OBJECTIVESTo analyze the technical aspects of uterine artery embolization with dextran microspheres and to evaluate the effectiveness of this technique as the primary treatment of uterine fibroids in a series of 38 patients.

METHODSThirty-eight volunteers (age range, 24-48 years; mean, 37.2 years) with symptoms caused by uterine fibroids (menorrhagia, mass-related symptoms, and pelvic pain) were randomly included in this study. The fibroids were single in 32 patients and multiple in 6 patients. According to the tumor location, subserous fibroids were found in 4 patients and interstitial or submucosal fibroids in 34. Tumor size was from 2 to 10.9 cm in diameter. We performed embolization with a single Headhunter catheter using the right-femoral artery approach, injection of dextran microspheres (225-450 micro m), and an absorbable gelatin sponge. Follow-up included clinical and sonographic examinations at one-month intervals for 6 months.

RESULTSEmbolization was successfully performed in all patients. Post-procedural pain control was good in 35 (92%) patients. In most patients, symptoms were improved at 3 months (36/38, 95%). Clinical failure of the treatment occurred in only 2 patients (2/38, 5%). Progressive reduction in leiomyoma size was revealed during sonographic follow-up, and the reduction rate at the sixth month after embolization was 68%. The tumor had vanished in five submucosal fibroid patients. Histopathological tests showed that the tumor was degenerative as fibrosis and hyalinosis.

CONCLUSIONSUterine artery embolization with dextran microspheres is a micro-invasive method for the treatment of uterine fibroids. It is clinically effective in most patients and induces a progressive reduction in the size of fibroids. Based on this study, we believe that this new technique is much more suitable for submucosal fibroids with massive menorrhagia.