The complication rate associated with UAE has been reported to be very low, and most complications have been found to be transient [
2]. The most serious complication associated with UAE is endometritis/uterine infection, with a reported incidence of approximately 2 % [
2‐
4]; however, the associated morbidity rate was found to be very low [
2]. Complications following UAE can be classified into immediate (peri-procedure), early (within 30 days), and late (beyond 30 days) complications [
5]. Most immediate complications are local complications, such as hematoma, arterial thrombosis, dissection, and pseudoaneurysm, and other complications include spasm and non-target embolization [
5]. Non-target embolization is relatively rare, and it does not occur if a good technique is used [
5]. Most early complications are associated with post-embolization syndrome and include pain, nausea, fever, and malaise, and other complications are rare [
5]. Most complications of UAE have been shown to occur more than 30 days after the procedure [
5]. Late complications include vaginal discharge, fibroid expulsion and impaction, infection, amenorrhea, and sexual dysfunction [
5]. The rate of hysterectomy subsequent to UAE ranges from 0.25 to 1.6 % [
2‐
4]. Uterine necrosis is a rare complication after UAE, and it necessitates hysterectomy and treatment with antibiotics to prevent bacteremia, sepsis, and death [
2,
6]. In our case, we believe that the uterine fibroids became necrotic following UAE and the necrotic tissue caused hyperkalemia and acute kidney failure. Some reports have mentioned that patients with a septic uterus required urgent surgery 7 or more days after the initial procedure [
2,
6]. However, in our case, necrotic tissue caused serious complications and necessitated surgical intervention within 48 hours. In addition, our patient needed a blood transfusion in spite of the small intraoperative blood loss; we think a blood transfusion was needed because after UAE the necrotic uterine fibroids lost blood.
Previous reports found that the size of the uterine fibroid was not associated with complications after UAE [
7‐
10]. In one report, complications were found to be associated with a large uterus size (500 mL), large dominant tumor volume (100 cm
3), and high post-intervention creatine kinase level (170 U/L) [
11]. Among previous reports, the largest fibroid was approximately 4000 cm
3 [
7‐
10], while the uterus in the present case was 9964 cm
3; therefore, it was not possible to generalize the previous findings to the present case. In our case, fibroid volume was the most important risk factor for serious complications.