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Uterine artery embolization (UAE) is a well-accepted treatment for symptomatic uterine fibroids, but endpoints of UAE remain controversial. This is of significant concern as incomplete embolization can lead to treatment failure, necessitating repeat embolization or alternative treatments such as hysterectomy. Multiple potential causes of UAE failure have been described including failure to catheterize one or both of the uterine arteries, uterine artery spasm, clumping of embolic material and collateral blood supply vascularizing the fibroids. In this review, we discuss potential approaches to identifying collateral blood supply to the uterus and suggest that intra-procedural non-contrast cone beam CT provides unique advantages to addressing this issue.