Long-term outcomes and reinterventions following uterine artery embolization for the treatment of uterine leiomyomata.

PURPOSE: Uterine artery embolization (UAE) is a minimally invasive treatment for symptomatic uterine fibroids, but long-term data on subsequent reintervention and effects on ovarian function remain limited. This study quantifies the frequency and timing of gynecologic reintervention at five to thirteen years following UAE. METHODS: This is a single-institution retrospective cohort of 199 patients with MRI-confirmed symptomatic fibroids who underwent UAE between January 2013 and December 2018. Demographics, symptomology, procedural details, and follow-up data were collected by chart review. Cumulative procedural reintervention was estimated using Kaplan-Meier analysis with censoring at the date of last clinical contact. A multivariable Cox proportional hazards model was used to calculate risk factors for requiring reintervention. RESULTS: At least five-year follow-up information was available for 184 patients (92.5%). Of 175 survey respondents, 132 (75.4%) reported significant symptom improvement at least two years following embolization. Sixty-one patients (33.2%) required additional medical (32, 17.4%) and/or procedural (34, 18.5%) intervention, with hysterectomy the most common subsequent procedure (29, 15.8%). The Kaplan-Meier 10-year cumulative incidence of any secondary procedure was 19.4% (95% CI 13.1-25.3), with younger age at embolization significantly associated with reintervention (HR 0.91, 95% CI 0.86-0.97, p = 0.003). CONCLUSION: UAE provides durable symptom relief with a low periprocedural complication rate. Procedural reintervention is required in approximately one in five patients over a decade with no clear high-risk window but with younger age at embolization independently associated with reintervention.