The authors would like to thank the entire team of the 3rd Chair and Department of Gynecology and Department of Interventional Radiology and Neuroradiology, Medical University of Lublin for their help in implementing the Uterine Arteries Embolization Lublin protocol.

The authors have nothing to disclose.
STATEMENT:
Piotr Szkodziak as the author of Figure 1, illustrating the FIGO uterine fibroids classification, allows free use of the figure for scientific and educational applications without any modifications. The intention to modify the figure should be accepted by the author (piotr.szkodziak@gmail.com).

Because of the differences in the structure, size, localization, and symptoms of uterine fibroids, the creation of a uniform UAE protocol has not been an easy task. There have been many discrepancies regarding the assumptions of this therapeutic method with the expectations of patients, both at the stage of qualification and the effects of treatment. More than once, patients referred for UAE did not report any clinical signs of fibroids and were not aware that these uterine tumors would not be removed radically. The only explicit expectation was to get rid of fibroids without surgery.
Therefore, it is important that the patient understands the assumptions of this method, accepts it, and knows the differences regarding alternative methods of uterine fibroid treatment. Her conscious choice (section 1.1. of the Qualification for UAE Protocol) is a critical point, and its proper implementation will allow the protocol to be continued.
During the implementation of the protocol, some procedures are repeated. This is intended and results from the formula adopted by this journal, in which individual commands are written in imperative mode and are directed to one person. However, several doctors are often involved in the qualification, preparation, and other UAE stages. These are also critical points of the protocol; their omission may result in UAE under non-optimal conditions or with the presence of contraindications. Hence the division of the protocol into 5 chapters. This allows it to be continued by various specialists, and the repeated protocol points are then independently checked.
An additional difficulty in creating a uniform protocol of uterine artery embolization in the treatment of uterine fibroids is the current large number of recommendations (as many as 11) that relate to the same procedure41. Although their assumptions are similar, as always, &#34;the devil is in the detail&#34;, which details required unification. Relative contraindications regarding the location of fibroids or reproductive plans of patients undergoing UAE are the most controversial during qualifications. Applying more stringent criteria proposed by SOGC, patients should be excluded from this procedure, while more liberal RCOG recommendations allow qualification for UAE14,32,43. The question is what to do. During the protocol creation, we based the decision (apart from extensive literature) on the analysis of our cases and experience gained, which requires an individual approach to each patient. Therefore, the protocol does not exclude the performance of UAE in patients with relative contraindications (sections 1.4 of the qualification for UAE Protocol). The right qualification and preparation for UAE seem to be the key to therapeutic success. The technique itself is also very important, as well as UAE care, which ensures not only therapeutic success or patient satisfaction but also the lack of complications described above.
Regardless of the number of fibroids, all lesions are embolized during one procedure. Usually, more the fibroids, more will be the embolization material that will be injected. This extends the duration of the embolization but does not change the procedure. UAE can be modified if we see an obvious connection to the ovarian artery, which may result in an increased risk of non-target embolization. We can then close such a connection (e.g., using coils), thus separating the supply of the ovaries and the uterus, and then continue embolization with the use of 700 &#956;m particles. If it is not possible to implant coils, then we increase the particle diameter to 900 &#956;m.
There are also some cases when the fibroids can be supplied from the side of the ovarian arteries; then, the uterine arteries are hypoplastic. In these cases, to successfully perform embolization, a microcatheter should be inserted into the ovarian artery and past the ovary, depositing the embolization material into the uterine vascular bed, while maintaining proper ovarian supply.
The undoubted advantage of embolization is the fact that it is not a technically difficult procedure and does not require sophisticated equipment.
The strong points of the protocol are the points regarding the treatment of post-embolization pain, which at least half of the patients had not heard about when qualifying for UAE. The standard procedure that we propose is the use of a PCA pump (section 4.2 of the Patient care after the UAE Protocol), and the results obtained confirm the high effectiveness of such a treatment.
Regarding future modifications to the UAE protocol, it seems possible to change section 10 of the preparing for the UAE Protocol, which requires removal of the IUD from the uterus before the procedure due to the risk of inflammation and sepsis. In large follow-up studies, the risk of infection in the pelvis combined with the presence of an IUD is less than 1 in 130049.
UAE has been treated as an experimental method since its first use because it required assessing the effectiveness and examining the complications that this procedure may give in short and long-term periods. During these years, indications and contraindications have been modified based on new test results and clinical observation. Current data, including several randomized controlled studies, recognize UAE as a valuable treatment method for symptomatic uterine fibroids, whose effectiveness and safety have been well established.
The creation of the above protocol is due to a thorough analysis of current literature, relevant recommendations and experience gained as a result of the close cooperation of gynecologists and surgical radiologists during the decade.

