Predictors of hysterectomy after uterine artery embolization for leiomyoma
An abstract for this study was presented orally as the Frank Lynch Memorial Essay at the 73rd Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society, Sun Valley, ID, Oct. 4-8, 2006.
Received 1 September 2006; received in revised form 22 November 2006; accepted 2 March 2007.
Objective
This study was undertaken to describe long-term outcomes after uterine artery embolization for leiomyoma.
Study Design
Data from Kaiser Permanente Northern California members undergoing uterine artery embolization for leiomyoma before July 2001 were collected. Survival analysis was performed to describe hysterectomy rates and identify predictors of hysterectomy.
Results
Uterine artery embolization was performed in 562 women from 1997-2001. Thirty-three women (5.9%) had unilateral uterine artery embolization. One hundred women (18%) underwent hysterectomy after uterine artery embolization, and 32 (5.7%) had additional uterine sparing procedures. Only unilateral uterine artery embolization predicted subsequent hysterectomy (relative risk = 2.19; 95% CI 1.34-3.57), whereas age, indication, uterine volume, embolizing particle, and radiologist experience did not. The rate of hysterectomy at 5 years was 19.7%; rates for bilateral and unilateral uterine artery embolizations were 18.5% and 39.2%, respectively. Fifty-four women (9.6%) had emergency room visits and 17 (3%) had unplanned readmissions.
Conclusions
Uterine artery embolization for leiomyoma permits uterine conservation in more than 80% of women monitored long-term. When bilateral procedures cannot be performed, failure rates are considerably higher.
1Department of Obstetrics and Gynecology, San Francisco, CA
2Division of Research, Oakland, Kaiser Permanente Northern California, CA
3Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
Cite this article as: Gabriel-Cox K, Jacobson GF, Armstrong MA, Hung YY, et al. Predictors of hysterectomy after uterine artery embolization for leiomyoma. Am J Obstet Gynecol 2007;196:588.e1-588.e6.
Reprints not available from the authors.
This study was funded in part by the Women’s Health Research Institute, Kaiser Permanente Northern California.
ABSTRACT