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Predictive factors for fibroids recurrence after uterine artery embolisation
Henri Marret1, Jean Philippe Cottier, Ana Maria Alonso
1Department of Gynaecology, Obstetrics, Fetal Medicine and Human Reproduction, Bretonneau University Hospital, 2 boulevard Tonnellé, 37044 Tours cedex 1, France.
Objectives:
To assess clinical failure and symptom recurrence after uterine artery embolisation (UAE) and to define predictive factors.
Design:
Prospective study of a case series.
Setting:
Gynaecology and radiology departments of a French University Hospital.
Population:
Eighty-five women who underwent embolisation for the treatment of uterine fibroids.
Method:
Vascular access was obtained via the right common femoral artery. Free-flow embolisation was performed using 150-250 mum polyvinyl alcohol particles and an absorbable particle sponge.
Main Outcome Measures:
Clinical failure was defined as persistence of symptoms at three months of follow up and recurrence as return of symptoms. The main outcome measure was the need for further treatment after UAE.
Results:
Results are available for 81 patients. Median follow up was 30 months. There were 15 clinical failures and recurrences requiring further treatment (eight hysterectomies, five hysteroscopic resections for submucous fibroids, one second embolisation and one woman refusing further treatment). Recurrence-free survival rate at 30 months (no clinical failure, no recurrence) was 82.8% (95% CI 73.7-91.8%). Multivariate analysis identified two predictive factors: dominant fibroid size on ultrasound imaging (each 1 cm increase: HR = 1.68, 95% CI 1.10-2.69) and number of fibroids (each additional fibroid: HR = 1.34, 95% CI 1.08-1.66).
Conclusions:
Symptom recurrence rate 30 months after fibroid embolisation was 17.2%. Fibroid size and number were predictive factors for recurrence. As most recurrences occurred after two years, we recommend that patients be monitored clinically and that imaging be for more than two years after UAE.