ABSTRACT

A Narrative review of clinical outcomes after Uterine Artery Embolization Versus High-Intensity-Focused-Ultrasound for Treatment of Uterine Fibroids

Sufia Athar

Objectives:

Uterine fibroids are asymptomatic but nearly one-third of the patients have severe symptoms that need case-specific management. Out of the uterine-sparing options available, Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MR-HIFU) and uterine artery embolization (UAE) remain the modality of choice due to being a non-invasive procedure. A narrative review was performed to assess the short- and long-term outcomes of magnetic resonance-guided focused ultrasound ablation of fibroids that may aid in patient selection.

 

Design: A narrative review of the literature.

 

Methods: An online MEDLINE and Embase search was conducted on studies published in English between January 2000 and July 2022. 1733 studies were retrieved. Twenty-seven quality studies published within the time zone reporting relevant data with good sample size and statistical analysis were included. The data on the efficacy, side effects, complications and need for re-intervention after MR-HIFU and UAE were retrieved from the studies.

 

Results:

The mean volume reduction rates were observed in 9%-38% and 39.5%-90% post-MR-HIFU and 50% -91% and 44.1% and 68% after UAE in twelve and twenty-four months of follow up respectively. Reductions in symptoms were noted in 32% to 74% and 70%-92% of patients after MR-HIFU and UAE. The reintervention rate after UAE was less as compared to MR-HIFU after one year (0.07 vs 0.12) but very high for MR-HIFU after five years (0.21 vs 0.49). Minimal side effects with no severe complications were observed after MR-HIFU but higher complication rates were noted with UAE. Higher fertility rates were reported after MR-HIFU in comparison to UAE.

 Conclusions:

Both UAE and MR-HIFU are effective for the treatment of fibroids. Though MR-HIFU remains the modality of choice due to being a non-invasive procedure with the least side effects, least long-term sequelae, and fertility-preserving modality, the re-intervention rates of MR-HIFU are very high after five years of intervention. UAE offers similar clinical outcomes with higher complication rates and uncertain fertility outcomes. MR-HIFU may be considered in women desiring fertility and in women in their late forties. UAE may be considered in younger women who have completed their family. Patient selection and counselling remain the key to attaining the desirable outcomes after UAE or MR-HIFU.