Uterine-Artery Embolization or Myomectomy for Uterine Fibroids

To the Editor:

The study by Manyonda et al. (July 30 issue)¹ provides a balanced and widely applicable comparison of two uterus-sparing treatments for uterine fibroids — myomectomy and uterine-artery embolization — by including diverse institutions and patient populations. The authors report that patients who underwent myomectomy had a better fibroid-related quality of life at 2 years than those who underwent uterine-artery embolization. However, the reasons for the surprisingly high complication rates for uterine-artery embolization remain unclear. In this group, the intention-to-treat analysis of perioperative or predischarge major hemorrhage and blood transfusion showed rates of 2% and 4%, respectively. Earlier studies have shown vessel injury or bleeding rates of less than 0.5%.^2,3 None of these complications were reported in the per-protocol analysis, which suggests that complications that were attributed to uterine-artery embolization may have actually followed crossover to myomectomy. Similarly, this study showed a postdischarge infection rate of 14%, without designation of the infection location or severity. Major and minor postdischarge infection rates have been reported at far lower rates of 0.6 to 5.0% and 0 to 3.0%, respectively.^2,3 With the limited descriptions and definitions of techniques used in uterine-artery embolization, the embolic material used, and complications and their severity, it is challenging for the reader to reconcile the higher rates of complications in this trial.