Current concepts in uterine fibroid embolization

Uterine fibroid embolization (UFE) has become established as an accepted minimally invasive treatment for uterine fibroids and should be considered a treatment option for patients with symptomatic uterine fibroids. It is important for diagnostic radiologists to understand the procedure, since imaging is a key component in the evaluation and care of these patients. Both the interventional radiologist and the gynecologist must fully evaluate a patient before recommending UFE as a treatment for symptomatic fibroids. However, relatively few absolute contraindications exist (pregnancy, known or suspected gynecologic malignancy, and current uterine or adnexal infection). A thorough evaluation includes a medical history, menstrual history, physical examination, and discussion of fertility goals. In almost all cases, bilateral uterine artery catheterization and embolization are needed, since most uterine fibroids, whether single or multiple, receive blood supply from both uterine arteries. After UFE, patients can reasonably expect resolution of symptoms such as menorrhagia, pelvic pressure, and pelvic pain. Although infrequent, major adverse events can occur and include ovarian failure or amenorrhea, fibroid expulsion, and rarely venous thromboembolism. Hysterectomy remains the definitive and most common treatment for uterine fibroids, but less-invasive approaches such as UFE are becoming of greater interest to both patients and physicians.