<table>
	<tbody>
		<tr>
			<td>2% lignocaine in an ampoule</td>
			<td></td>
			<td></td>
			<td>Intended for interventional radiologist (section 3)</td>
		</tr>
		<tr>
			<td>Access to Angio Suite for Minimally Invasive Vascular Surgery</td>
			<td></td>
			<td></td>
			<td>Intended for interventional radiologist (section 3)</td>
		</tr>
		<tr>
			<td>Angiogarfic set</td>
			<td>Balton</td>
			<td>INT5F</td>
			<td>(5 Fr sheath, needle, guidewire) Intended for interventional radiologist (section 3)</td>
		</tr>
		<tr>
			<td>Angiografic kit</td>
			<td>Panep</td>
			<td>44000291</td>
			<td>(Sterile Disposable Angiography DRAPE) Intended for interventional radiologist (section 3)</td>
		</tr>
		<tr>
			<td>Cervical (PAP) smear kit</td>
			<td></td>
			<td></td>
			<td>Intended only for the gynecologist (section 1)</td>
		</tr>
		<tr>
			<td>Diagnostic lab (possibility to use)</td>
			<td></td>
			<td></td>
			<td>Necessary to perform laboratory tests (section 1, 2 and 5)</td>
		</tr>
		<tr>
			<td>Disinfectant</td>
			<td></td>
			<td></td>
			<td>Intended for interventional radiologist (section 3)</td>
		</tr>
		<tr>
			<td>Dressings</td>
			<td></td>
			<td></td>
			<td>Intended for interventional radiologist (section 3)</td>
		</tr>
		<tr>
			<td>Embozene 700 &#956;m</td>
			<td>Varian Medical</td>
			<td>17020-SI</td>
			<td>(Particles) Intended for interventional radiologist (section 3)</td>
		</tr>
		<tr>
			<td>Epidural anesthesia kit</td>
			<td></td>
			<td></td>
			<td>Intended only for the anesthesiologist (section 3 and 4)</td>
		</tr>
		<tr>
			<td>Equipment for gynecological examination</td>
			<td></td>
			<td></td>
			<td>Intended only for the gynecologist (section 1 and 2)</td>
		</tr>
		<tr>
			<td>Intravaginal antibiotic</td>
			<td></td>
			<td></td>
			<td>Intended for the gynecologist or vascular surgeons (section 2)</td>
		</tr>
		<tr>
			<td>Intravenous antibiotic</td>
			<td></td>
			<td></td>
			<td>Intended for the gynecologist or vascular surgeons (section 2)</td>
		</tr>
		<tr>
			<td>Intravenous nonsteroidal anti-inflammatory drug</td>
			<td></td>
			<td></td>
			<td>Intended for the gynecologist or vascular surgeons (section 4)</td>
		</tr>
		<tr>
			<td>Morphine in ampoules</td>
			<td></td>
			<td></td>
			<td>Intended for interventional radiologist and gynecologist or vascular surgeons (section 3, 4)</td>
		</tr>
		<tr>
			<td>MRI lab (possibility to use)</td>
			<td></td>
			<td></td>
			<td>Intended for interventional radiologist (section 1 and 2)</td>
		</tr>
		<tr>
			<td>Oral anxiolytic</td>
			<td></td>
			<td></td>
			<td>Intended for the gynecologist or vascular surgeons (section 2)</td>
		</tr>
		<tr>
			<td>Oral Furazidin</td>
			<td></td>
			<td></td>
			<td>Intended for the gynecologist or vascular surgeons (section 4)</td>
		</tr>
		<tr>
			<td>Oral Paracetamol or nonsteroidal anti-inflammatory drug</td>
			<td></td>
			<td></td>
			<td>Intended for the gynecologist or vascular surgeons (section 4)</td>
		</tr>
		<tr>
			<td>Pain Assessment Card</td>
			<td></td>
			<td></td>
			<td>Intended for the gynecologist or vascular surgeons (section 4)</td>
		</tr>
		<tr>
			<td>Patient Controlled Analgesia Pump</td>
			<td></td>
			<td></td>
			<td>Intended for the gynecologist or vascular surgeons (section 4)</td>
		</tr>
		<tr>
			<td>Progreate Microcathete PROGREA 2.7 Fr x 130 cm STR w/Marker + GW 100 mm x 2.7 Fr</td>
			<td>Terumo</td>
			<td>MC-PE27131</td>
			<td>(Microcatheter) Intended for interventional radiologist (section 3)</td>
		</tr>
		<tr>
			<td>RADIFOCUS GUIDE WIRE M Standard Angled 0.032&#8221;/0.81 mm 180 cm 30 mm flex</td>
			<td>Terumo</td>
			<td>RF-GA32183M</td>
			<td>(Guidewire) Intended for interventional radiologist (section 3)</td>
		</tr>
		<tr>
			<td>RADIFOCUS OPTITORQUE 5 Fr x 80 cm Cobra 2 Middle SH0</td>
			<td>Terumo</td>
			<td>RH-AB55108M</td>
			<td>(Catheter) Intended for interventional radiologist (section 3)</td>
		</tr>
		<tr>
			<td>RADIFOCUS OPTITORQUE 5 Fr x 80 cm UFE Type 1 19 SH0</td>
			<td>Terumo</td>
			<td>RH-AUB5108M</td>
			<td>(Catheter) Intended for interventional radiologist (section 3)</td>
		</tr>
		<tr>
			<td>Rectal nonsteroidal anti-inflammatory drug</td>
			<td></td>
			<td></td>
			<td>Intended for the gynecologist or vascular surgeons (section 2, 4)</td>
		</tr>
		<tr>
			<td>Shaving kit</td>
			<td></td>
			<td></td>
			<td>Intended for the gynecologist or vascular surgeons (section 2)</td>
		</tr>
		<tr>
			<td>Single-use Endometrial Biopsy Kit</td>
			<td></td>
			<td></td>
			<td>Intended only for the gynecologist (section 1)</td>
		</tr>
		<tr>
			<td>Solution of 0,9% NaCl</td>
			<td></td>
			<td></td>
			<td>Intended for the gynecologist or vascular surgeons (section 4)</td>
		</tr>
		<tr>
			<td>Ultrasound machine with 3D-transvaginal probe</td>
			<td></td>
			<td></td>
			<td>Intended only for the gynecologist (section 2 and 5)</td>
		</tr>
		<tr>
			<td>Ultrasound machine with transvaginal probe</td>
			<td></td>
			<td></td>
			<td>Intended only for the gynecologist (section 1 and 2)</td>
		</tr>
	</tbody>
</table>

