6 (N=36) 6 (N=37)
Ravazi et al (2002)	Retrosp	UAE 67 AM 44	14 (N=62) 15 (N=40)
Spies et al (2004)	Retrosp	UAE 102 H 50	12 (N=76) 12 (N=30)
Volers et al (2007)	RCT	UAE 88 H 89	24 (N=81) 24 (N=73)