The Role of Interventional Radiology in the Diagnosis and Treatment of Gynecological Conditions

Interventional radiology (IR) has reshaped contemporary management strategies for selected gynecological and obstetric disorders by introducing minimally invasive, organ-sparing therapeutic alternatives to conventional surgical approaches. This review examines the current applications of IR in the treatment of symptomatic uterine fibroids, pelvic congestion syndrome, placenta accreta spectrum, cesarean scar pregnancy, and selected gynecological malignancies requiring palliative or preoperative embolization. In addition, selected vascular conditions in pregnancy, including visceral and cerebral aneurysms, are discussed due to their high-risk clinical profile and growing relevance for endovascular management. These entities were chosen because of their substantial clinical relevance, risk of severe complications, and the expanding body of evidence supporting endovascular management. Techniques such as uterine artery embolization and ovarian vein embolization are associated with high technical success and meaningful symptom reduction, while simultaneously decreasing hospitalization time, perioperative morbidity, and convalescence compared with traditional surgery. In complex obstetric scenarios—including placenta accreta spectrum and splenic artery aneurysm—prophylactic balloon occlusion and endovascular embolization may significantly limit life-threatening hemorrhage and improve maternal prognosis in appropriately selected patients when implemented within a multidisciplinary setting; for splenic artery aneurysm in particular, this evidence currently derives from case reports and small case series rather than comparative trials. Imaging modalities, including ultrasonography, computed tomography, magnetic resonance imaging, and angiography, are integral to diagnosis, patient qualification, procedural planning, and post-intervention monitoring. Although existing data generally confirm the safety and efficacy of interventional techniques, important limitations persist, including heterogeneous study populations, relatively small cohorts, and insufficient long-term reproductive follow-up. Greater standardization of clinical indications and procedural protocols, ongoing technological advancement, and well-designed multicenter trials are required to consolidate the evidence base. In gynecologic oncology, embolization techniques may provide effective hemorrhage control and facilitate surgical treatment in selected patients. In addition, uterine artery embolization has emerged as an important uterus-preserving adjunct in the management of cesarean scar pregnancy, although long-term reproductive (fertility) outcome data remain limited. IR is becoming an increasingly important component of modern gynecological care, supporting individualized, uterus-preserving, and less invasive therapeutic strategies; fertility preservation specifically is an important goal that, for several of the indications discussed, remains incompletely proven by long-term reproductive-outcome data.