Uterine Fibroid Embolization / Uterine Artery Embolization
Uterine Fibroid Embolization [UFE] Reasons to do?
Fibroids are tumors that come from smooth muscle in a woman’s womb (uterus) of reproductive age. There are many causes of fibroids including, genetics mutations, sex hormones, growth hormones, and vitamin deficiency. Women who wait a long time to have children, obese and black have been known to be more prone to getting fibroids.
The signs and symptoms of fibroids are heavy prolonged menstrual bleeding, pelvic pain and pressure, and reproductive difficulty. Other symptoms are loss of bladder control, severe anemia, constipation, and discomfort during sexual intercourse.
The women who come to see me for fibroids usually complain of heavy prolonged menstrual bleeding, pelvic pain, and pressure.
Uterine Fibroid Embolization [UFE] Pre-Procedure Investigations?
After taking a history from the patient and doing a physical exam to detect the fibroids, I order a pelvic ultrasound or an MRI of the pelvis to confirm the presence, location, and the number of the fibroids. I review the ultrasound or MRI to exclude other tumors that may be mimicking a fibroid and look for other causes of pelvic pain.
For women who present with heavy prolonged menstrual bleeding, It may be necessary to do an endometrial biopsy to exclude malignancy.
The other labs we require are complete blood count, basic metabolic profile, and pregnancy test on the date of the procedure.
Uterine Fibroid Embolization [UFE] other uses?
Another important benign tumor of the uterus is called Adenomyosis. It is important because it is a fibroid mimicker or can be present in combination with a fibroid. Adenomyosis arises from the inside lining of the uterus (endometrium) but is in the wrong location in the middle muscle layer. It is important to identify Adenomyosis because it can cause life-threatening bleeding if it is mistaken for a fibroid in a woman undergoing Myomectomy surgery. It may be necessary to do an unplanned removal of a woman’s womb (hysterectomy) in order to save her life. These would be devastating for a woman who desires future pregnancy.
Very very rarely a woman with suspected fibroids and awaiting a procedure or surgery complain of a rapidly growing uterus. Only one such case that I saw turned out to be a leiomyosarcoma at Myomectomy. Leiomyosarcoma is extremely aggressive, rare, and rapidly fatal. It should be considered when a woman presents with a rapidly growing uterus while awaiting or after a Uterine Artery Embolization.
Uterine Fibroid Embolization [UFE] procedure?
UFE procedure is a same-day procedure which means that women recover and go home the same day or the following morning. The procedure does not involve any cutting and there is minimal or no blood loss with it. I do this procedure in the Angiography lab under conscious sedation. I use morphine and Valium type medications to sedate my patients.
My nurse gives IV fluids to the patient during the procedure who is also receiving oxygen through the nose. The wrist or groin is cleaned and draped in a sterile fashion. I use lidocaine for skin anaesthesia and enter the artery using ultrasound for guidance. I perform a series of exchanges using a technique that was developed by Dr. Seldinger. Next, I guide a special catheter over a wire to the uterine artery under live Xray vision and then inject a little dye to see the fibroids.
The next part is the Embolization of the fibroids which means blocking blood flow to the fibroids. I draw up some microspheres that are made of gelatin beads and inject them into the uterine artery until there is a stoppage of blood flow to the fibroids but still blood flows to the uterus. These microspheres beads are about 20 times the size of a red blood cell and they are taken up permanently by the fibroids so that the fibroids continue to shrink for years after. Blood flow is only returned to the uterus but not the fibroids in 24 hours.
In the final step of the procedure, I remove the catheters and wires and I close the artery with a closure device or pressure control device.
The patient is then transferred to the post-procedure area for observation by the nurses. Patients are able to walk after 2 hours and can be discharged home after 6 hours or the next morning.
Uterine Fibroid Embolization [UFE] risks?
The UFE procedure is able to treat all the fibroid in the uterus in one session of treatment. It is successful in over 90 percent who undergo UFE for fibroids. To my knowledge, there have been no reported fatalities during or following the UFE procedure.
Severe pelvic pain is expected due to absent blood flow needed to infarct the fibroids. The pain begins to subside after 24 hours and it is well managed with morphine type medicines and anti-inflammatory medicines.
I get a lot of questions about the effects of Uterine Fibroid Embolization on fertility. Studies have shown many women get pregnant and deliver successfully after UFE. Many of these women will need to have an elective caesarean section for delivery. Some investigations measured follicle-stimulating hormone FSH (a surrogate for fertility) in women between ages 35 and 45. The study did not show a change in levels of FSH related to a UFE procedure.
Uterine Fibroid Embolization [UFE] Outcome?
Most women report correction of the abnormal menstrual cycle and pelvic pain at the first month’s follow up. Some women with fibroids that have a larger portion of it in the inner lining of the uterus may expel the breakdown product. Additional pad changes will be required until resolution usually by the first month. Very rarely a woman may need a dilation of the cervix and assist removal of the breakdown products from the inside of the uterus.
Uterine Fibroid Embolization [UFE] follow up?
I do a 6 month follow up Pelvic MRI or Ultrasound to ensure that the fibroids are not viable and shrink in size. The treatment is quite durable so that patients followed out to 4 years show shrinkage and nonviability.
In conclusion, Uterine Fibroid Embolization or Uterine Artery Embolization is a safe same day and nonsurgical procedure that is as effective as myomectomy and hysterectomy surgery for the treatment of fibroids and should be discussed with all women contemplating treatment for fibroid symptoms.
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