Uterine Artery Embolization Indications and Contraindications

  • James B. Spies
Part of the Medical Radiology book series (MEDRAD)


Uterine artery embolization (UAE) has become accepted as an effective therapy for most women with symptomatic fibroids (ACOG Practice Bulletin 2008). And while the vast majority of patients would be well treated with embolization, the decision as to whether it is the best choice for any individual patient requires a consideration of the extent of the fibroids and also patient-related factors, such as interest in future childbearing, preferences toward surgery, and the relative risks of differing therapies for individual patients. Therefore, the decision as to whether UAE is appropriate for a patient is based on a multilayered consideration of factors. This chapter will review what is known about the patient selection for UAE, including the indications and contraindications of the procedure, as well as medical conditions in which patient care may be a particular challenge. We also will review the anatomic limitations of UAE, with regard to uterine and fibroid size and specific subtypes of fibroids that may have diminished results. The hope is to provide the reader with all the tools needed to appropriately guide patients in the decision of whether UAE is a good choice for them.


Pelvic Pain Uterine Artery Embolization Uterine Fibroid Endometrial Polyp Heavy Menstrual Bleeding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. ACOG practice bulletin (2008) Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol 112:387–400CrossRefGoogle Scholar
  2. Alyeshmerni D, Banovac F, Pehlivanova M et al (2011) Resolution of hydronephrosis after uterine artery embolization for fibroids. J Vasc Interv Radiol 22:865–869PubMedCrossRefGoogle Scholar
  3. Andrews RT, Spies JB, Sacks D et al (2009) Patient care and uterine artery embolization for leiomyomata. J Vasc Interv Radiol 20:S307–S311PubMedCrossRefGoogle Scholar
  4. Baig A, Mukherji R (2011) Pulmonary embolism after uterine fibroid embolization: a case report. Cardiovasc Interv Radiol 34:1113–1114 (Case Reports Letter)CrossRefGoogle Scholar
  5. Czeyda-Pommersheim F, Magee ST, Cooper C et al (2006) Venous thromboembolism after uterine fibroid embolization. Cardiovasc Interv Radiol 29:1136–1140CrossRefGoogle Scholar
  6. Goodwin S, Vedantham S, McLucas B et al (1997) Preliminary experience with uterine artery embolization for uterine fibroids. J Vasc Interv Radiol 8:517–526PubMedCrossRefGoogle Scholar
  7. Hamoda H, Tait P, Edmonds DK (2009) Fatal pulmonary embolus after uterine artery fibroid embolisation. Cardiovasc Interv Radiol 32:1080–1082 (Case Reports)CrossRefGoogle Scholar
  8. Katsumori T, Nakajima K, Mihara T (2003) Is a large fibroid a high-risk factor for uterine artery embolization? AJR Am J Roentgenol 181:1309–1314PubMedCrossRefGoogle Scholar
  9. Kim MD, Lee M, Jung DC et al (2012) Limited efficacy of uterine artery embolization for cervical leiomyomas. J Vasc Interv Radiol 23:236–240PubMedCrossRefGoogle Scholar
  10. Klatsky P, Tran ND, Caughey AB et al (2008) Fibroids and reproductive outcomes: a systematic literature review from conception to delivery. Am J Obstet Gynecol 198:357–366PubMedCrossRefGoogle Scholar
  11. Leibsohn S, d’Ablaing G, Mishell DR Jr et al (1990) Leiomyosarcoma in a series of hysterectomies performed for presumed uterine leiomyomas. Am J Obstet Gynecol 162:968–974; discussion 74–76Google Scholar
  12. Mara M, Maskova J, Fucikova Z et al (2008) Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Interv Radiol 31:73–85CrossRefGoogle Scholar
  13. McLucas B, Adler L, Perella R (1999) Predictive factors for success in uterine fibroid embolization. Minim Ivasive Ther Allied Technol 8:429–432CrossRefGoogle Scholar
  14. ACR Manual on Contrast Media (2010), version 7. American College of Radiology, Reston, VA, USAGoogle Scholar
