Interventional Radiology :: Procedures :: Vascular :: Uterine Fibroid Embolization (UFE)
Procedures & Treatments
 
Procedures Vascular Uterine Fibroid Embolization (UFE)
 
About the Procedure

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Fibroids are noncancerous (benign) growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding.

Fibroids range greatly in size from very tiny (a quarter of an inch) too larger than a papaya (10 inches or more). In some cases, they can cause the uterus to grow to the size of a five-month pregnancy and the woman looks as though she is pregnant. In most cases, there is more than one fibroid in the uterus.
Procedure Details

 

Fibroids are noncancerous (benign) growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding. Fibroids range greatly in size from very tiny (a quarter of an inch) too larger than a papaya (10 inches or more). In some cases, they can cause the uterus to grow to the size of a five-month pregnancy and the woman looks as though she is pregnant. In most cases, there is more than one fibroid in the uterus.
 
Symptoms
 
Depending on location, size and number of fibroids, a woman might experience the following:
  • Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots, which can    lead to anemia (a low blood count). This is the most common symptom associated with fibroids.
  • An increase in pain during her monthly periods.
  • Lower abdominal pain or, more accurately, pressure or discomfort in the pelvis that is caused by the bulk or weight of the fibroids pressing on nearby structures
  • Pain in the back, flank or legs as the fibroids press on nerves that supply the lower abdomen and legs
  • Pain during sexual intercourse
  • Pressure on the urinary system, which typically results in increased frequency of urination, including the need to get up at night. (Occasionally, an enlarged uterus may press on the ureter connecting the bladder to the kidney, resulting in partial blockage of urine flow from the kidneys.)
  • Pressure on the intestine , leading to constipation and bloating
  • Abnormally enlarged (distended) abdomen, which can be misinterpreted as a progressive weight gain
Treatment Options

If symptoms develop, there are a number of treatment options:
Drug therapy : birth-control pills and hormone therapy;
 
Surgical treatments: including myomectomy (surgical removal of the fibroids) and hysterectomy (surgical removal of the uterus); and
 
Uterine Fibroid Embolization : a new non-surgical treatment that causes the fibroid to shrink.

Uterine Fibroid Embolization

Known medically as uterine artery embolization, this is a fundamentally new approach to the treatment of fibroids.

The interventional radiologist makes a small needle puncture in the skin  at the crease at the  top of the leg to access the femoral artery, and inserts a tiny tube (catheter) into the artery. The interventional radiologist steers the catheter through the artery to the uterus using X-ray imaging (fluoroscopy) . The catheter is moved into the uterine artery at a point where it supplies 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.

The interventional radiologist slowly injects tiny plastic (polyvinyl alcohol or PVA) particles the size of grains of sand into the vessels. The particles flow to the fibroids. 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. As a result of the restricted blood flow, the tumor (or tumors) begin to shrink. (Click on animation)
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 are prescribed following the procedure to combat cramping, which is a common side effect.. Total recovery generally takes one week.

While embolization to treat uterine fibroids has been performed for more than ten 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 world,. As of the end of 2007, about 40,000 fibroid embolization procedures had been done in U.S.A. alone. In the several cases performed at our center and in others in the country the statistics have been almost identical .

Expected Results

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.

Fertility

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.

Patient Preparation


For the patient the procedure is very similar to angiography .A small amount of blood will be drawn before starting the procedure to make sure that your kidneys are working. A small dose of sedative may be given through the IV line to lessen your anxiety during the procedure.The area of the groin or arm where the catheter will be inserted is shaved.

The are most commonly the upper thigh is cleaned, and numbed with local anesthetic. The radiologist will make a small needle puncture  in the skin where the catheter can be inserted into an artery. The catheter is then guided through the arteries to the area to be examined. After the contrast material is injected through the catheter and reaches the blood vessels being studied, several sets of x-rays are taken.During injection of the contrast agent you may be asked to hold your breath for a few seconds. Most people get a warm feeling in the region of examination during injection of contrast

Post procedure

Following the procedure the tubes are taken out from the puncture site and compression given   for a few minutes to stop the bleeding . The patient is advised to keep the leg that was punctured straight for 6 – 8 hours . The patient is allowed to walk after 12 hours.

Most patients may have some pain in the region embolized for the next few days .The pain will respond to pain killers. if the pain persists or if the patient has fever ,foul smelling discharge or increasing pain she is advise to contact the physician. In certain fibroids bits of fibroid come out over the next few weeks its called fibroid abortion and is normal

Complications

Complications occur in fewer than 3 percent of patients. 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. Long-term complications are not expected.
 
     Though rare any vascular interventional procedure carries the following risks.
  1.  The procedure may fail and one may have to resort to surgery.
  2.  A normal vessel may get blocked and the patient may suffer due to lack of supply to that region.
  3. Drugs including the dye used for angiography can produce an allergic reaction which can rarely be severe and dangerous to life.
  4. Patient may develop bleeding from the site of puncture for angiography in the leg or arm, this can be stopped by compression for a few minutes
For further information contact : dr.mathewcherian@gmail.com
Phone : +91 600900373,+91 422 262862
 
Case Study
Fibroid Embolization
 
 
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