Combined endovascular and surgical therapy of uterine fibroma.

Since the first description of uterine artery embolisation for the treatment of symptomatic fibroids of the uterus in 1994, this minimally invasive procedure has been increasingly performed in many countries. Transcatheter embolisation of the uterine arteries feeding large fibroids is a minimally invasive technique. This paper presents the combined endovascular and surgical therapy in the treatment of uterine fibroma. The purpose of this therapy is saving the reproductive function of the uterus even in cases with very large fibromas or located in areas with difficult access, in which hysterectomy would have been needed. The therapy has a high rate of success, it is accompanied by disappearance of the symptoms and it has a low risk of intra- and postoperatory complications. The first step is the embolisation of uterine arteries--a safe therapy of uterine fibroma. The procedure eliminates the risk of post-miomectomy relapse through the symultaneous devascularisation of all fibroma nodules, even of the very small ones which are unapparent clinically or imagistically. The post-embolisation surgical intervention is undertaken in conditions of operative comfort, with minimal bleeding; it eliminates the need for blood transfusions and diminishes the duration of intervention. Three representative cases where this therapy has been successfully applied are presented in this article. The embolisation of the uterine arteries represents an efficient therapy of the uterine fibroma, with very good results noted in the speciality literature.