Modified-BRTO (balloon-occluded retrograde transvenous obliteration) for the treatment of portal hypertensive variceal bleeding

Purpose: To assess the efficacy, complications, and reintervention incidence of uterine fibroid embolization (UFE) on patients with large uterine fibroids. Materials and Methods: A retrospective cohort study of 333 women (mean age, 44.2 years; range 26-58 years) who underwent UFE for uterine fibroids between January 2009 – January 2013 was undertaken. They were divided into two groups based on ultrasound or serial MRI findings, those with a dominant fibroid Z10cm on its longest axis and/or a uterine volume Z700cm (group 1, n1⁄4130) and the control group (group 2, n1⁄4203). Dominant fibroid and uterine volume reduction were determined by comparing baseline and follow-up ultrasound and MRI findings. Symptoms improvement and satisfaction with both the procedure and their outcome were assessed using standardized Likert scale questionnaires completed at followup (mean, 6.8 months). Post-procedural complications and reinterventions were recorded. All post-procedural continuous variables were compared using the Mann-Whitney U test, while categorical variables were compared using the chisquared test. Results: o significant differences were observed between the groups in dominant fibroid reduction (median 43% in group 1, 51% in group 2, p 1⁄4 .332), patient reported symptom improvement (bleeding, p 1⁄4 .076; pain, p 1⁄4 .551; pelvic pressure, p 1⁄4 .763; urinary frequency or urgency, p 1⁄4 .486), complications (p 1⁄4 .171), and patient satisfaction of the procedure (p 1⁄4 .915) and outcome (p 1⁄4 .731). However, a significant difference was observed in uterine volume reduction (median 46% in group 1, 34% in group 2, p 1⁄4 .000). Conclusion: Apart from uterine volume reduction, outcomes of UFE on patients with large fibroids are comparable to those with small fibroids. Patients with large fibroids can expect greater uterine volume reduction. Fibroid size and uterine volume are not key factors in determining suitability for UFE and successful outcomes can be obtained in patients with large fibroids.