According to this study:

* Uterine artery embolization patients recovered more quickly.

* Surgical intervention patients had less treatment failure.

Since the mid-1990s, patients with symptomatic uterine fibroids have been treated with uterine artery embolization as an alternative to the traditional surgical interventions of hysterectomy and myomectomy. Researchers from the United Kingdom studied patients' outcomes after embolization and surgery. They found that patients who underwent embolization recovered more quickly than those who had surgery; however, they also experienced more complications after discharge and greater treatment failure.

A total of 157 women were randomized to either uterine artery embolization (n = 106) or surgery (n = 51). Eligible patients were at least 18 years old, symptomatic, and had at least one fibroid greater than 2 cm in diameter that could be seen on magnetic resonance imaging and that the physician felt warranted surgical treatment. The primary outcome measure was quality of life one year after the procedure, which was assessed with a 36-item general health survey. Secondary outcomes included pain 24 hours after the procedure, complications, treatment failure, and time to resuming normal activities. There were no significant differences in baseline patient characteristics in the two groups.

At one month after the procedure, patients in the embolization group reported significantly higher scores related to physical and social functions and physical role. At 12 months, no significant differences were noted between the groups in any of the survey components. In comparison with those who had surgery, patients in the embolization group reported significantly lower pain scores 24 hours after their procedure, had significantly shorter hospital stays (one day versus five), and returned to normal activities significantly sooner. However, those in the surgery group had significantly better symptom control at one and 12 months after the procedure, and there was a 20% (n = 21) treatment failure rate in the embolization group. Ten of the treatment failures occurred within 12 months of embolization. In the surgical group, one myomectomy had to be converted to a hysterectomy during the initial procedure.

During the median follow-up of 32 months, 16 (15%) major adverse events occurred in the embolization group, 15 of them after the patient was discharged from the hospital. In the surgical group, there were 10 (20%) major adverse events, 80% of which occurred while the patient was still hospitalized.

The authors conclude that patients must weigh the benefits of embolization (less pain, shorter hospitalization and recovery time) against the risks (late adverse events and greater chance of treatment failure) when determining which procedure is best for them.

AK