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Recurrence after fibroid embolisation

The incidence of recurrence after fibroid embolisation is very low. Often what is labelled as recurrence is really under-embolisation of the fibroid mass in the first place leaving some residual fibroids still viable. In a number of cases this does not actually matter as the fibroids may well be small and inconsequential, but in other cases re-embolisation is required.

If embolisation is carried out by a skilled and experienced operator, then the so-called recurrence rate and re-embolisation rate should be very low (around 1-2%). This may be slightly higher in young Afro-Caribbean women where the embolisation is maybe undertaken at an earlier age as the disease is more aggressive in this particular group. Obviously if the Radiologist performing the embolisation is insufficiently skilled or experienced then the rate of inadequate embolisation and therefore persistent fibroid viability is going to be higher and, indeed, in the MARA Trial from the Czech Republic there was a technical failure rate of embolisation of something around 10%, with a failure to kill the dominant fibroid of 30%. This is hopeless as the figure should be 1-2%.

The Radiologists doing this were however very inexperienced Radiologists who had been given no training in fibroid embolisation. Unfortunately, in the early days of fibroid embolisation it was all too common for Gynaecologists to ask Interventional Radiologists to perform fibroid embolisations who were either very inexperienced or indeed had done none at all.

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