Repeat uterine artery embolization following technical failure

This retrospective chart review was performed to evaluate the success of uterine artery embolization performed in two sessions due to initial technical failure. Patients undergoing embolization for symptomatic uterine myomata between 1997 and 2007 were included in the study. Patients who initially suffered unilateral technical failure were offered repeat embolization. This group was contrasted with patients who underwent bilateral embolization during the initial procedure. Success was defined as relief of symptoms based on pre- and post-procedure questionnaires, and/or > 30% shrinkage of the largest myoma. During the study period, 1078 uterine artery embolization procedures were performed. 1024 (94.9%) were initial bilateral procedures; 34 (3.2%) were unilateral procedures due to technical failure and 20 (1.9%) were unilateral procedures due to anatomical reasons. Twenty-two of the patients who experienced technical failure elected to undergo a repeat procedure. Sixteen patients who underwent repeat embolization were available for review. Eleven patients underwent post-embolization imaging; seven (63.6%) had successful shrinkage of the largest myoma. Three patients underwent post-embolization magnetic resonance imaging evaluation; none demonstrated enhancement of myomata. Fifteen patients completed questionnaires, fourteen (93.3%) reported symptom relief. Seven hundred and thirty-one of the patients who underwent initial bilateral embolization during the study period were available for review. Of the 582 patients with imaging data, 376 (64.6%) had successful shrinkage of the largest myoma. All 731 patients completed questionnaires. 728 patients (99.6%) reported symptom relief. Two-step bilateral embolization seems to be an effective management option after technical failure.