Preoperative Uterine Artery Embolisation for Large Uterine Fibroids with Subsequent Uterus Preservation - Three Case Histories and Review of the Literature.

Uterine artery embolisation (UAE) is an established procedure to treat uterine fibroids as an alternative to surgery. The combination of both approaches is reserved for only a few cases. A preoperative UAE (PUAE) contributes to reducing bleeding complications and helps preserve the uterus. We report here on 3 patients, each with very large fibroid (all > 1100 g), who were successfully treated by interdisciplinary hybrid intervention (embolisation followed by surgery). Preserving the uterus was a "sine qua non" for all 3 patients. As discussed in some articles, PUAE should be considered when treating patients who wish to preserve their uterus at all costs but who are considered preoperatively to be at increased risk of bleeding and/or patients who are considered to be at high risk of requiring a hysterectomy "for technical reasons". The additional costs of embolisation can be set against the potentially shorter hospitalisation times due to the more favourable intraoperative and postoperative course, the savings arising from the reduced need for blood transfusions, and the greater patient satisfaction.