Incidence and Risk Factors for Clinical Failure of Uterine Leiomyoma Embolization

Tropeano, Giovanna MD; Di Stasi, Carmine MD; Amoroso, Sonia MD; Vizzielli, Giuseppe MD; Mascilini, Floriana MD; Scambia, Giovanni MD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e31825cb88e
Original Research
Abstract

OBJECTIVE: To estimate the incidence of clinical failure after uterine leiomyoma embolization and identify possible risk factors.

METHODS: One hundred seventy-six consecutive women undergoing uterine leiomyoma embolization were followed prospectively for a median of 48 months (range 12–84 months) to estimate the occurrence of clinical failure, defined as persistence or recurrence of leiomyoma symptoms, and any subsequent invasive treatment. Cumulative failure and reintervention rates were estimated by survival analysis and log-rank tests according to baseline patient characteristics. Multivariable Cox proportional hazards analysis was performed to adjust for confounders.

RESULTS: Overall, there were 18 failures at a median of 36 months (range 3–84 months). The cumulative failure rate increased steadily over time, 3% at 1 year, 7% at 3 years, 14% at 5 years, and 18% at 7 years. Of the 18 failures, 11 had reintervention, including six hysterectomies, four myomectomies, and one repeat uterine leiomyoma embolization, at a median of 56 months (range 15–84 months). The cumulative reintervention rate was 0 at 1 year, 3% at 3 years, 7% at 5 years, and 15% at 7 years. Women aged 40 years or younger had a higher failure risk (hazard ratio [HR] 5.89, 95% confidence interval [CI] 2.50–20.02, P=.023) compared with older women. A history of previous myomectomy was also associated with an increased failure risk (HR 3.79, 95% CI 2.07–13.23, P=.037).

CONCLUSION: The 7-year cumulative rates of clinical failure and reintervention after uterine leiomyoma embolization were 18% (95% CI 8.2–27.8) and 15% (95% CI 5.2–24.8), respectively. The failure risk was higher for younger patients and for those with a prior myomectomy.

LEVEL OF EVIDENCE: III

In Brief

The 7-year cumulative risk of clinical failure after uterine leiomyoma embolization is 18%, but patient age and gynecologic history may modify the failure risk.

Author Information

From the Departments of Obstetrics, Gynecology, and Radiology, Università Cattolica del Sacro Cuore, Rome, Italy.

Corresponding author: Giovanna Tropeano, MD, Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168 Roma, Italy; e-mail: giovanna.tropeano@rm.unicatt.it.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2012 The American College of Obstetricians and Gynecologists