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Uterine Artery Embolisation for Women with Giant Versus Non-giant Uterine Fibroids: A Systematic Review and Meta-analysis

Abstract

Background

Evidence supporting uterine artery embolisation (UAE) for giant fibroids (≥ 10 cm and/or uterine volume ≥ 700 CC) remains sparse. We performed a systemic review and meta-analysis of UAE outcomes for symptomatic giant versus non-giant fibroids.

Methods

The literature was systematically reviewed. Research studies of UAE as an adjunct to surgery, and those not using peri-operative MRI were excluded. Primary outcomes were fibroid size and uterine volume reduction, procedure time, length of hospital stay, reinterventions, patient symptom improvement/satisfaction and complications.

Results

We identified four observational studies (839 patients; giant = 163, non-giant = 676). Both groups demonstrated reduction in fibroid size and uterine volume after UAE, with equivocal difference in uterine volume reduction (Mean difference (MD) − 0.3 95% confidence interval (CI) − 3.8 to 3.1, p = 0.86) and greater reduction in non-giant dominant fibroid size (MD − 5.9 95% CI − 10.3 to − 1.5, p < 0.01). Giant fibroids were associated with 5.6 min longer mean operative time (MD 5.6 min 95% CI 2.6–8.6, p < 0.01) and 4.8 h longer mean hospital stay (MD 4.8 h 95% CI 1.1–8.6, p = 0.01). Patient symptoms/satisfaction outcomes were summarised, but too heterogeneous for meta-analysis. Major complication and reintervention rates were low, with a statistically higher rate of major complications (Odds ratio (OR) 4.7 95% CI 1.5–14.6, p < 0.01) and reinterventions (OR 3.6 95% CI 1.7–7.5, p < 0.01) in giant fibroids.

Conclusions

Current evidence shows UAE is a safe and effective option to treat giant fibroids. However, the limited available data indicate a relatively higher risk of complications and reinterventions when compared with non-giant fibroids. Patients should be selected, counselled and managed accordingly.

Level of Evidence

Level III, Systematic review of retrospective cohort studies.

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Acknowledgements

This research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. Thanks to Dr Jelena Savovic for statistical guidance and Dr Sarah McKeogh for assistance with data collection.

Funding

This study was not supported by any funding.

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Correspondence to Oliver Llewellyn.

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Appendix 1: Search Strategy

Appendix 1: Search Strategy

Search No. Search strategy*
#1 (fibroid emboli*ation).ti,ab
#2 (“fibroid emboli*ation”).ti,ab
#3 (“uterine artery emboli*ation”).ti,ab
#4 (uterine artery emboli*ation).ti,ab
#5 (ufe).ti,ab
#6 (1 OR 2 OR 3 OR 4 OR 5)
#7 (giant OR large OR massive).ti,ab
#8 (non-giant OR small).ti,ab
#9 (7 OR 8)
#10 (fibroid*).ti,ab
#11 LEIOMYOMA/
#12 (leiomyoma*).ti,ab
#13 (10 OR 11 OR 12)
#14 (9 AND 13)
#15 (complication*).ti,ab
#16 (reintervention).ti,ab
#17 (reintervention).ti,ab
#18 (“uterine volume”).ti,ab
#19 (devasculari*ation).ti,ab
#20 (satisfaction).ti,ab
#21 “PATIENT SATISFACTION”/
#22 “INTRAOPERATIVE COMPLICATIONS”/
#23 “POST-OPERATIVE COMPLICATIONS”/
#24 (15 OR 16 OR 17 OR 18 OR 19 OR 20 OR 21 OR 22 OR 23)
#25 (6 AND 14 AND 24)
  1. *Strategy used to search PubMed, EMBASE, MEDLINE, and Cochrane Central Register of Controlled Trials

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Llewellyn, O., Patel, N.R., Mallon, D. et al. Uterine Artery Embolisation for Women with Giant Versus Non-giant Uterine Fibroids: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 43, 684–693 (2020). https://doi.org/10.1007/s00270-019-02359-7

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Keywords

  • Uterine
  • Leiomyoma
  • Fibroid
  • Embolisation
  • Giant
  • Non-giant