Search

R. Torrance Andrews, MD, James B. Spies, MD, David Sacks, MD, Robert L. Worthington-Kirsch, MD, Gerald A. Niedzwiecki, MD, M. Victoria Marx, MD, David M. Hovsepian, MD, Donald L. Miller, MD, Gary P. Siskin, MD, Rodney D. Raabe, MD, Scott C. Goodwin, MD, Robert J. Min, MD, Joseph Bonn, MD, John F. Cardella, MD, and Nilesh H. Patel, MD, for the Task Force on Uterine Artery Embolization and the Standards Division of the Society of Interventional Radiology

Objective To determine whether there is significant quality of life score improvement after uterine artery embolization (UAE) and to compare UAE and myomectomy outcomes. Design Prospective cohort controlled study. Setting Sixteen medical centers in the United States. Patient(s) One hundred forty-nine UAE patients and 60 myomectomy patients. Patients were assigned to myomectomy or UAE on the basis of a best treatment decision made by the patient and her physician. All patients were observed for 6 months. The UAE patients also had follow-up examinations at 1 year. Intervention(s) Myomectomy or UAE. Main Outcome Measure(s) Quality of life score changes, menstrual bleeding score changes, uterine size differences, time off, and adverse events. Result(s) Both groups experienced statistically significant improvements in the uterine fibroid quality of life score, menstrual bleeding, uterine volume, and overall postoperative quality of life. The mean hospital stay was 1 day for the UAE patients, compared with 2.5 days for the myomectomy patients. The UAE and myomectomy patients returned to their normal activities in 15 days and 44 days, respectively, and returned to work in 10 days and 37 days, respectively. At least one adverse event occurred in 40.1% of the myomectomy patients, compared with 22.1% in the UAE group. Conclusion(s) The uterine fibroid quality of life score was significantly improved in both groups. No significant differences were observed in bleeding improvement, uterine volume reduction, uterine fibroid quality of life score improvement, and overall quality of life score improvement between groups. Patients receiving UAE required fewer days off work, fewer hospital days, and experienced fewer adverse events.

Scott C. Goodwin, MD, Sheila C. Bonilla, MD, David Sacks, MD, Richard A. Reed, MD, James B. Spies, MD,Wendy J. Landow, MPH, Robert L. Worthington-Kirsch, MD, the Members of the Reporting Standards forUterine Artery Embolization (UAE) Subcommittee, the Members of the UAE Task Force StandardsSubcommittee, and the Members of the Society of Interventional Radiology Technology Assessment Committee

Building a uterine fibroid embolization (UFE) practice can be a complex process. Choices must be made regarding whether to align oneself with a gynecologist or to accept direct referrals. For the interventional radiologist, the responsibilities of evaluation and patient care pose unique and time-consuming administrative and clinical challenges. Physician extenders, either nurse practitioners or physician's assistants, play key roles as clinical coordinators by guiding the patient through the medical system and making certain that she is cleared for the procedure medically and logistically. In some settings, they may also assist in many of the technical aspects of the procedure and postoperative care. Interventional radiologists must be prepared for battles with insurance companies and be willing to go through the appeals process. Business officers must also be trained to properly code for the procedures to insure optimal reimbursement. The success of building a UFE practice may also be bolstered by directly marketing to patients and by providing them with access via the Internet. Copyright 2002, Elsevier Science (USA). All rights reserved.

Fortunately, the number of complications reported after uterine fibroid embolization (UFE) is extremely low. Angiographic mishap or drug reaction are probably more common than purely UFE-related complications. However, the possibility of infection or necrosis of the uterus, with their significant attendant morbidity, is a sobering reminder that embolotherapy can have a powerful impact on the target organ(s). Knowledge of the expected time course for symptom resolution and the often confusing imaging findings shortly after UFE are critical for avoiding unnecessary delay in surgical intervention or, perhaps more important, an inappropriate rush to surgery when antibiotics alone will suffice. Other complications include alteration of uterine physiology, which may disrupt sexual function, and menstrual irregularity and even premature menopause.

