Success and unsolved issues of embolization of the uterine arteries in uterine fibroid

Abstract

Introduction: According to the clinical recommendations of the Healthcare Ministry of Russia (2021), uterine artery embolization (UAE) in uterine fibroid is an alternative to surgical treatment in case of high surgical risk and absence of contraindications in women who do not desire pregnancy. The advantages of UAE are associated with lesser blood loss, shorter hospital stay, and recovery of the working capacity. Here, we present an analysis of the literature and our 14-year clinical experience in performing UAE in uterine fibroid. Screening and primary diagnosis of uterine fibroid and indications and contraindications of UAE in the current publications were analyzed. Different methods of EUA implementation were described, and the advantages of the transradial access (TRA) are demonstrated on the basis of the actual clinical experience. Conclusion: The results obtained in the use of TRA revealed the reduction of radioscopy time and surgery time in general, which are beneficial in terms of the reduction of radiation exposure. Besides, an argument for the given access is a considerably lower frequency of serious complications at the access site. The main obstacles to the introduction and wide use of TRA are based on the lack of specialist experience, absence of specialized training programs, and use of unsuitable and traumatizing instruments. One of the unsolved questions is the absence of an anesthesia protocol, which must be developed with the participation of both gynecologists and specialists on X-ray endovascular diagnostics and treatment.