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SummaryUterine fibroids are the most common pelvic tumors the prevalence in autopsies is 35- 40% in women an above 35 years (Reidr et al., 1998).Leiomyomas are clinically important because they are a major cause of abnormal uterine bleeding and are the most commonly cited reason for hysterectomy (Wiloeox et al., 1994).Klagsbrun et al. (1993) reported that; leiomyoma produce many growth factors. Several of these growth factors are angiogenic in that they stimulate proliferation and/or migration of vascular endothelial cells. some are also mitogenic for (SMCs). whereas many think of leiomyomas primarily as fibrotic disease, they also appear to be a disease of abnormal blood vessel structure or function. leiomyomas are well vascularized tumors with a complex net work of blood vessels (Sampson, 1912). Thus, leiomyomas are similar to many other tumors, including malignant tumors that are dependant on development of an adequate blood supply for there survival.In women with symptomatic uterine fibroids, uterine artery embolization has been reported to be a safe, effective, and minimally invasive alternative to traditional therapies such as hysterectomy myomectomy, and hormone therapy. In larger series of patients, a number of authors have reported that embolization contributed to the improvement of clinical symptoms associated with uterine fibroids and resulted in tumor and uterine volume reduction with few complications during the follow-up period (Siskin et al., 2000).In the present study patients were selected for conservative uterine artery embolization the study population comprised 20 adult women (age range, 20-40 years; mean age, 30 years).10 patients (50%) were virgins, 10 patients (50%) were nullipara.All patients preferred embolization to surgery because a strong desire to keep the uterus or to avoid surgical procedure.Symptoms related to leiomyomas were classified in three categories; abnormal bleeding (menorrhagia, metrorrhagia), bulk-related symptoms(frequency of urination., sensation of pressure or mass), and pelvic pain.the distribution of symptoms was as follows ;abnormal bleeding (n = 8), bulk-related symptoms (n = 3), pelvic pain (n = 1), abnormal bleeding and bulk -related symptoms (n = 4), abnormal bleeding with pelvic pain (n = 2), bulk-related symptoms with pelvic pain (n = 1), and abnormal bleeding with bulk -related symptoms and pelvic pain (n = 1).Moreover, abnormal bleeding was responsible for anemia in 9 patients (range of hemoglobin level, 4-10 mg/dl).The maximum diameter of the largest fibroid, the number of fibroids per patient, the location of the dominant fibroid, and the uterine volume were obtained on baseline ultrasonography then defining the largest fibroid as the dominant fibroid.All patients were subjected to bilateral UAE through trans-catheter approach (trans-femoral artery) through which UAE was performed by gelatin sponge particle (gel foam)alone. The analgesia was pethedine 50-150 mg and sodium declophenate.there was prophylactic antibiotics for 2-7 days.All patients were followed for 6 months a clinical examination was performed for each patient every 2 hours during hospitalization.all symptoms were recorded ;fever, pain, headache, and bleeding.Systematic follow-up after discharge from the hospital included clinical and sonographic examinations at 1, 3, and 6 moths.sonographic examinations were always performed with a 3.5-MHzabdominal probe and with a 4-8MHz transvaginal probe.Evolution of clinical symptoms was classified as increased, unchanged, improved, or absent (i.e., symptom-free).Evolution of sonographic finding was analyzed by measuring the size of the uterus and the diameters of leiomyoma.As regard Procedure;Both uterine arteries were canulated without problem in 18 patients(90%).Difficulties of catheterization and failed technichqe in 2 patients (10%), one patient was uncooperative and move her lower limb during procedure, the other patient uterine arteries couldn’t be visualized on fluoroscopy.As regard Complications;There was mild subcutaneous hematoma in 4 patients (20%) that was resolved in 5-12 days.A small leak of contrast medium occurred in one patient (5%)during catheterization of the left uterine artery.This complication, which was caused by vascular perforation, was immediately and successfully treated by embolization of uterine artery with a gelatin sponge particles.During hospitalization 15 (75%) patients had no post-procedural complications.one patient (5%) was feverish (≥ 38˚C) for 16hr after embolization.Fever resolved spontaneously without specific treatment.Two patients (10%) developed severe pelvic pain in the 1st 12 hrs.pain was controlled by increasing dose of pethedine by 50mg.Two weeks after embolization, one patient (5%) suffer from pelvic pain associated with offensive vaginal discharge that was controlled by metronidazole 500mg three times daily, 3rd generation cephalosporin and gentamycin.As regard success rate and patients satisfaction;After one month of embolization;Of 18 patients symptoms remained unchanged in 5 patients (27.77%), were improved in 10 (55.55%), and had resolved in 3 patients (16.66%).sonographic examinations revealed a mean reduction in leiomyoma size of 15%.At 3 months;Of 18 patients; Abnormal bleeding had increased in one patient (5.55%) after period of stability.A second embolization procedure was necessary for one patient (5.55%) with posterior wall fibroid, but patient prefer surgical treatment (myomectomy) to avoid pain which suffered from in previous embolization.Symptoms remained unchanged in 3 patients (16.66%), were improved in 8patients (44.44%), and had resolved in 6 patients (33.33%).Sonographic examinations showed a mean reduction in leiomyoma(s) size of 25%.At 6 months;Of 17 patients symptoms remained unchanged in one (5.88%), and were improved in two(11.76%). The other 14 patients were symptom-free.Sonographic examinations showed a mean reduction in leiomyoma size of 43%.ConclusionUAE is safe and effective modality in management of well-selected cases uterine fibroid.UAE is more acceptable to patients as it is associated with rapid recovery and short hospital stay (as out-patient procedure).UAE by gelatin sponge particles alone is more safe and give nearly the same results of U.A.E. by poly vinil alcohol without serious complications.Careful patient selection is essential point to avoid complications and gain good results.UAE need more evaluation on large number of patients and for long duration.
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