275 - Revised Outcomes of Sequential Uterine Fibroid Embolization and Hysteroscopic Myomectomy for Large Intracavitary Fibroids

Purpose: Management of large, symptomatic intracavitary uterine fibroids poses several challenges. While hysteroscopic myomectomy (HM) offers definitive resection, the procedure is frequently limited by fibroid size, depth of myometrial penetration, and risks of intraprocedural complications including prolonged surgical time and increased systemic fluid absorption. Uterine fibroid embolization (UFE), on the other hand, is effective in reducing fibroid vascularity and size, but treatment of large fibroids can lead to endometritis, sepsis, and expulsion of residual tissue. Given the limitations of these procedures as stand-alone treatments, combining UFE with subsequent HM may improve procedural safety and efficacy. The purpose of our study is to evaluate the outcomes of patients who receive UFE prior to HM for treatment of large intracavitary uterine fibroids.

Materials and Methods: All patients presenting with symptoms concerning for uterine fibroids were seen in a combined fibroid center clinic run by interventional radiology (IR) and gynecology. Prior to intervention, a contrast-enhanced MRI was performed to assess the size, intramural extension, and presence of additional fibroids. Eligible patients were then discussed with a multidisciplinary uterine tumor board, and scheduled for UFE and subsequent HM. A retrospective chart review of these patients was performed to evaluate patient characteristics and outcomes of the combined procedure.

Results: A total of 80 patients (mean age: 45 years, mean fibroid size: 5.8 cm) underwent successful UFE with no noted post-procedural complications, followed by HM at a mean interval of 37 days. 69 patients (86%) had a successful complete surgical resection while 11 patients (14%) only had a partial resection with no additional intervention pursued. Of the 69 patients with complete surgical resection, 63 patients underwent resection in a single session whereas 7 patients needed a repeat myomectomy. None of the patients required a hysterectomy.

Conclusion: Pre-operative UFE followed by hysteroscopic myomectomy is a safe and effective strategy to treat large symptomatic intracavitary uterine fibroids. The above findings support the role of a combined IR-gynecology approach as a viable alternative to single-modality treatment in appropriately selected patients.