Clinical Investigation

CardioVascular and Interventional Radiology

, Volume 36, Issue 3, pp 676-681

First online:

Randomized Comparison of Uterine Artery Embolization (UAE) with Surgical Treatment in Patients with Symptomatic Uterine Fibroids (REST Trial): Subanalysis of 5-Year MRI Findings

  • Ganapathy AnanthakrishnanAffiliated withDepartment of Interventional Radiology, Gartnavel General Hospital Email author 
  • , Lilian MurrayAffiliated withVital Statistics
  • , Moira RitchieAffiliated withDepartment of Interventional Radiology, Gartnavel General Hospital
  • , Gordon MurrayAffiliated withDepartment of Medical Statistics, Centre for Population Health Sciences, University of Edinburgh
  • , Fiona BrydenAffiliated withStobhill Hospital
  • , Sue LassmanAffiliated withDepartment of Interventional Radiology, Gartnavel General Hospital
  • , Mary Ann LumsdenAffiliated withDepartment of Medical Education and Gynaecology, Reproductive and Maternal Medicine, Room 12, Level 4, Walton Building
  • , Jon G. MossAffiliated withDepartment of Interventional Radiology, Gartnavel General Hospital

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To report 5-year contrast-enhanced magnetic resonance imaging findings of the REST trial recruits who underwent either uterine artery embolization (UAE) or myomectomy.


A total of 157 patients were randomized to UAE or surgery (hysterectomy or myomectomy). Ninety-nine patients who had UAE and eight patients who had myomectomy were analyzed. MRI scans at baseline, 6 months, and 5 years were independently interpreted by two radiologists. Dominant fibroid diameter, uterine volume, total fibroid infarction (complete 100 %, almost complete 90–99 %, partial <90 %), and new fibroid formation were the main parameters assessed and related to the need for reintervention.


In the UAE group, mean ± standard deviation uterine volume was 670 ± 503, 422 ± 353, and 292 ± 287 mL at baseline, 6 months, and 5 years, respectively. Mean dominant fibroid diameter was 7.6 ± 3.0, 5.8 ± 2.9, and 5 ± 2.9 cm at baseline, 6 months, and 5 years. Fibroid infarction at 6 months was complete in 35 % of women, almost complete in 29 %, and partial in 36 %. Need for reintervention was 19, 10, and 33 % in these groups, respectively (p = 0.123). No myomectomy cases had further intervention. At 5 years, the prevalence of new fibroid was 60 % in the myomectomy group and 7 % in the UAE group (p = 0.008).


There is a further significant reduction in both uterine volume and dominant fibroid diameter between 6 months and 5 years after UAE. Complete fibroid infarction does not translate into total freedom from a subsequent reintervention. New fibroid formation is significantly higher after myomectomy.


Arterial intervention Embolization Embolotherapy Fibroid Urogenital