Uterine Artery Embolization Failure Secondary to Collateral Parasitization from Celiac and Superior Mesenteric Arterial Branches: A Case Report and Literature Review

Abstract Purpose: To present a rare case of uterine artery embolization (UAE) failure due to collateral arterial supply from the celiac axis and superior mesenteric artery (SMA), and to review the diagnostic and interventional considerations in such presentations. Case Presentation: A 41-year-old woman with symptomatic fibroids underwent bilateral UAE. Follow-up imaging showed persistent vascularity of a dominant 20 cm fibroid due to collateral supply from the celiac axis and SMA. As surgery was contraindicated, GnRH agonist therapy was used for symptom management, resulting in partial fibroid shrinkage. Conclusion: Persistent fibroid vascularization after UAE may result from unrecognized extra-uterine arterial supply. Recognition of atypical collateral pathways through cross-sectional angiography is essential for optimizing management and preventing treatment failure.