the lublin protocol of the uterine arteries embolization in the treatment of symptomatic uterine fibroids

Uterine fibroids are benign tumors originating from smooth muscle tissue, constituting uterine muscle stroma. Uterine fibroids are the most common benign tumors found in women. In 20%&#8211;50% of women, fibroids are asymptomatic and do not require any treatment. The main symptoms of uterine fibroids are profuse menstrual bleeding, abnormal uterine bleeding, and pressure symptoms. Pressure symptoms can cause pelvic pain syndrome, urination disorders, and constipation.
The treatment methods that are currently used include surgical treatment, pharmacological therapy, and minimally invasive procedures. The most commonly applied minimally invasive method is the embolization of uterine arteries. This procedure is currently a widely accepted method of treatment for symptomatic uterine fibroids and has been recognized as such by the National Institute for Health and Clinical Excellence in the guidelines for heavy menstrual bleeding.
This is a complicated procedure and requires close cooperation between gynecologists and interventional radiologists. We present a protocol applicable to uterine artery embolization in the treatment of symptomatic uterine fibroids. The protocol is divided into five section. The first two section are intended for gynecologists and interventional radiologists, explaining how to qualify and prepare a patient for embolization in a step-by-step manner. Section three, which is directed at interventional radiologists, explains how embolization should be done. Section four is directed at gynecologists or hospital ward doctors who look after the patients after embolization. This section of the protocol offers a method for treating post-embolization pain using the Patient Controlled Analgesia (PCA) pump. Section five completes the procedure with an assessment of the effects and late complications of uterine artery embolization.
All five section create a uniform protocol directed at clinicians, experts, and researchers new to the field.

