Uterine Fibroid Embolization (also know as UAE or Uterine Artery Embolization) is a relatively new non-surgical and less invasive way to treat symptomatic fibroid tumors. "Embolization" is simply a medical therm that means cutting off the blood supply. Embolization has been used for many years for many reasons other than fibroid tumors. Embolization has been used to treat liver tumors, kidney tumors, and internal bleeding secondary to a variety of causes. The application of embolization, however, specifically to treat fibroids is relatively new. This procedure was introduced in France in the early 1990's and has become an extremely popular non-surgical alternative for the treatment of symptomatic uterine fibroid tumors. To date, thousands and thousands of these procedures have been performed worldwide and this procedure has been shown to be a safe and effective treatment option for many women plagued by fibroid tumors.
Fibroid embolization is performed by a specially trained doctor called an
interventional radiologist. The uterine fibroid embolization (UFE) procedure is performed in a special state-of-the-art angiography suite like the one at right. This room is similar to an operating room but contains a large camera unit and multiple monitors that are used by Dr. Fischer to guide the procedure. During the procedure, the interventional radiologist makes a tiny nick in the skin usually at the top of the right leg near the right hip. A tiny spaghetti-like tube (called a catheter) is inserted into the artery at the top of the leg (known as the common femoral artery) and is carefully guided using a moving x-ray (fluoroscopy) picture into each of the arteries feeding the
uterus (See Fig. 1 below). Once a satisfactory position of the tube has been obtained in each of the uterine arteries, tiny sand-like gelatinous particles called embospheres are injected through the tube and into the tiny arteries feeding the uterine fibroid tumors. The particles are carried by the blood flow into the smaller and smaller branches of the uterine artery feeding the fibroids until eventually they are larger than the artery through which they are trying to pass. The particles then become "stuck" within the artery and stack on top of one another until blood supply to the fibroids has been significantly reduced or eliminated (See Fig. 2 below). The fibroids are deprived of the blood supply and nutrients that they need to survive and therefore shrink and die. Usually both the left and right uterine arteries can be treated through a single puncture site in the skin that is so small that it does not require a stitch. The procedure is painless and requires only local anesthetic (like a shot at the dentist office) at the puncture site in the top of the right leg and occasionally mild intravenous sedation to relieve anxiety. The procedure does not require general anesthesia or the patient to be put completely to sleep.
Figure 1
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Figure 2
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Click Here for still images of an actual UFE/UAE procedure.
After fibroid embolization, most patients are kept in the hospital overnight for observation. During this time, the patient receives any pain killing medications and/or other drugs that may be necessary to control the cramping and pelvic pain, which often develop shortly after the procedure and are a normal and expected part of the "post-embolization syndrome." In addition to pelvic pain and cramping, other post-embolization syndrome symptoms include nausea and/or vomiting, general feelings of malaise (a lack of energy), and low-grade fevers. While these symptoms are most severe the first 24-hours following the procedure and are usually well controlled with medication, the post embolization symptoms usually last in a less severe form for five to seven days after the procedure. The majority of women undergoing fibroid embolization are discharged the morning after the procedure on a medication regimen to control any symptoms and/or discomfort that they may have at home. Most women to their normal daily activities including work and/or school within one week.
Studies show that approximately 80 to 95% of women who have this procedure experience significant or total relief from their symptoms caused by the fibroid tumors. Furthermore, this procedure is able to treat most types of fibroids at once and recurrence of treated fibroids after embolization is extremely rare.
This is an example of a fibroid uterus before and after embolization.
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Fibroid embolization is also considered to be extremely safe though as with any procedure, there are associated risks. The most common complications or side effects are considered minor and are usually related to bruising or swelling at the arterial puncture site at the top of the leg. A very small number (1 to 4%) of patients have experienced premature ovarian failure and premature menopause after fibroid embolization. This is more likely to occur in perimenopausal women in their late 40's or older who are nearing menopause. A very small number of patients have experienced infection as a result of fibroid embolization. Most of the time, infection can be controlled with oral or IV antibiotics, although severe infections requiring hysterectomy have been reported (less than 1% chance). Myomectomy and hysterectomy also carry significant risks including infection, bleeding, or the development of abdominal/pelvic adhesions, which cause organs in the abdomen and pelvis to fuse together. Adhesions and scarring may also lead to infertility. Overall, major complication rates for uterine fibroid embolization are lower than those of hysterectomy and myomectomy. You should talk to your doctor about the possible risks of any procedure that you may choose.
While the Food and Drug Administration does not regulate the practice of medicine, it does approve devices and medications used during procedures. All of the devices, equipment, and medications used for UFE are approved by the Food and Drug Administration for use in people.
What are fibroids?