Patient Care and Uterine Artery Embolization for Leiomyomata R. Torrance Andrews, MD, James B. Spies, MD, David Sacks, MD, Robert L. Worthington-Kirsch, MD, Gerald A. Niedzwiecki, MD, M. Victoria Marx, MD, David M. Hovsepian, MD, Donald L. Miller, MD, Gary P. Siskin, MD, Rodney D. Raabe, MD, Scott C. Goodwin, MD, Robert J. Min, MD, Joseph Bonn, MD, John F. Cardella, MD, and Nilesh H. Patel, MD, for the Task Force on Uterine Artery Embolization and the Standards Division of the Society of Interventional Radiology J Vasc Interv Radiol 2004; 15:115–120 Abbreviation: UAE = uterine artery embolization THROUGHOUT this document, the procedure under discussion will be re- ferred to as uterine artery emboliza- tion for symptomatic leiomyomata or by the acronym UAE. Although the phrase “uterine fibroid embolization” (UFE) is used in other publications, for the purposes of clarity and scientific accuracy, the colloquial term “fibroid” will not be used in this document. UAE is a percutaneous image- guided therapy that offers an alterna- tive to chronic hormonal therapy and traditional surgical procedures, such as myomectomy and hysterectomy, to women with symptomatic leiomyo- mata (fibroids). The published experi- ence indicates that this is an effective and safe therapy for leiomyomata. UAE is unique among interven- tional radiology procedures in several ways. These differences require that the interventional radiologist perform- ing UAE assume a far more active role in patient management than has tradi- tionally been the case. With this posi- tion comes a great deal of responsibil- ity that cannot be overemphasized. The Society of Interventional Radiol- ogy Task Force on Uterine Artery Em- bolization has developed this consen- sus statement to clarify the operating physician’s responsibility to the pa- tient and to address technical and pro- cedural factors that will enhance the likelihood of a clinically successful treatment. PATIENT SELECTION At this time, the Task Force recom- mends that embolization be offered to only patients with symptomatic uter- ine leiomyomata. Because the symp- toms associated with leiomyomata can also be caused by other processes, it is critical that patients undergo prepro- cedural evaluation that is adequate to confirm that their symptoms are in fact caused by leiomyomata or signif- icantly contributed to by leiomyomata. It is equally critical that unrelated but potentially more important processes (such as ovarian malignancy) be ex- cluded. The symptoms most commonly caused by leiomyomata include: • Heavy menstrual bleeding; • Pain (including pelvic, back, leg, and flank pain); and • Bulk-related symptoms, including: Pelvic pressure, heaviness or discomfort; Abdominal bloating; Urinary frequency or incontinence; Ureteral compression; and Rectal pressure. Leiomyomata have also been impli- cated in infertility, subfertility, and complications during pregnancy, but it is not known what effect uterine embolization will have on these issues. Therefore, at this time, UAE is not rec- ommended as a primary therapy for infertility in patients with leiomyoma who are reasonable candidates for and will accept myomectomy. For patients who desire children in the future, the decision to perform UAE should be made in the context of the patient’s extent of disease and response to pre- vious treatments and the potential for other treatments to control the symp- toms without impairing ability to achieve and maintain pregnancy. From the Department of Vascular and Interven- tional Radiology (R.T.A.), University of Washington Medical Center, Seattle; Department of Radiology (R.D.R.), Sacred Heart Medical Center, Spokane, Washington; Department of Radiology (J.B.S.), Georgetown University Medical Center, Washing- ton, DC; Department of Radiology (D.S.), The Read- ing Hospital and Medical Center, West Reading; Interventional Radiology (R.L.W.K.), Image-Guided Surgery Associates; Department of Radiology (J.B.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Advanced Interventions (G.A.N.), Clearwater, Florida; Department of Radiology (M.V.M.), Los Angeles County and University of Southern California Medical Center; Department of Veterans Affairs (S.C.G.), Greater Los Angeles Health Care Systems, Los Angeles, California; Divi- sion of Vascular and Interventional Radiology (D.M.H.), Mallinckrodt Institute of Radiology, St. Louis, Missouri; Department of Radiology (D.L.M.), National Naval Medical Center, Bethesda, Mary- land; Department of Vascular Radiology (G.P.S.), Albany Medical College, Albany; Department of Ra- diology (R.J.M.), Weill Medical College of Cornell University, New York; Department of Radiology, SUNY Upstate Medical University (J.F.C.), Syracuse, New York; and Department of Interventional Radi- ology (N.H.P.), Rush University Medical Center, Chicago, Illinois. Address correspondence to the Society of Interventional Radiology, 10201 Lee High- way, Suite 500, Fairfax, VA 22030 © SIR, 2004 DOI: 10.1097/01.RVI.0000109408.52762.35 Standards of Practice 115