Purpose: Uterine artery embolization is a safe and effective mode of treatment for patients with fibroids. Conventionally, bilateral uterine artery embolization is performed as one procedure. However, patients often experience considerable post-procedural pain, requiring opioid analgesia, and hospitalization. We have employed a two-procedure technique, involving successive unilateral uterine artery embolization as day-case procedures. We assess the safety and efficacy of this technique in comparison with the conventional bilateral approach.
Methods and Materials: Between January 2002 and April 2003, patients referred for uterine artery embolization were asigned to one of two groups. Group 1 underwent 2 separate procedures. Initially the left uterine artery was embolized to stasis using Polyvinyl-alcohol particles 500 microns (PVA) via a right femoral artery puncture (5F system). As a separate procedure, performed 7 days later, the right uterine artery was embolized using PVA via a left femoral artery puncture. Both procedures were performed on a day-case basis. Group 2 underwent bilateral uterine artery embolization as a single procedure, with a single femoral artery puncture (5F system). These pateints were admitted as in-patients. Radiation dose and screening times for all patients were recorded. Uterine volume measurements (MRI) were performed pre and post procedure (3-12 months). Subjective pain scores were collected from both groups.
Results: In Group 1 the mean radiation dose for both procedures was 42.6 Gycm2 (range 12.2 - 96.4 Gycm 2 ) and the mean screening time for both procedures was 16.4 mins (range 11.3 - 35.4 mins). In Group 2 the mean radiation dose was 63.7 Gycm 2 (range 3 - 364 Gycm 2 ) and the mean screening time was 16.8 mins (range 8.1 - 45.4 mins). There was no significant difference in screening times, uterine volume reduction and symptom relief between the two groups. Group 1 reported less post-procedure pain than Group 2. No complications occurred relating to puncture site in either group, despite twice as many femoral artery punctures being performed on Group 1 patients. No patients from Group 1 required overnight admission.
Conclusion: Successive unilateral uterine artery embolization as a two-stage day-case procedure is a safe and effective treatment for fibroids which does not incur additional radiation dose or screening time when compared with conventional technique. Additional benefit appears to be reduction of post-procedural pain with no incresed risk of puncture site complications in this series.
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