Complications of uterine fibroid embolization

Abstract

Uterine fibroid embolization (UFE) is an increasingly popular, minimally invasive treatment option for women with symptomatic fibroid disease. UFE therapy in qualified hands is an effective, well-tolerated procedure that offers relief of fibroid symptoms with a low risk of complications. In the acute postprocedural period, immediate complications may relate to vascular access, thromboembolic events, infection, and pain management. Reported major complications include but are not limited to pulmonary embolus, uterine ischemia, necrosis, sepsis, and death. Non-life-threatening complications include altered ovarian and sexual function, subcutaneous tissue necrosis, expulsion of fibroid tissue, and treatment failure. Awareness of the known complications of UFE may allow more rapid diagnosis and effective therapeutic responses to complications when they occur.

Keywords: Fibroids; complications; embolization.

Figures

Figure 1

(A) Sagittal T2-weighted MRI shows a large submucosal fibroid; (B) sagittal T2 postcontrast image with marked heterogeneous enhancement obscuring the uterine anatomy.

Figure 2

Severe uterine ischemia with recovery. (A) Preoperative sagittal T1 post-gadolinium-contrast administration. (B) Postoperative day 1: near complete loss of enhancement of the fibroids with a thin enhancing rim of endometrial uterine wall concerning for early necrosis (C). Postoperative day 3: follow-up shows slight internal increased uterine perfusion. (D) Postoperative day 7: continued interval improvement of uterine perfusion following the administration of gadolinium. (E) Postoperative day 21: slight decrease in overall size of the uterus with shrinking necrotic fibroids and interval increase in uterine enhancement.

Figure 3

(A–C) Uterine necrosis. (C) Gross pathological specimen following urgent hysterectomy.

Figure 4

Prolapsing fibroid seen on (A) pre- and (B) postcontrast sagittal T2 images.