Uterine Artery Embolization for Pedunculated Subserosal Fibroids: A Systematic Review and Meta-Analysis

Area of Science:

• Interventional Radiology
• Gynecologic Surgery
• Vascular Imaging

Background:

• Pedunculated subserosal fibroids can cause significant gynecological symptoms.
• Uterine artery embolization (UAE) is an established treatment for uterine fibroids, but its efficacy for pedunculated subserosal fibroids requires specific evaluation.
• Assessing the safety and efficacy of UAE for this specific fibroid subtype is crucial for patient management.

Purpose of the Study:

• To comprehensively review the existing literature on the safety and efficacy of UAE in patients with pedunculated subserosal fibroids.
• To synthesize data on adverse events, devascularization rates, and volume reductions following UAE for this fibroid type.

Main Methods:

• A systematic literature search was conducted using MEDLINE and Embase databases.
• Observational studies were included to assess safety (adverse events) and efficacy (devascularization, fibroid/uterine volume reduction).
• Meta-analysis was employed for quantitative synthesis of outcomes, using random-effects modeling.

Main Results:

• Eleven studies involving 181 patients were analyzed, reporting a pooled adverse event rate of 1.7%.
• The pooled devascularization rate was 75.9%, with a mean fibroid volume reduction of 38.6% and uterine volume reduction of 36.7%.
• Moderate adverse events included fibroid torsion and persistent bleeding; one severe event involved fibroid necrosis causing bowel obstruction. No deaths were reported.

Conclusions:

• Uterine artery embolization demonstrates a favorable safety profile for pedunculated subserosal fibroids.
• UAE is an effective treatment, leading to significant reductions in both fibroid and uterine volume.