In their July article (“Uterine artery embolization for abnormal bleeding”), Drs. Ducksoo Kim and Stephen D. Baer provide critical information about this procedure, which represents an important new option for women who experience diminished quality of life as a result of fibroids.
However, in the discussion of mortality, they noted that 2 deaths had been reported: 1 described in a letter to the editor in the form of a case study1 and the other in a 2003 report by de Blok et al.2
I would like to point out that no deaths have occurred in any of the randomized clinical trials to date, which have enrolled well over 1,000 patients. Further, clinicians should keep in mind that the most common alternative to UAE is hysterectomy, which, like any surgery, also carries risk. For example, in a study involving 53,000 US women undergoing hysterectomy, a mortality rate of 19 per 10,000 women was reported.3
Although UAE is not without risk, the procedure does not pose excessive risk. Close collaboration between the ObGyn and the interventional radiologist is important to treat any infections promptly and reduce risk.
Linda D. Bradley, MD
Director of Hysteroscopic Services
Cleveland Clinic Foundation
References
- Vashisht A, Studd J, Carey A, Burn P. Fatal septicaemia after fibroid embolisation [letter]. Lancet. 1999;354:307-308.
- de Blok S, De Vries C, Prinssen HM, Blaauwgeers HL, Jorna-Meijier LB. Fatal sepsis after uterine artery embolization with microspheres. J Vasc Interv Radiol. 2003;14:779-793.
- Kjerulff K, et al. The socioeconomic correlates of hysterectomies in the United States. Am J Pub Health. 1993;83:106-108.
Drs. Kim and Baer respond:
We appreciate Dr. Bradley’s further clarification of the 2 cases of fatal sepsis associated with uterine artery embolization (UAE), which occurred before 2003. Since then there have been no other fatal septic complications reported, although more than 50,000 UAE procedures have been performed to date.
Dr. Bradley correctly noted that there have been no deaths associated with any randomized clinical trials, which have involved more than 1,000 patients. This coincides with our experience with more than 800 cases to date and with the short-term outcomes data of the Fibroid Registry on UAE procedures in more than 3,000 patients at 72 sites in the United States.1
Dr. Bradley was also right to point out that the risk of mortality is significantly greater with surgical options.
Uterine artery embolization has been the preferred therapeutic option for symptomatic fibroids in our collaborative interventional radiology/ObGyn practice since 1997. We strongly believe that the close interdisciplinary collaboration is essential to achieve favorable technical and clinical outcomes.