Uterine artery embolization for fibroids: understanding the technical causes of failure.

THE growing evidence of the effectiveness of uterine artery embolization (UAE) has led to its acceptance as a treatment for fibroids in many centers around the world. It has created considerable interest among women and in the mainstream press. Gynecologists are becoming aware of the procedure and many are regularly referring patients for evaluation and treatment. The published case series are uniformly positive in their assessment of outcome (1–10). In this issue of JVIR, Pelage and coworkers (11) report their experience with a newer embolic agent, tris-acryl gelatin microspheres (Embospheres; Biosphere Medical, Rockland, MA), with results similar to those of earlier reports. Their work also fuels an ongoing debate: which is the preferred embolic agent for UAE? What is the appropriate endpoint of embolization with each of the products in current use? These questions point to a more central issue. What factors are associated with failure in UAE and how might a failed procedure be avoided? As our knowledge of this procedure increases, we need to focus on optimizing our technique to yield the best possible clinical outcome.

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