557 UAE procedures were performed in the period from 2009 to 2019. A mean of the patients&#8217; age was 38 years (31&#8211;53 years of age). Technical success was achieved in 547 patients (98.2%).
The mean reduction of the fibroid volume (MRI volume assessment) 3 months after UAE procedure performed in the period from 2009 to 2013 in the group of 206 patients aged 32 to 52 years (mean age: 39 years) was 62%. The smallest reduction was 9% (patient with hyalinized fibroid). Complete reduction (100%) was achieved in patients with the separated submucosal fibroid (FIGO 0). 90% of patients reported satisfaction after the UAE procedure64.
The mean reduction of the fibroid volume 3 months after UAE (ultrasound VOCAL volume assessment) in a group of 65 patients aged 29&#8211;52 years (mean age: 43.1 years) was 50.1% (2.7%&#8211;93.5%). Before the UAE procedure, median fibroid volume was 101 cm3 (range from 23.6 to 610.0 cm3), whereas, after 3 months, the reduction of median fibroid volume to 50.4 cm3 (range from 6.9 to 193.9 cm3) was observed. The Spearman correlation test showed a statistically significant, but relatively weak, positive correlation (R = 0.33; p = 0.006) between the initial dominant fibroid volume and percentage volume reduction. Interestingly, smaller fibroids showed a great variability of fibroid volume reduction at 3 months after UAE, while larger fibroids showed a stable, predictable reaction to UAE72.
Reduction of doppler vascular indices (VI, FI, and VFI) in the group of 17 patients 3 months after UAE was observed. The percentage reduction in VI and VFI was 95.4%, whereas in FI the reduction was 58.3%75.
Assessment of ovarian reserve was performed in 30 patients aged 33&#8211;40 years (mean age: 35 years) 3 months after UAE. The mean dominant fibroid volume was 107.75 cm3 (range from 87.4 to 131.1 cm3). The following markers of the ovarian reserve were investigated: antral follicle count (AFC), AMH, inhibin B (INHB), FSH, and estradiol (E2). A significant decrease in AFC (56.7%; p &#60; 0.001), AHM (36.7%; p &#60; 0.001), INHB (46.7%; p &#60; 0.001), and E2 (43.3%; p &#60; 0.001) was observed. Simultaneously, a significant increase in FSH serum level (43.4%; p &#60; 0.001) was observed65.
Three months after UAE procedure, in two patients with submucosal fibroids (FIGO 0) (with diameters of 6 cm and 8 cm) uterine inversion was observed during excretion of demarked, necrotic fragments of fibroids through the cervical canal, which resulted in an emergency hysterectomy.
Post-embolization pain reduction (according to PAC) with the use of PCA (procedure 4.2 of the Patient care after the UAE Protocol) was assessed in 60 patients on the NRS scale on the day after the UAE procedure. The median NRS immediately after UAE was 10 (range 5&#8211;10), while after treatment the median NRS was rated 4 (range 1&#8211;5). The Spearman&#39;s correlation test between the initial volume of fibroids (median 194.5 cm3, range 79&#8211;411 cm3) and NRS immediately after UAE showed a statistically significant, strong positive correlation (R = 0.6; p &#60; 0.001), whereas the correlation between the initial volume of fibroids and NRS after treatment showed a statistically significant, weak positive correlation (R = 0.34; p &#60; 0.001). Analyzing the above relationships, it can be concluded that major fibroids after UAE cause stronger post-embolization pain after UAE. However, the treatment of post-embolization pain after UAE of smaller fibroids with the use of PCA gives better results.
Summarized data for Representative Results are provided in Table 1.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/61530/61530fig01.jpg" /> 
Figure 1: FIGO uterine fibroids classification. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/61530/61530fig02.jpg" /> 
Figure 2: Pelvic examination using a transvaginal ultrasound scan. 
Visible a uterine fibroid (FIGO 5) with dimensions of 73 x 50 x 55 mm. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/61530/61530fig03.jpg" /> 
Figure 3: Pelvic MRI examination in pre-qualification for UAE. 
Visible in the sagittal section a big uterine fibroid (FIGO 2&#8211;5) with mass effect. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/61530/61530fig04.jpg" /> 
Figure 4: Pelvic MRI examination in pre-qualification for UAE. 
