Predictors of hysterectomy after uterine artery embolization for leiomyoma.

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.