CardioVascular and Interventional Radiology

, Volume 36, Issue 3, pp 676–681

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 Ananthakrishnan
  • Lilian Murray
  • Moira Ritchie
  • Gordon Murray
  • Fiona Bryden
  • Sue Lassman
  • Mary Ann Lumsden
  • Jon G. Moss
Clinical Investigation

DOI: 10.1007/s00270-012-0485-y

Cite this article as:
Ananthakrishnan, G., Murray, L., Ritchie, M. et al. Cardiovasc Intervent Radiol (2013) 36: 676. doi:10.1007/s00270-012-0485-y

Abstract

Purpose

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

Methods

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.

Results

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).

Conclusion

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.

Keywords

Arterial interventionEmbolizationEmbolotherapyFibroidUrogenital

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012

Authors and Affiliations

  • Ganapathy Ananthakrishnan
    • 1
  • Lilian Murray
    • 2
  • Moira Ritchie
    • 1
  • Gordon Murray
    • 3
  • Fiona Bryden
    • 4
  • Sue Lassman
    • 1
  • Mary Ann Lumsden
    • 5
  • Jon G. Moss
    • 1
  1. 1.Department of Interventional RadiologyGartnavel General HospitalGlasgowUK
  2. 2.Vital StatisticsGlasgowUK
  3. 3.Department of Medical StatisticsCentre for Population Health Sciences, University of EdinburghEdinburghUK
  4. 4.Stobhill HospitalGlasgowUK
  5. 5.Department of Medical Education and Gynaecology, Reproductive and Maternal MedicineRoom 12, Level 4, Walton BuildingGlasgowUK