Unilateral uterine artery embolization for symptomatic uterine fibroids: retrospective review of clinical outcomes of 78 patients in single center over 15 years and literature review

Uterine artery embolization (UAE) is typically performed bilaterally; however, in some cases only unilateral embolization is feasible. Evidence on clinical outcomes of unilateral UAE remains limited. This study aimed to evaluate clinical outcomes and morphological changes in the uterus and fibroids following unilateral UAE. Angiography and MRI reports from 887 UAE patients (2008–2023) were reviewed to identify unilateral cases. Pre- and post-procedure uterine and fibroid volumes were measured. Clinical follow-up and quality-of-life (QoL) scores (0 = unbearable symptoms, 100 = perfect QoL) were assessed via questionnaire. Data are presented as medians (IQR). Patients were categorized into technical failure (T) and non-identifiable uterine artery (Ni) groups. Statistical analysis was performed using the paired Wilcoxon test. Seventy-eight patients underwent unilateral UAE (T: n = 54; Ni: n = 24). Median uterine volume decreased by 18.0% in the T group ( p = 0.0007) and 22.4% in the Ni group ( p = 0.032). Median largest fibroid volume decreased by 45.4% (T, p = 0.0056) and 48.2% (Ni, p = 0.013). Clinical follow-up was available for 50 patients (T: n = 35; Ni: n = 15). QoL scores improved significantly in both groups (T: 20 to 90; Ni: 35 to 100; p < 0.01), with no significant difference between groups. Complication rates were within guideline ranges and did not differ significantly. Unilateral UAE results in significant morphological and clinical improvement in both groups. These findings support unilateral UAE as a clinically effective alternative when bilateral embolization is not feasible.