Uterine Fibroid Embolization

Uterine fibroid embolization (UFE) is a new way of treating fibroid tumors of the uterus. Fibroid tumors, also known as myomas, are masses of fibrous and muscle tissue in the uterine wall which are benign, but which may cause heavy menstrual bleeding, pain in the pelvic region, or pressure on the bladder or bowel. With angiographic methods similar to those used in heart catheterization, a catheter is placed in each of the two uterine arteries and small particles are injected to block the arterial branches that supply blood to the fibroids. The fibroid tissue dies, the masses shrink, and in most cases symptoms are relieved.

Uterine fibroid embolization, done under local anesthesia, is much less invasive than open surgery done to remove uterine fibroids. The procedure is performed by an experienced interventional radiologist, a physician specially trained to perform uterine fibroid embolization and similar procedures. Uterine fibroid embolization was first used to limit blood loss during surgical removal of fibroid tumors. It was found that after embolization and while awaiting surgery, many patients no longer had symptoms, and frequently the operation itself proved not to be necessary. Today uterine fibroid embolization is used as a stand-alone treatment for women who have symptom-producing uterine fibroids.

By far the most common reason for embolizing the uterine arteries is to treat symptoms caused by fibroid tumors. This is accomplished by stopping the growth of fibroid tumors and attempting to shrink them. Because the effects of uterine fibroid embolization (UFE) on fertility are not yet known, the ideal candidate is a premenopausal woman with symptoms from fibroid tumors who no longer wishes to become pregnant, but wants to avoid having a hysterectomy (surgical removal of the uterus).

Uterine fibroid embolization may be an excellent alternative for women who, for reasons of health or religion, do not want to receive blood transfusions as may be necessary if open surgery is carried out. The procedure also benefits women who for any reason cannot receive general anesthesia. Embolization of the uterine arteries also may be used to halt severe bleeding following childbirth or caused by malignant gynecological tumors.

What to expect with your procedure

A woman considering uterine fibroid embolization needs a gynecological work-up to make sure that fibroid tumors are the actual cause of her symptoms. Imaging of the uterus by magnetic resonance imaging (MRI) or ultrasonography is performed to fully assess the size, number and location of the fibroids.

Occasionally your gynecologist may want to take a direct look by performing laparoscopy. If bleeding is a major symptom, a biopsy of the endometrium (the inner lining of the uterus) may be done to rule out cancer. Uterine fibroid embolization is carried out in an angiography suite equipped with an x-ray machine, where sterile conditions are maintained. Your heart rate, blood pressure, electrocardiogram, breathing and blood oxygen level will be monitored constantly during the procedure, which typically takes 60 to 90 minutes.

Preparing for your procedure

After injecting a sedative to make you sleepy and a local anesthetic to numb the skin at the groin, the interventional radiologist will make a small nick in the skin less than a quarter-inch long and thread a thin tube (catheter) into the femoral artery. Using x-ray guidance and periodic injections of radiographic contrast material to map the blood vessels, the catheter is threaded into the uterine arteries. Under x-ray observation, the particles are injected until blood flow in the uterine arteries is blocked. In most cases, both uterine arteries can be treated through a single catheter insertion. After completing uterine fibroid embolization, the site of skin puncture is cleaned and bandaged.

Typically, you will be admitted to the hospital for overnight observation follwoing the procedure. You will need to remain in bed for 4 to 6 hours to allow the arterial puncture wound to heal.