Skepticism Mounts Over Embolization Procedure.

KAMUELA, HAWAII -- Aggressive pain management is key to making uterine artery embolization an outpatient procedure, Dr. Martin L. Schwartz said at the annual meeting of the Pacific Coast Obstetrical and Gynecological Society

He reported on 35 patients who underwent the controversial procedure at Kaiser Permanente Northwest in Portland, Ore., drawing fire from his audience of ob.gyns. who are skeptical about whether uterine artery embolization (UAE) should be performed outside the scope of randomized, prospective clinical trials or, in fact, at all.

"This is still, in a sense, investigational, but we have to look at reality" Dr. Schwartz countered. "Laparoscopic cholecystectomy spread like wildfire in the community before it was studied in a scientific manner by the academic community"

Driven by interventional radiologists who perform the procedure and intense pressure from women seeking an alternative to surgery for uterine fibroids, UAE involves selective catheterization and occlusion of both uterine arteries to deprive fibroids of their blood supply Occlusion is accomplished with particles of polyvinyl alcohol or Gelfoam, which remain in place, Dr. Schwartz said at the meeting.

The procedure is extremely painful, necessitating hospitalization for pain management in the vast majority of published series. Additionally, the literature contains a large number of reports of postembolization syndrome that can occur 1-5 days after the procedure. Fever, pelvic pain, malaise, nausea and vomiting, and leukocytosis are hallmarks of the condition, which occurs in more than half of patients.

Dr. Schwartz and his colleagues sought to determine whether these complications could be safely managed in the outpatient setting.

Thirty-five "extremely self-selected" patients were enrolled beginning in mid-1998. Their mean age was 46 years, and their mean uterine size at the time of UAE was comparable to that of a 16-week pregnancy with a range of 8-24 weeks.