Uterine artery embolization: Long term follow-up and implementation

This thesis aims to determine the position of uterine artery embolization (UAE) in the spectrum of treatments for symptomatic uterine fibroids and to stimulate its implementation into daily practice. To do this, firstly the following aspects of UAE were investigated: the long-term clinical results of UAE, the summary of the body of evidence on UAE in comparison to established surgery and to other/new minimally invasive alternatives, and finally the patients’ preferences on UAE and the methods of pain management with this procedure. Herewith the position of UAE in fibroid management was established. We concluded that UAE is a valuable alternative to hysterectomy of which all women with symptomatic uterine fibroids should be counseled. We also concluded that despite this evidence UAE was not applied widely in the Netherlands. To initiate its implementation we investigated the hampering factors for the application of UAE and acted on the results of this inquiry by integrating UAE in the national guideline on heavy menstrual bleeding (HMB), thus enabling its further introduction into standard clinical practice.