Fibromes utérins. Embolisation : pratiques actuelles

Uterine artery embolization is a radiological procedure that consists in occluding the perifibroid arterial plexus to induce fibroid ischemia. To date, with more than 50,000 women treated worldwide, embolization seems to be a valuable alternative to hysterectomy and multiple myomectomies particularly in women with severe menorrhagia. Embolization should ideally be performed in case of intramural or submucosal uterine fibroids. It must be preferably realized in case of multiple fibroids, be they intramural or submucosal (when hysteroscopic resection is not feasible). Complication rates are low if large calibrated microspheres are used to perform embolization and if pedunculated subserosal fibroids are excluded. In case of associated adenomyosis clinical recurrence seems more frequent. The role of embolization as an alternative to single myomectomy, particularly in young women who desire future pregnancy, remains a matter of debate and should be evaluated with clinical randomized trials. Multidisciplinary management is the key to a widened acceptance of uterine artery embolization in the management of uterine fibromas.