Uterine Artery Embolization
Treatment For Uterine Fibroids

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diagram of uae procedure

Uterine Fibroid Embolization

Contents

What Is Uterine Artery Embolization?
What Is The Procedure?
How Effective Is It?
Does It Affect Fertility?
Can It Cause Menopause?
Complications And Risks



Other Articles:

Uterine Fibroids Guide
Fibroids Diet Plan
Hospital Departments Explained
The Female Body
What Is Uterine Artery Embolization?

It is a new, minimally invasive treatment for uterine fibroids. In uterine artery embolization (UAE), the fibroids are starved of blood when the doctor injects small particles into the arteries that supply them blood. The goal is to shrink the fibroids so that they eventually die. Based on some trials, UAE appears to cause fewer complications than hysterectomy (surgical removal of the womb and fibroids) and myomectomy (the surgical removal of fibroids). Initially UAE was used in combination with myomectomy to help decrease blood loss during surgery - but then, to the surprise of the doctors - they found that patients spontaneously healed with UAE alone.

UAE Facts And Statistics

• Between 20 and 40 percent of women aged over 35 in the United States have fibroids, and the incidence rate is even higher in African-American women (up to 50 percent).
• Of the 600,000 hysterectomies performed every year, one third are due to fibroids. For this reason, treating fibroids is a major public health issue.
• An estimated 30,000 UAE procedures are performed every year in the U.S.
• While using UAE as a treatment for fibroids is a relatively recent development (since 1995), it is not a new procedure. UAE has been used by radiologists since the 1980s to treat heavy bleeding after childbirth and since 1966 to treat tumors.
• UAE as a treatment is covered by most major insurance companies.

What Is The Procedure?

UAE is performed under conscious sedation (you are awake but unable to feel pain). It takes about 45 to 60 minutes to perform and you will need to stay in hospital overnight for observation. It is performed by a doctor called an interventional radiologist (IR).

Preparation

In the radiology procedure room a thin tube will be inserted into the vein in your arm to give you anesthetics, fluids, antibiotics and painkillers. A urinary catheter (long thin tube) is placed into your bladder through the urethra to keep your bladder empty.

Procedure

In the procedure room a painkiller is applied to the skin around your groin. The radiologist will make a small incision in the skin and insert a catheter into your femoral artery and guide it up to one of your two uterine arteries. These are the arteries that supply blood to the uterus (womb). Small plastic or gelatin particles (the size of a grain of sand) are injected through the catheter into the artery, and these will block the blood supply in the tiny arteries that feed the fibroids. Without blood, the fibroids shrink and eventually die. The procedure is repeated in the other artery (generally both arteries can be accessed through the same incision).

Recovery

In the recovery room you will need to lie flat for several hours to prevent blood clots forming in the femoral artery site. So what else can you expect?

Pain: You are likely to be in some pain, doctors believe the pain is in response to stopping blood flow to the fibroids or due to temporary reduction in blood flow to the womb. It usually peaks within 24 hours and you will given morphine or nonsteroidal anti-inflammatory drugs (NSAIDs) to help ease it. Some hospitals allow patients to manage their own dose of pain medication through a patient controlled analgesia (PCA) - this system delivers medication to your blood stream every time you press a button.

Post-Embolization Syndrome: Many patients suffer from what is called post-embolization syndrome - a combination of extreme tiredness, nausea, vomiting, pain and low grade fever. Doctors believe it may be due to the release of chemicals from dying (degenerating) fibroids. It usually resolves spontaneously but patients are monitored to ensure it is there are no signs of infection (endomyometritis).

Most women return home the next day after their procedure. You will be prescribed painkillers. The pain and cramping should subside within 2 days, although some women report pain for several weeks. You are usually able to resume all normal activity within 7 to 10 days.

Follow Up Care

You will have a series of ultrasound scans or magnetic resonance imaging (MRI) examinations after the procedure to monitor the shrinkage of fibroids. The first test is performed about 3 months after treatment and continue for 2 years.

