Objective of the study was to improve the effectiveness of uterine artery embolization (UAE) in women with uterine leiomyomata and to prevent complications. To achieve study goals 94 women treated by UAE. All patients tested with standard clinical assays, coagulation assay and hormonal assay. Ultrasonography, dopplerometry, angiography was used. A specific questionnaire UFS-QOL used to assess the quality of life at baseline and in 3 and 6 months after treatment. Endovascular operation was performed with unilateral access through right femoral artery using PVA particles of 400 µm - 740 µm or PVA embospheres 700 µm - 1200 µm. Fifty women (mean age, 41.1 years; range, 30-57 years; mean uterine volume, 286 cm3; range, 90-824 cm3) had manual compression for hemostasis (group I) and elastic compression of legs as thromboprophylaxis. Forty-four women (mean age, 44.5 years; range, 27-55 years; mean uterine volume, 273 cm3; range, 74-678 cm3) treated with vascular closure device Angio-Seal (group II). In addition to elastic leg compression, short course of enoxaparin was used in group II. Enoxaparin injected subcutaneously, with 4000 anti-Xa IU given twice on UAE day with 12-hour interval beginning 2-3 hours prior to embolization. Women in group I had bed rest for 24 hours. Women in group II had early ambulation, approximately no later than 2 hours after UAE. No statistically significant differences noted in ultrasound and Doppler characteristic of two groups. Group I had slightly elevated coagulation markers after UAE comparing with baseline: fibrinogen (p<0.05), prothrombin index (p<0.05), thrombocyte aggregation rate (p<0.05) and thrombocyte aggregation speed (p<0.05). Women of group I had two cases of thrombotic complications, such as acute ascending thrombophlebitis of superficial veins of the left leg and non-fatal pulmonary embolus. Former case required crossectomy vein surgery on the left side and anticoagulation therapy. Later case successfully treated with intravenous thrombolytic and anticoagulation therapy. Group II had longer prothrombin time (p<0.01), lower thrombocyte aggregation rate (p<0.001) and aggregation time (p<0.05) after UAE comparing to baseline analyses. No thromboembolic complications noted in that group. In conclusion, elastic compression of low extremities alone is insufficient for thromboprophylaxis after UAE in women with uterine leiomyoma. Vascular closure devices allow ambulation as early as 2 hours after UAE and usage of low-molecular-weight heparins without the risk of hemorrhagic complications at puncture cite. Predisposing factors for thromboembolism are heart disease (in 50 per cent of patients), endocrine pathology (in 11,7 per cent of patients), varicose veins (in 15 per cent of women), oral contraceptives intake and long period of bed rest in case of compression method of hemostasis. Short-course low-molecular-weight heparin regimen and has no negative impact on the effectiveness of UAE. It has been scientifically substantiated that UAE has no negative impact on ovarian function in reproductive age women. Only slightly elevated but statistically insignificant FSH levels for 28 per cent from 5,19±1,12 mUI/ml to 6,64±4,46 mUI/ml noted in 6 moths time after treatment (p>0.05). Estrogen levels slightly decreased for 25 per cent from 153,2±105,3 pg/ml to 114,22±83,35 pg/ml but insignificantly after the same period of time (p>0.05). AMH levels slightly diminished in 6 months after UAE to 0,56±0,41 ng/ml comparing to 0,55±0,46 ng/ml at baseline (p>0.05). The reduction in mean uterine volume measured by pelvic ultrasound comparing to pre-treatment was 38,8 per cent in 6 moths, 43 per cent in 9 months and 56,3 per cent in 12 months. There was statistical difference in uterine volume reduction in 6 months between two groups: 45,5 per cent in group versus 32,1 per cent (p<0,05). However, no difference noted in 9 or 12 months. The uterine arterial embolization proved effective by substantially reducing menstrual bleeding, pain and bulk symptoms of pressure as early as in 3 months after treatment. The mean score of severity of symptoms scale dropped from 49,6±16,7 to 26,0±16,0 (p<0,05). The mean score for general quality of life improved for 26 per cent from 52,7±22,9 to 66,4±23,4 (p<0,05) in 3 months and for 47 per cent to 77,3±18,3 (p<0,05) in 6 months after UAE. Unfortunately, during 12 months after endovascular treatment 9 additional operations were performed in group I with overall rate of 14 per cent comparing with 8 operations in group II (overall rate 13,6 per cent, p>0,05). The operations included hysterectomy for recurrent menstrual bleeding, pain or bulk symptoms, and also curettage and hysteroscopy due to retained necrotic tissue in the uterine cavity. The developed algorithm for management of patients with uterine leiomyomata after UAE prevents thromboembolic, septic and hemorrhagic complications