  15. Mirsadraee S, Tuite D, Nicholson A (2008) Uterine artery embolization for ureteric obstruction secondary to fibroids. Cardiovasc Interv Radiol 31:1094–1099CrossRefGoogle Scholar
  16. Munro MG, Heikinheimo O, Haththotuwa R et al (2011) The need for investigations to elucidate causes and effects of abnormal uterine bleeding. Semin Reprod Med 29:410–422PubMedCrossRefGoogle Scholar
  17. SOGC clinical practice guidelines (2005) Uterine fibroid embolization (UFE). Number 150. Int J Gynaecol Obstet 89:305–318, Oct 2004CrossRefGoogle Scholar
  18. Parker WH (2007) Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril 87:725–736PubMedCrossRefGoogle Scholar
  19. Parker WH, Fu YS, Berek JS (1994) Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing leiomyoma. Obstet Gynecol 83:414–418 (Case Reports)PubMedGoogle Scholar
  20. Prollius A, de Vries C, Loggenberg E et al (2004) Uterine artery embolisation for symptomatic fibroids: the effect of the large uterus on outcome. BJOG 111:239–242PubMedCrossRefGoogle Scholar
  21. Ravina J, Herbreteau D, Ciraru-Vigneron N et al (1995) Arterial embolisation to treat uterine myomata. Lancet 346:671–672PubMedCrossRefGoogle Scholar
  22. Smeets AJ, Nijenhuis RJ, Boekkooi PF et al (2009) Safety and effectiveness of uterine artery embolization in patients with pedunculated fibroids. J Vasc Interv Radiol 20:1172–1175PubMedCrossRefGoogle Scholar
  23. Smeets A, Nijenhuis RJ, Boekkooi FP et al (2010a) Is an intrauterine device a contraindication for uterine artery embolization: a study of 20 patients. J Vasc Interv Radiol 21:272–274PubMedCrossRefGoogle Scholar
  24. Smeets AJ, Nijenhuis RJ, van Rooij WJ et al (2010b) Uterine artery embolization in patients with a large fibroid burden: long-term clinical and MR follow-up. Cardiovasc Intervent Radiol 33:943–948CrossRefGoogle Scholar
  25. Spies JB, Ascher SA, Roth AR et al (2001) Uterine artery embolization for leiomyomata. Obstet Gynecol 98:29–34PubMedCrossRefGoogle Scholar
  26. Spies J, Roth A, Jha R et al (2002) Uterine artery embolization for leiomyomata: factors associated with successful symptomatic and imaging outcome. Radiology 222:45–52PubMedCrossRefGoogle Scholar
  27. Spies J, Allison S, Sterbis K et al (2004) Polyvinyl alcohol particles and tris acryl gelatin microspheres for uterine artery embolization for leiomyomas: results of a randomized comparative study. J Vasc Interv Radiol 15:793–800PubMedCrossRefGoogle Scholar
  28. Spies J, Myers ER, Worthington-Kirsch R et al (2005a) The FIBROID Registry: symptom and quality-of-life status 1 year after therapy. Obstet Gynecol 106:1309–1318PubMedCrossRefGoogle Scholar
  29. Spies J, Bruno J, Czeyda-Pommersheim F et al (2005b) Long-term outcome of uterine artery embolization of leiomyomas. Obstet Gynecol 106:933–939PubMedCrossRefGoogle Scholar
  30. Steen R, Shapiro K (2004) Intrauterine contraceptive devices and risk of pelvic inflammatory disease: standard of care in high STI prevalence settings. Reprod Heath Matters 12:136–143CrossRefGoogle Scholar
  31. Tanaka YO, Nishida M, Tsunoda H et al (2004) Smooth muscle tumors of uncertain malignant potential and leiomyosarcomas of the uterus: MR findings. J magn reson imaging 20:998–1007PubMedCrossRefGoogle Scholar
  32. Wegienka G, Baird DD, Hertz-Picciotto I et al (2003) Self-reported heavy bleeding associated with uterine leiomyomata. Obstet Gynecol (Research Support, U.S. Gov’t, P.H.S.) 101:431–437Google Scholar
  33. Worthington-Kirsch R, Spies J, Myers E et al (2005) The fibroid registry for outcomes data (FIBROID) for uterine artery embolization: short term outcomes. Obstet Gynecol 106:52–59PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of RadiologyGeorgetown University HospitalWashingtonUSA

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