Systematic review of uterine artery embolisation practice guidelines: are all the guidelines on the same page?
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AIM: To evaluate the degree of concordance amongst the currently available guidelines informing the use of uterine artery embolisation (UAE), and identify any inconsistencies present. MATERIALS AND METHODS: Standards of practice and quality improvement guidelines were retrieved through a search of PubMed and EMBASE. Additional sets of guidelines were retrieved directly from the websites of known obstetrics and gynaecology and radiological associations. RESULTS: Eleven guidelines were retrieved from organisations located in Europe, North America, and Australia. Two main points of divergence were identified in the presented guidance: firstly, on whether submucosal, subserosal, and/or pedunculate fibroids should be considered a relative contraindication to UAE; secondly, on whether UAE should be recommended as an option in patients desiring future fertility. CONCLUSIONS: The guidelines reviewed generally suggest UAE to be a safe and effective option for fibroid treatment that can be offered as an alternative to surgical management; however, the number of differing interpretations arising from an apparently similar pool of evidence raises questions about the objectivity of practice guidelines. Although practice guidelines are understood to be a synthesis of clinical evidence and expert opinion, a systematic approach to presenting evidence is necessary to clearly distinguish empirically versus experientially informed guidance.
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