Uterine artery embolization versus occlusion for uterine leiomyomas: a pilot randomized clinical trial.

ABSTRACT

STUDY OBJECTIVE: To compare perioperative pain and institutional use for women undergoing transcatheter uterine artery embolization (UAE) and transcatheter uterine artery occlusion (UAO) for the treatment of heavy uterine bleeding associated with uterine leiomyomas. DESIGN: A pilot double-blind, randomized clinical trial (Canadian Task Force classification I). SETTING: Large, university-affiliated community hospital with multiple residency programs including obstetrics and gynecolgoy and radiology. PATIENTS Premenopausal women with heavy uterine bleeding related to uterine leiomyomas were enrolled. INTERVENTIONS: Either a standard UAE with microspheres or UAO using vascular coils was used. The main outcome measures were analgesic use, institutional stay, and postprocedural numeric pain scales. MEASUREMENTS AND MAIN RESULTS: Sixteen women were enrolled and 14 underwent study procedures (UAE n = 8, UAO n = 6). Baseline Aberdeen Menorrhagia Severity Scale scores, also known as the Ruta scores, were similar in each group (UAE = 54, UAO = 53). Median preprocedural uterine volume was similar for each group (UAE = 557 mL, UAO = 612 mL). The median postprocedural pain scale was less for UAO than UAE (UAO 1, UAE 5; p <.05). Six patients with UAE and no patients with UAO required parenteral narcotic analgesia in the recovery room (p <.05) (median UAO 0 and UAE 1). Patients with UAE used 6 hospital nights and patients with UAO used 1 hospital night (p =.09) (median UAO 0 and UAE 1). Three-month Aberdeen Menorrhagia Severity Scale scores were reduced to a similar degree in each group (UAE = 58%, UAO = 63%). CONCLUSION: Transcatheter UAO is a promising alternative transcatheter technique for the treatment of symptoms related to uterine leiomyomas, with less postprocedural pain, reduced requirements for analgesics, and shorter hospital stays than transcatheter UAE. Although the results of the study are promising, larger-scale trials with longer follow-up are needed to both confirm these results and evaluate the long-term efficacy of transcatheter UAO.