How Effective Is It?

1. Studies show that on average 85 to 90 percent of patients who undergo UAE have significant or total relief from uterine fibroid symptoms - primarily relief from heavy bleeding and pelvic pain. However, not many of these studies are large-scale or have long-term follow ups.
2. Recurrence of treated fibroids is very rare, this is comparable with myomectomy (the surgical removal of fibroids). See also, do fibroid grow back?
3. UAE appears to be an effective treatment for multiple and large fibroids. As such it is a viable alternative to myomectomy.

Does It Affect Fertility?

Limited studies report similar rates of fertility in women who are treated with UAE as with myomectomy. Although the risk of entering premature menopause is low, there is a chance your ovaries may be damaged. It may also increase the risk of pregnancy complications should you become pregnant such as placenta previa or placental insufficiency. Despite these risks, many women go on to have successful pregnancies following UAE.

Can It Cause Menopause?

Yes, there is a possibility. Less than 2 percent of UAE patients enter menopause as a result of treatment. This is more likely to happen if the woman is in her mid 40s or older and is already nearing menopause.

Complications And Risks

UAE is considered a 'safe and effective' treatment by the American College of Obstetricians and Gynecologists. Before recommending treatment an ultrasound or MRI diagnostic test will be performed to help the interventional radiologist determine if the patient is a suitable candidate. But, like all procedures, there are some potential (but rare) complications, including:
Infection: A degenerating fibroid can be a site for bacterial growth and lead to infection. Most cases can be treated with antibiotics, in rare cases it requires hysterectomy. Infection is more likely with submucosal fibroids (fibroids located on the inside of the womb). Delayed infections as well as watery vaginal discharge are sometimes reported up to 12 months after treatment.
Nearby organ damage: Nearby organs may be unintentionally damaged - the ovaries are most at risk. This could result in your periods stopping, but such cases are unusual in women under 40. While the ovaries are at risk of damage from radiation exposure, the level of radiation is about the same as having two barium enemas (used in examining the colon).
Scar tissue: Bands of scar tissue or adhesions can form, but this risk is similar to myomectomy.
Pregnancy: There is a slight higher risk of pregnancy and delivery complications after treatment.

When UAE Is Not Suitable

The following are reasons to avoid this procedure. If you have:

• A history of kidney failure.
• A history of pelvic radiation or possible pelvic cancer.
• Active or recent pelvic infection.
• Poorly controlled diabetes.
• A bleeding disorder.
• Allergy to contrast materials containing iodine.

Sources
- Outcome of uterine embolization and hysterectomy for leiomyomas: Results of a multicenter study. Published in American Journal of Obstetrics & Gynecology (2004).
- Based on sales and market data from Boston Scientific and Biosphere Medical, device companies with embolic agents approved by FDA for UFE (updated 2009).
- Uterine artery embolization versus myomectomy: a prospective trial. Published in the Journal of Vascular and Interventional Radiology (2004).
- Uterine artery embolization for symptomatic fibroids: clinical result in 400 women with imaging follow-up. American Journal of Obstetrics & Gynecology; 2002.
- Pregnancy after fibroid uterine artery embolization: the Ontario uterine fibroid embolization (UFE) trial. Published in the Journal of Vascular and Interventional Radiology; 2003.
- The Ontario uterine fibroid embolization trial, part 2. Baseline patient characteristics, fibroid burden and impact on life. Published in Fertility and Sterility; 2003.
- The Ontario uterine fibroid embolization trial, part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Fertility and Sterility; 2003.
- UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstetrics & Gynecology; 2002;
Uterine artery embolization for leiomyomata. Obstetrics & Gynecology, 2001
Embolization of uterine fibroids, patient selection and results of treatment. Journal of Women’s Imaging, 2001.

 

Related Articles on Fibroids

For more on these benign tumors, see the following:

Fibroids and weight gain: Can they cause weight gain?
Fibroids during pregnancy: Signs and treatment options.
Reproductive system disorders: Symptom checker.

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