Uterine artery embolization
Although rapidly adopted by enthusiasts, the introduction of UAE has
varied widely across the globe (Moss and Christies, 2016). This technique
was first used in 1995 (Ravina et al., 1995) to treat uterine
fibroids in women wishing to preserve their uterus.
UAE constitutes complete uterine therapy, as most fibroids are supplied
by the uterine arteries. In UAE, percutaneous ablation of the fibromatous
uterus is applied to induce ischemic necrosis of the fibroids,
while the myometrium revascularizes. Most fibroids are targeted simultaneously.
UAE has been shown, in randomized trials, to result in QoL
similar to that achieved after surgery, but with a shorter hospital stay
and earlier resumption of normal activities (Gupta et al., 2012, 2014).
Although UAE is highly effective for treating symptoms (reduction
in bleeding and fibroid size), the risk of reoperation is a reality:
15–20% after successful embolization and up to 50% in cases of
incomplete infarction (Kroencke et al., 2010; Gupta et al., 2014; Mara
and Kubinova, 2014; Vilos et al., 2015, Spies, 2016).
High-frequency magnetic resonance-guided
focused ultrasound surgery
High frequency magnetic resonance-guided focused ultrasound surgery
(MRgFUS) is thermal ablation using MRI to visualize the myoma and define the target. Ultrasonic energy is directed to a point inside
the fibroid and coagulation tissue necrosis is induced in the myoma.
In theory, damage to surrounding tissue is minimal (Clark et al., 2014;
Park et al., 2014) but, in fact, the impact on critical neighboring structures
cannot be excluded (Fischer et al., 2015; Kim et al., 2015).
Vaginal occlusion of the uterine arteries
Occlusion of the uterine arteries with a clamp-like device that
remains in place for 6 h leads to myoma ischemia by interfering with
the blood supply to the uterus (Hald et al., 2004). However, this
technique is not recommended for women wishing to conceive in the
future.