For Physicians: Representative Cases

Case 1 | Case 2 | Case 3 | Case 4

39yo BF, Jehovah's Witness, who presented with a several year h/o severe menometrorrhagia, pelvic heaviness, lethargy, and dyspareunia. Hysteroscopy revealed a submucous leiomyoma and MRI confirmed a 3cm fibroid along with several smaller ones. She had completed her childbearing and was offered hysterectomy for treatment of her fibroids. She chose UFE instead due to concerns about blood loss during surgery.

Results: At 6 month follow-up her periods have normalized and all symptoms, including dyspareunia, have completely resolved. MRI showed 70% decrease in dominant fibroid and 50% decrease in total uterine volume. She stated "I haven't felt this good since I was a teenager." No recurrence of symptoms at 4 year follow-up.

Figure 1 : Right uterine artery pre- and post-embolization. Pre-embolization right uterine arteriogram reveals hypervascular fibroids. See faint filling of right ovarian artery and filling of left main uterine artery. After embolization there is no further flow into the fibroids.

Figure 2 : Left uterine artery pre- and post-embolization. Pre-embolization left uterine arteriogram shows hypervascular fibroids with faint filling of left ovarian artery. Following embolization there is persistent filling of the cervico-vaginal branch, but no filling of the fibroids.

This case emphasizes the importance of embolizing both uterine arteries due to the rich collateral network between the two. If only one artery is embolized, branches from the other can keep the fibroid viable, and the procedure will be unsuccessful.

Case 1 | Case 2 | Case 3 | Case 4