Visible in the sagittal section a uterine fibroid (FIGO 2&#8211;5). <a href="https://www.jove.com/files/ftp_upload/61530/61530fig04large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/61530/61530fig05.jpg" /> 
Figure 5: Assessment of uterine fibroid&#8217;s volume using VOCAL software. 
In this case, the volume is estimated at 119.7 cm3. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig05large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/61530/61530fig06.jpg" /> 
Figure 6: Assessment of uterine fibroid&#39;s vascularization using VOCAL software. 
In this case, the vascularization indexes were calculated (VI 4.85, FI 25.38, and VFI 1.23). <a href="https://www.jove.com/files/ftp_upload/61530/61530fig06large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 7" class="xfigimg" src="/files/ftp_upload/61530/61530fig07.jpg" /> 
Figure 7: The picture shows a fragment of the angiographic laboratory. 
In the lower-left corner, the patient with an exposed groin through which more tools are introduced. In the upper-left corner, the C-arm of the angiograph can be seen. In the upper-right corner, the monitors are visible, where the operator tracks the input tool. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig07large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 8" class="xfigimg" src="/files/ftp_upload/61530/61530fig08.jpg" /> 
Figure 8: A set for arterial punctures. 
From the bottom: a needle, a vascular lock with an introducer, and a guide. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig08large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 9" class="xfigimg" src="/files/ftp_upload/61530/61530fig09.jpg" /> 
Figure 9: Close-up of the groin with visible vascular lock inserted into the femoral artery. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig09large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 10" class="xfigimg" src="/files/ftp_upload/61530/61530fig10.jpg" /> 
Figure 10: On the left, angiography from a catheter placed in the abdominal aorta. 
The visible vascular bearing of uterine myomas. For comparison (on the right), a control test performed after UAE. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig10large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 11" class="xfigimg" src="/files/ftp_upload/61530/61530fig11.jpg" /> 
Figure 11: Selective angiography using RUC catheter placed in the proximal parts of the uterine arteries. 
Visible vascular bed of uterine fibroids. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig11large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 12" class="xfigimg" src="/files/ftp_upload/61530/61530fig12.jpg" /> 
Figure 12: The single X-ray imaging showing the stasis of the contrast agent in the right uterine artery. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig12large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 13" class="xfigimg" src="/files/ftp_upload/61530/61530fig13.jpg" /> 
Figure 13: Control angiography performed from the main catheter located, respectively, in the left and right iliac artery, confirms the lack of inflow of fresh blood (shading) into the uterine arteries. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig13large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 14" class="xfigimg" src="/files/ftp_upload/61530/61530fig14.jpg" /> 
Figure 14: The vascular access site after the completion of UAE. 
Visible 2 mm incision near the right groin. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig14large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 15" class="xfigimg" src="/files/ftp_upload/61530/61530fig15.jpg" /> 
Figure 15: PCA pump parameter settings for post-embolization pain after UAE treatment (section 4.2.3 of the Patient care after the UAE PROTOCOL). <a href="https://www.jove.com/files/ftp_upload/61530/61530fig15large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 16" class="xfigimg" src="/files/ftp_upload/61530/61530fig16.jpg" /> 
Figure 16: PCA pump in operation. 
The ratio of on-demand intravenous bolus to &#34;empty bolus&#34; (section 4.2.6.2. of the Patient care after the UAE PROTOCOL) 1:1 (50%:50%). <a href="https://www.jove.com/files/ftp_upload/61530/61530fig16large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 17" class="xfigimg" src="/files/ftp_upload/61530/61530fig17.jpg" /> 
Figure 17: PCA pump in operation. 
