Known medically as uterine artery embolization (or uterine fibroid
embolization), this is a fundamentally new approach to the treatment of fibroids
that blocks the arteries that supply blood to the fibroids. It is a minimally
invasive procedure, which means it requires only a tiny nick in the skin, and is
performed while the patient is conscious but sedated — drowsy and feeling no
pain. Fibroid embolization is usually done in a hospital by an
interventional radiologist, a physician who is specially trained to perform this
and other minimally invasive procedures.
radiologist makes a small nick in the skin (less than one-quarter of an inch) at
the crease at the top of the leg to access the femoral artery, and inserts a
tiny tube (catheter) into the artery. Local anesthesia is used so the needle
puncture is not painful. The
interventional radiologist steers the catheter through the artery to the uterus
using X-ray imaging (fluoroscopy) to guide the catheter's progress. The catheter
is moved into the uterine artery at a point where it divides into the multiple
vessels supplying blood to the fibroids. An arteriogram (a series of images
taken while radiographic dye is injected) is performed to provide a road map of
the blood supply to the uterus and fibroids.
radiologist slowly injects tiny plastic (polyvinyl alcohol or PVA) or gelatin
sponge particles the size of grains of sand into the vessels. The particles flow
to the fibroids first, wedge in the vessels and cannot travel to other parts of
the body. Over several minutes, the arteries are slowly blocked. The
embolization is continued until there is nearly complete blockage of the blood
flow in the vessel. The procedure is then repeated on the other side so the
blood supply is blocked in both the right and left uterine arteries. Some
physicians block both uterine arteries from a single puncture site, while others
puncture the femoral artery at the top of both legs. After the embolization,
another arteriogram is performed to confirm the results. The skin puncture where
the catheter was inserted is cleaned and covered with a bandage. As a result of
the restricted blood flow, the tumor (or tumors) begin to shrink.
Fibroid embolization usually requires a hospital stay of one night, although
some women do go home the same day. About six to eight hours of bed rest is
typical after the procedure. Pain-killing medications and drugs that control
swelling typically are prescribed following the procedure to combat cramping,
which is a common side effect. Fever also is an occasional side effect, and is
usually treated with acetaminophen. Total recovery generally takes one to two
weeks, but can take longer.
While embolization to treat uterine fibroids has been performed for more than
six years, embolization of arteries in the uterus is not new. The procedure has
been used successfully by interventional radiologists in uterine arteries for
more than 20 years to treat heavy bleeding after childbirth. Today, fibroid
embolization is being performed at hospitals and medical centers across the
country, in Canada and around the world. As of the end of 1998, about 1,500 to
2,000 fibroid embolization procedures had been done world-wide.
The results of studies that have been published or presented at scientific
meetings report that 78 percent to 94 percent of women who have the procedure
experience significant or total relief of pain and other symptoms, with the
large majority of patients considerably improved. The procedure has been
successful even when multiple fibroids are involved. Most patients have rated
the procedure as "very tolerable." The expected average reduction in the volume
(size) of the fibroids is 50 percent after three months, with a reduction in the
overall size of the uterus of about 40 percent.
The long-term outcome is not known as only short-term follow-up is available. It
is not yet known if the fibroids can re-grow, however no recurrences have
occurred in women who have been followed for up to six years.
The majority of patients who have fibroid embolization are finished with
childbearing and few women have tried to subsequently become pregnant, making
fertility difficult to study. More than a dozen pregnancies have been reported,
however, and patients who have had uterine arteries embolized for other reasons,
such as bleeding after childbirth, have successfully become pregnant. Research
is underway to study this issue.
There have been a few women whose menstrual periods have stopped after the
procedure, which would result in infertility. See side effects/complications for
a further discussion of this topic.
Fibroid embolization is considered to be very safe, however, there are some
associated risks, as there are with almost any medical procedure. Most patients
experience moderate to severe pain and cramping in the first several hours
following the procedure; some experience nausea and, possibly, fever. These
symptoms can be controlled with appropriate medications. Most symptoms are
substantially improved by the next morning, however, there may be some pain and
cramping for several days or more. Many women report returning to work within a
week of having the procedure.
Complications occur in fewer than 3 percent of patients. Serious possible
complications include injury to the uterus from decreased blood supply or
infection. This is uncommon and hysterectomy to treat either of these
complications occurs in less than 1 percent of patients. Injury to other pelvic
organs is possible but has not yet been reported and the chance of other
significant complications is less than 1 percent.
Long-term complications are not expected, although questions about potential
side effects remain. It is not known what effect, if any, fibroid embolization
has on the menstrual cycle. The overwhelming majority of women who have had
embolization have had decreased bleeding with normal menstrual cycles. There
have been a few women, most of whom are near the age of menopause, whose
menstrual periods have stopped after the procedure. It is uncertain whether
these cases are a result of decreased ovarian function resulting from the
procedure. Based on this limited information, it appears that the procedure may
cause a loss of menstrual cycles (premature menopause) in a very small number of
A number of insurance companies are paying for fibroid embolization procedures.
You will want to talk with your interventional radiologist about this before
|How "new" is this procedure?
|While embolization to treat uterine
fibroids has been performed for more than six years, embolization of
arteries in the uterus is not new. The procedure has been used
successfully by interventional radiologists in uterine arteries for
more than 20 years to treat heavy bleeding after childbirth.