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

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.

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References

  1. 1.

    Broder MS, Goodwin S, Chen G et al (2002) Comparison of long term outcomes of myomectomy and uterine artery embolisation. Obstet Gynecol 100(5 Pt 1):864–868

    Google Scholar 

  2. 2.

    Pelage JP, Guaou NG, Jha RC et al (2004) Uterine fibroid tumors: long-term MR imaging outcome after embolization. Radiology 230:803–809

    PubMed  Article  Google Scholar 

  3. 3.

    Katsumori T, Kasahara T, Kin Y, Nozaki T (2008) Infarction of uterine fibroids after embolization: relationship between postprocedural enhanced MRI findings and long-term clinical outcomes. Cardiovasc Intervent Radiol 31:66–72

    PubMed  Article  Google Scholar 

  4. 4.

    Kroencke TJ, Scheurig C, Poellinger A, Gronewold M, Hamm B (2010) Uterine artery embolization for leiomyomas: percentage of infarction predicts clinical outcome. Radiology 255:834–841

    PubMed  Article  Google Scholar 

  5. 5.

    Van der Kooij SM, Hehenkamp WJ, Volkers NA et al (2010) Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial. Am J Obstet Gynecol 203(105):e1–e13

    PubMed  Google Scholar 

  6. 6.

    Moss J, Cooper K, Khaund A et al (2011) Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG 118:936–944

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Kirby JM, Burrows D, Haider E et al (2011) Utility of MRI before and after uterine fibroid embolization: why to do it and what to look for. Cardiovasc Intervent Radiol 34:705–716

    PubMed  Article  Google Scholar 

  8. 8.

    REST Trial Investigators (2007). Uterine-Artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med 356:360–370

    Google Scholar 

  9. 9.

    Scheurig C, Gauruder-Burmester A, Kluner C et al (2006) Uterine artery embolization for symptomatic fibroids: short-term versus mid-term changes in disease-specific symptoms, quality of life and magnetic resonance imaging results. Hum Reprod 21:3270–3277

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgments

Funded by Chief Scientist Office, Scottish Government Health Directorates, St. Andrew’s House, Regent Road, Edinburgh, EH1 3DG, Scotland, UK.

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The authors declare that they have no conflict of interest.

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Correspondence to Ganapathy Ananthakrishnan.

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Ananthakrishnan, G., Murray, L., Ritchie, M. et al. Randomized Comparison of Uterine Artery Embolization (UAE) with Surgical Treatment in Patients with Symptomatic Uterine Fibroids (REST Trial): Subanalysis of 5-Year MRI Findings. Cardiovasc Intervent Radiol 36, 676–681 (2013). https://doi.org/10.1007/s00270-012-0485-y

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Keywords

  • Arterial intervention
  • Embolization
  • Embolotherapy
  • Fibroid
  • Urogenital