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Predictors and Clinical Outcomes of Fibroid Expulsion After Uterine Artery Embolization

  • Clinical Investigation
  • Embolisation (arterial)
  • Published:
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Abstract

Purpose

To evaluate rates of fibroid expulsion after uterine artery embolization (UAE) and risk factors.

Materials and Methods

Single-center retrospective study of UAEs for fibroids between 2016 and 2020. Preoperative UAE and patients with incomplete follow-up were excluded. Patients underwent MRI before and 3 months after UAE and/or as indicated. Medical records were reviewed, and patient demographics, fibroid characteristics and clinical events were recorded. Fibroid expulsion included fibroid exposure to the endometrial cavity on MRI, and tissue loss/passage as observed clinically or on MRI. Symptoms were considered major if requiring additional clinic visits or treatment. Statistical tests included Chi-square, Fisher’s exact test, and logistic regression models.

Results

One hundred ninety-nine women were included. Symptomatic fibroid expulsion occurred after 31 (16%) procedures: 16 minor and 15 major. Symptoms included vaginal discharge (n = 23), bleeding (n = 9), tissue passage (n = 9), cramping/pain (n = 3), and fever (n = 4). Fifteen women (8%) needed additional care, of whom 6 (3%) required invasive procedures (4 elective hysterectomies, 1 hysteroscopic resection, 1 transvaginal removal of passing tissue). The International Federation of Gynecology and Obstetrics (FIGO) classification was significantly associated with symptomatic fibroid expulsion (p = 0.001). Odds ratio for symptomatic expulsion and expulsion requiring additional care for FIGO 3–7 versus 0–2 fibroids was 0.32 (95% confidence interval, 0.14–0.71, p = 0.005) and 0.28 (95% confidence interval, 0.10–0.83, p = 0.02), respectively. Other factors were not consistently associated with expulsion.

Conclusion

Fibroid expulsion after uterine artery embolization was more common than previously reported but mostly asymptomatic or minimally symptomatic. Women with FIGO ≤ 2 fibroids should be appropriately counseled regarding risk for expulsion.

Graphical Abstract

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Funding

This study was not supported by any funding.

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Author notes

  1. Moaz M. Choudhary

    Present address: Department of Radiology, Wake Forest University School of Medicine, Winston Salem, NC, USA

Authors and Affiliations

  1. Department of Radiology, MedStar Georgetown University Hospital, Washington, DC, USA

    Nathan E. Frenk, Moaz M. Choudhary, Donna Buckley & James B. Spies

  2. Department of Radiology, Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA

    Nathan E. Frenk

  3. Georgetown University School of Medicine, Washington, DC, USA

    Jai W. Jung & JiMin Ko

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Correspondence to Nathan E. Frenk.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Frenk, N.E., Jung, J.W., Choudhary, M.M. et al. Predictors and Clinical Outcomes of Fibroid Expulsion After Uterine Artery Embolization. Cardiovasc Intervent Radiol 46, 1583–1593 (2023). https://doi.org/10.1007/s00270-023-03532-9

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