Uterine fibroid embolization (also known as uterine artery embolization) represents a fundamentally new approach to the treatment of fibroids. Embolization is a minimally invasive means of blocking the arteries that supply blood to the fibroids. It is a procedure that uses angiographic techniques (similar to those used in heart catheterization) to place a catheter into the uterine arteries. Small particles are injected into the arteries, which results in the blockage of the arteries feeding the fibroids. This technique is essentially the same as that used to control bleeding that occurs after birth or pelvic fracture, or bleeding caused by malignant tumors. The procedure was first used in fibroid patients in France as a means of decreasing the blood loss that occurs during myomectomy. It was discovered that after the embolization, while awaiting surgery, many patient’s symptoms went away and surgery was no longer needed. The blockage of the blood supply caused degeneration of the fibroids and this resulted in resolution of their symptoms. This has led to the use of this technique as a stand-alone treatment for symptomatic fibroids.
The Procedure
The procedure is usually done in the hospital with an overnight stay after the procedure. The patient is sedated and very sleepy during the procedure. The uterine arteries are most easily accessed from the femoral artery, which is at the crease at the top of the leg as shown in the figure. Initially, a needle is used to enter the artery to provide access for the catheter. Local anesthesia is used, so the needle puncture is not painful. The catheter is advanced over the branch of the aorta and into the uterine artery on the side opposite the puncture. A second arterial catheter is then placed from the opposite femoral artery to the other uterine artery. Before the embolization is started, an arteriogram (x-ray) is performed to provide a road map of the blood supply to the uterus and fibroids.
After the arteriogram, particles of polyvinyl alcohol (PVA) are injected slowly with X-ray guidance. These particles are about the size as grains of sand. Because fibroids are very vascular, the particles flow to the fibroids first. The particles wedge in the vessels and cannot travel to any other parts of the body. Over several minutes the arteries are slowly blocked. The embolization is continued until there is nearly complete blockage of flow in the vessel. Once one side is completed, the other side is embolized. After the embolization, another arteriogram is performed to confirm the completion of the procedure. Arterial flow will still be present to some extent to the normal portions of the uterus, but flow to the fibroids is blocked. The procedure takes approximately 1 to 1 1/2 hours.
Side Effects
Most patients will experience several hours of moderate to severe pain after the procedure. There may also be nausea, and possibly fever. The pain and nausea is controlled with intravenous medications, usually with a pump that allows self-administration of the medications. After an initial period of bed rest for six to eight hours, those patients with mild to moderate symptoms may be discharged. Most patients are hospitalized overnight. Most symptoms are substantially improved by the next morning allowing discharge from the hospital.
After discharge, most patients will have periodic moderate to severe cramping over several days. Pain medications are prescribed to control these symptoms. These cramping episodes usually diminish over several days. Most patients will feel tired and may have a fever or nausea periodically. All these symptoms usually resolve over several days, but may last longer. Most women can anticipate returning to work 7 to 14 days after the procedure.
Complications
Complications are anticipated in less than 3% of patients. Serious possible complications include injury to the uterus from decreased blood supply or infection. Fortunately, this is quite rare and hysterectomy to treat either of these complications occurs in less than 1% of patients. Injuries to other pelvic organs is possible but has not yet occurred and the chance of other significant complications is less than 1%.
Long-term complications are not expected, although several questions about potential side effects remain. X-rays are used to guide the procedure and this raises a concern about potential long-term effects. In a study measuring the X-ray exposure during uterine embolization, the exposure was found to be below the level that would be expected to cause any health effect to the patient herself or to future children.
Uterine Fibroids Treatment
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