The ratio of on-demand intravenous bolus to &#34;empty bolus&#34; (section 4.2.6.3. of the Patient care after the UAE PROTOCOL) 1:2 (33%:67%). This requires additional analgesic treatment (procedure 4.2.6.4. of the Patient care after the UAE PROTOCOL). <a href="https://www.jove.com/files/ftp_upload/61530/61530fig17large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 18" class="xfigimg" src="/files/ftp_upload/61530/61530fig18.jpg" /> 
Figure 18: PCA pump in operation. 
The ratio of on-demand intravenous bolus to &#34;empty bolus&#34; (section 4.2.6.3. of the Patient care after the UAE PROTOCOL) 1:3 (25%:75%). This requires continuing additional analgesic treatment (procedure 4.2.6.4. of the Patient care after the UAE PROTOCOL). <a href="https://www.jove.com/files/ftp_upload/61530/61530fig18large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 19" class="xfigimg" src="/files/ftp_upload/61530/61530fig19.jpg" /> 
Figure 19: Pelvic MRI examination 3 months after the UAE procedure (the same case as in Figure 3). 
Visible in the sagittal section is a uterine fibroid (FIGO 5), significantly smaller than before the procedure, different density of the fibroid tissue. <a href="https://www.jove.com/files/ftp_upload/61530/61530fig19large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 20" class="xfigimg" src="/files/ftp_upload/61530/61530fig20.jpg" /> 
Figure 20: Pelvic MRI examination 1 year after UAE procedure (the same case as in Figure 4). 
Visible in the sagittal section is a uterine fibroid (FIGO 2&#8211;5), with a very large volume reduction after UAE. MRI was performed due to suspected tissue demarcation after the procedure (no possibility to assess the fibroid structure in a bimanual examination). <a href="https://www.jove.com/files/ftp_upload/61530/61530fig20large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td colspan="3">REPRESENTIVE RESULTS / THE LUBLIN PROTOCOL64,65,72</td>
		</tr>
		<tr>
			<td colspan="2">The number of UAE procedures performed in the period from 2009 to 2019</td>
			<td>557</td>
		</tr>
		<tr>
			<td colspan="2">Technical success</td>
			<td>Achieved in in 547 patients (98.2%)</td>
		</tr>
		<tr>
			<td colspan="2">The mean reduction of the fibroid volume (MRI volume assessment) 3 months after UAE in the group of 206 patients aged 32 to 52 years (mean age - 39 years)</td>
			<td>62.0% (9.0-100.0%)</td>
		</tr>
		<tr>
			<td colspan="2">The mean reduction of the fibroid volume (ultrasound VOCAL volume assessment) 3 months after UAE in the group of 65 patients aged 29-52 years (mean age &#8211; 43.1 years)</td>
			<td>50.1% (2.7-93.5%)</td>
		</tr>
		<tr>
			<td rowspan="5">Assessment of ovarian reserve</td>
			<td>Decrease in AFC</td>
			<td>56.7% (p&#60;0.001)</td>
		</tr>
		<tr>
			<td>Decrease in AMH</td>
			<td>36.7% (p&#60;0.001)</td>
		</tr>
		<tr>
			<td>Decrease in INHB</td>
			<td>46.7% (p&#60;0.001)</td>
		</tr>
		<tr>
			<td>Decrease in E2</td>
			<td>43.3% (p&#60;0.001)</td>
		</tr>
		<tr>
			<td>Increase in FSH</td>
			<td>43.4% (p&#60;0.001)</td>
		</tr>
		<tr>
			<td rowspan="2">Post-embolization pain reduction (according to PAC) with the use of PCA (procedure 2. of the &#8220;Patient care after the UAE&#8221; PROTOCOL) assessed in the group of 60 patients</td>
			<td>The median NRS immediately after UAE</td>
			<td>10 (range 5-10)</td>
		</tr>
		<tr>
			<td>The median NRS on the day after UAE </td>
			<td>4 (range 1-5)</td>
		</tr>
	</tbody>
</table>
Table 1: Representative Results of UAE technique in the treatment of symptomatic uterine fibroids performed in accordance with Lublin Protocol.

Read this Scientific Article Protocol about The Lublin Protocol of the Uterine Arteries Embolization in the Treatment of Symptomatic Uterine Fibroids at JoVE.com

The Lublin Protocol of the Uterine Arteries Embolization in the Treatment of Symptomatic Uterine Fibroids

Here, we present a uterine artery embolization method for the treatment of symptomatic uterine fibroids divided into five sections: qualification, preparation, performance, post-procedure care, and follow-up visits. This protocol requires close cooperation between gynecologists and interventional radiologists, enabling the proper execution of the above procedure.

Uterine fibroids are benign tumors originating from smooth muscle tissue, constituting uterine muscle stroma. Uterine fibroids are the most common benign ...

The Lublin Protocol of the Uterine Arteries Embolization in the Treatment of Symptomatic Uterine Fibroids

Abstract