AJOG global reports · 2025
Transradial uterine artery embolization for the treatment of symptomatic fibroids: A ten year experience.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Jiménez-Rámila Carlos, Redondo-Villatoro Ana, Ruiz-Salmerón Rafael J, Rodríguez de Leiras-Otero Sergio, Jiménez-Caraballo Antonio
Аннотация
BACKGROUND: Uterine fibroids are the most common tumors in women. They are generally asymptomatic but can cause bleeding problems and/or compression of neighboring structures and infertility. Embolization is an effective treatment for fibroids. However, transradial access is underused for various reasons.
OBJECTIVE: This study aimed to demonstrate that transradial access is safe and effective for treating symptomatic uterine fibroids to avoid the need for conventional surgery.
STUDY DESIGN: A single-center retrospective observational study of medical records between 2012 and 2022, in which 189 procedures were planned in patients with symptomatic uterine fibroids with fulfilled gestational desire, was conducted. The feasibility and safety of the technique, the need for subsequent surgery because of the lack of effectiveness of the treatment in women who could complete it from the date of the procedure until 24 months later, changes in uterine volume and in the largest fibroid, and changes in hemoglobin levels, follicle-stimulating hormone, luteinizing hormone, and estradiol were analyzed before and 6 months after the procedure. Changes in the quality of life questionnaire (Uterine Fibroid Symptom and Health-Related Quality of Life questionnaire) were analyzed before embolization and at 2 and 6 months after embolization.
RESULTS: Of note, 184 of 189 procedures (97.35%) were performed with total or partial angiographic success. Surgical intervention was not necessary 24 months after the procedure in 85.4% of patients (158/180 patients with complete angiographic success) with a very low rate of complications, all of them mild (13/185 [7%]). Between the first visit and the visit at 6 months after the intervention, both the uterine volume decreased (n=176; previous volume, 458.11 mL; volume after 6 months, 311.87 mL; -146.24 mL [95% confidence interval, -115.41 to -177.06]; P<.001) and the largest fibroid (previous volume 132.31 mL; volume after 6 months, 78.33 mL; -53.98 mL [95% confidence interval, -42.79 to -65.17]; P<.001) and the scores in the quality of life questionnaires and the hemoglobin level improved (previous level, 11.4 g/dL; level after 6 months, 12.85 g/dL; -9.94 [95% confidence interval, -1.74 to -1.16]; P<.001). Follicle-stimulating hormone (previous level, 18.61; level after 6 months, 30.68; -4.18 [95% confidence interval, -6.35 to -17.77]; P<.001) and luteinizing hormone (previous level, 13.52; level after 6 months, 20.91; -3.60 [95% confidence interval, -3.31 to -11.45]; P<.001) levels were elevated, but estradiol levels (previous level, 97.98; level after 6 months, 99.01; 0.11 [95% confidence interval, -32.40 to 28.84]) levels were not affected.
CONCLUSION: The transradial approach should be adopted as a safe and effective alternative for the treatment of symptomatic uterine fibroids in patients with fulfilled gestational desire.
OBJECTIVE: This study aimed to demonstrate that transradial access is safe and effective for treating symptomatic uterine fibroids to avoid the need for conventional surgery.
STUDY DESIGN: A single-center retrospective observational study of medical records between 2012 and 2022, in which 189 procedures were planned in patients with symptomatic uterine fibroids with fulfilled gestational desire, was conducted. The feasibility and safety of the technique, the need for subsequent surgery because of the lack of effectiveness of the treatment in women who could complete it from the date of the procedure until 24 months later, changes in uterine volume and in the largest fibroid, and changes in hemoglobin levels, follicle-stimulating hormone, luteinizing hormone, and estradiol were analyzed before and 6 months after the procedure. Changes in the quality of life questionnaire (Uterine Fibroid Symptom and Health-Related Quality of Life questionnaire) were analyzed before embolization and at 2 and 6 months after embolization.
RESULTS: Of note, 184 of 189 procedures (97.35%) were performed with total or partial angiographic success. Surgical intervention was not necessary 24 months after the procedure in 85.4% of patients (158/180 patients with complete angiographic success) with a very low rate of complications, all of them mild (13/185 [7%]). Between the first visit and the visit at 6 months after the intervention, both the uterine volume decreased (n=176; previous volume, 458.11 mL; volume after 6 months, 311.87 mL; -146.24 mL [95% confidence interval, -115.41 to -177.06]; P<.001) and the largest fibroid (previous volume 132.31 mL; volume after 6 months, 78.33 mL; -53.98 mL [95% confidence interval, -42.79 to -65.17]; P<.001) and the scores in the quality of life questionnaires and the hemoglobin level improved (previous level, 11.4 g/dL; level after 6 months, 12.85 g/dL; -9.94 [95% confidence interval, -1.74 to -1.16]; P<.001). Follicle-stimulating hormone (previous level, 18.61; level after 6 months, 30.68; -4.18 [95% confidence interval, -6.35 to -17.77]; P<.001) and luteinizing hormone (previous level, 13.52; level after 6 months, 20.91; -3.60 [95% confidence interval, -3.31 to -11.45]; P<.001) levels were elevated, but estradiol levels (previous level, 97.98; level after 6 months, 99.01; 0.11 [95% confidence interval, -32.40 to 28.84]) levels were not affected.
CONCLUSION: The transradial approach should be adopted as a safe and effective alternative for the treatment of symptomatic uterine fibroids in patients with fulfilled gestational desire.