Uterine Artery Embolization as a Gateway to Conservative Fibroid Surgery

Background: The management of symptomatic uterine fibroids in women of reproductive age remains a clinical challenge, with uterine preservation being a primary objective in order to safeguard fertility. To date, no clear consensus has been established in the literature regarding the optimal treatment strategy, as therapeutic choices largely depend on individual patient characteristics. In selected cases, the use of preoperative measures aimed at minimizing the risk of major intraoperative hemorrhage has been associated with an increased likelihood of adopting a more conservative surgical approach. Case presentation: We report the case of a young patient treated at our institution who presented large uterine fibroids and underwent Preoperative Uterine Artery Embolization (PUAE) before planned open myomectomy with positive outcomes. In our case, this approach provided excellent intraoperative hemostatic control, minimizing blood loss. At post-discharge follow-up, the patient showed marked symptom relief and improved quality of life. Long-term follow-up will assess sustained treatment efficacy. Conclusions: PUAE should be considered a valuable therapeutic option in patients with symptomatic uterine fibroids at high risk of surgical bleeding. When integrated into a multidisciplinary treatment plan, PUAE may enhance surgical safety, support fertility preservation, and broaden the range of conservative options available for women with complex fibroid disease.