Focus on uterine fibroids

Focus on uterine fibroids

11 September 2019

Professor Denis Herbreteau talks about treatment by embolization.

Uterine artery embolization (UAE) for symptomatic fibroids is a safe and effective treatment with world_wide acceptance. UAE is considered as a first-line therapy for women who are finished with childbearing and interested in a minimally invasive uterine-sparing therapy. UAE was first introduced by the French in 1995 as an alternative treatment to surgery for women with symptomatic fibroids [Arterial embolization: a new treatment of menorrhagia in uterine fibroma].

Now, a more wider applicability with only few relative and absolute contraindications remaining : women interested in pregnancy may be offered embolisation, but only after careful counselling and consideration of other possibilities and patient's reasonable expectations, needs and preferences.

The definitive decision regarding the treatment is best made by the patient and a well-cooperating fibroid team with interventionnal radiologists and gynaecologists.

The standard catheterisation technique for uterine artery embolisation of fibroids starts with punctunring the right common femoral artery after local anaesthesia.

Then, a bilateral uterine artery catheterisation and embolisation of the fibroma vessels is performed.

UAE has short_term advantages over surgery : fewer blood loss, shorter hospital stay and quicker resumption of work, with mid and long_term results demonstrated comparable health-related quality of life results.

The clinical success is 95%  : pain, heavy menstrual bleeding, bulk-related symptoms (pressure, urinary frequency or retention). Also, a significant improvement of sexual function in 80% of patients after uterine artery embolisation has been assesed by the EFUZEN study [Vernhet-Kovacsik, Herbreteau D 2017].

UAE is as well very interesting in women with symptomatic adenomyosis [Uterine artery embolisation in women with symptomatic adenomyosis]

* Le Professeur Denis Herbreteau est neuroradiologue interventionnel au CHU de Tours, et a publié de nombreux travaux aussi bien sur le traitement des fibromes uterins que sur le traitement endovasculaire des malformations vasculaires cérébrales.

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