Embolization or surgery for symptomatic uterine fibroids?

While recovery is faster after uterine-artery embolization, about 9% of recipients will require additional treatment within 1 year of the procedure, according to the findings of a randomized trial involving approximately 150 women.

The Randomized Trial of Embolization versus Surgical Treatment for Fibroids (REST) investigators found that while those women who received embolization were out of the hospital about 4 days sooner and back to work faster than those women receiving surgery, 9% required repeat embolization or hysterectomy for inadequate symptom control during the first year after the procedure and another 13% required hospitalization after the first year either for major adverse events or for reintervention for treatment failure.

Edwards RD, Moss JG, Lumsden MA, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007;356:360-370.

Uterine artery embolization (UAE) has become an attractive option for women with fibroids who want to avoid a hysterectomy, but it is not definitive therapy. The results of the REST Trial indicate, not surprisingly, that UAE is less effective than hysterectomy and repeat procedures are needed about 10% of the time. Knowing that the glass is 90% full and 10% empty ought to help clinicians and their patients make better decisions about the use of this procedure.