Increasing clinical experience with uterine fibroid embolization (UFE) has improved the ability of interventionalist radiologists to discern who is and who is not an appropriate candidate for this procedure. Initial evaluation should be directed at obtaining answers to the following key questions: (1) Does the patient have uterine fibroids that account for her symptoms and are they severe enough to require invasive treatment? (2) Does she desire future childbearing? (3) Are there any clinical indications or imaging signs of uterine malignancy? (4) Are there any medical or anatomic features that would favor a particular therapeutic modality? (5) What are her own preferences regarding treatment? Ultrasound and magnetic resonance imaging are vital elements to the assessment and planning of the appropriate course of action. Given the lack of prospective comparative trials between UFE and surgical treatment, recommendations are often highly influenced by patient preference.

MTCs were magnetically targeted and retained at a region of interest in a swine model after intra-arterial infusion. MTCs did not redistribute after removal of the magnetic field. Histopathology results demonstrated high particle density in the area of the magnetic field. Particles were observed in the interstitium and occasionally intra-arterially. Regional delivery of chemotherapeutic drugs will be tested with this technology.

UTERINE artery embolization (UAE) is a therapy that offers an alternative to traditional surgical procedures such as myomectomy and hysterectomy for women with symptomatic leiomyomata (fibroids). The clinical experience and the published literature indicate that this is an effective and safe therapy (1–9). For patients to receive the best possible care before, during, and after the embolization procedure, the Society of Interventional Radiology Task Force on Uterine Fibroid Embolization has developed this consensus statement to define the appropriate qualifications for physicians practicing in this field.

The Society of Interventional Radiology (SIR) continues to work for its members and is navigating a path to success for our specialty during this time of changes in the national health care environment. In response to nationally mandated expectations of improved quality at lower cost, SIR has pursued multiple pathways to help ensure the future success of interventional radiology (IR). SIR is collaborating with colleagues from other specialties to prevent or limit payment rate reductions. SIR remains an active participant in the national Current Procedural Terminology coding process and the accompanying code valuation, which takes place as part of American Medical Association Relative Value Scale Update Committee activities. We have invested hundreds of volunteer hours and staff resources in ensuring that our coding and valuation strategy is grounded on sound data driven by what is optimal for patient care. We have worked long and hard, and we have been able to preserve excellent value for IR treatments. SIR and the SIR Foundation have carefully examined various activities to ensure that they are consistent with our strategic goals, with an eye on ensuring that the Society’s and the Foundation’s pursuits are fully aligned. The Society established the Payment, Research and Policy (or PReP) Task Force to identify and prioritize data development and research needs to improve patient care in the long term and to help lead to a more efficient reimbursement system. Task force members are working

Several articles on uterine artery embolization for the treatment of uterine fibroids appear in this issue. Zupi et al. report on the selective embolization of fibroids in 26 women ages 32–54. Prior uterine artery embolization reports have described women who have undergone complete embolization of the uterine artery or partial embolization of the main uterine artery with cessation of flow or near cessation of flow in the ascending uterine artery and continued flow in the lower uterine segment. I am not aware of any paper that describes selective embolization of uterine artery branches specifically supplying the fibroid(s). This technique may be useful for patients with a single fibroid, such as were included in this study. However, the technique would be difficult if not impossible in patients with multiple fibroids. In this report, fibroid and uterine shrinkage and clinical success rates are comparable to results in prior studies. The authors note that patients with more vascular fibroids have a better outcome. This has been reported previously but has been an inconsistent result. They also report a level of radiation exposure to the ovaries, comparable to prior reports, at levels thought to be below what is necessary to injure the ovaries.

As compared with hysterectomy and myomectomy, uterine artery embolization is a safe and efficacious therapy. It should be offered as a legitimate alternative for the treatment of symptomatic fibroids.