ACOG Issues Opinion on Uterine Artery Embolization For Treatment of Fibroids
January 30, 2004
ACOG News Release
Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) strongly recommends that women who wish to undergo uterine artery embolization (UAE) have a thorough evaluation with an ob-gyn to help facilitate optimal collaboration with interventional radiologists and ensure that the procedure is appropriate, according to an opinion issued today.
UAE for the treatment of symptomatic fibroids, when performed by experienced physicians, appears to provide good short-term relief among appropriate candidates. However, there are insufficient data at this time to ensure that UAE is safe for women who may wish to become pregnant in the future, according to the ACOG opinion.
The concept of artery embolization was originally used in obstetrics and gynecology in 1979 to treat postpartum hemorrhage. It was first tried as an alternative treatment to the surgical removal (myomectomy) of fibroids in 1995. UAE is typically performed by an interventional radiologist and involves inserting a catheter into the common femoral artery to access the arteries to the uterus. The uterine arteries are then filled (or 'embolized') with polyvinyl alcohol particles or tris-acryl gelatin microspheres that stop the blood supply to the fibroid(s). Without a blood supply, the fibroids typically shrink.
To date, most data on patient satisfaction, fibroid and uterine size reduction, fertility, and complications are from case reports. In general, the reports have shown a short-term reduction in the size of fibroids and uteri, as well as short-term improvement in menstrual bleeding and other symptoms caused by fibroids. The complication rates associated with UAE are low, but in rare cases can include hysterectomy and death. ACOG recommends that all patients be informed about the potential complications with UAE.
Approximately 50 pregnancies have been reported in women who have had UAE. Nearly 60% of the resulting births were delivered by cesarean, 28% were preterm births, and 13% of patients had postpartum hemorrhage. According to ACOG, this procedure is still considered investigational for patients who may want to become pregnant, as further data are needed to draw conclusions about the safety of UAE in these patients.
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The American College of Obstetricians and Gynecologists is the national medical organization representing over 45,000 members who provide health care for women.
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