Uterine Artery Embolization
Known medically as uterine artery 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
VIA interventional radiologists were among the first in the tristate
area to perform UAE for the treatment of uterine fibroids and have
one of the largest experiences with the procedure in the tristate
area. VIA interventional radiologists are members of the national
uterine fibroid registry, a large multicenter research trial to investigate
the benefits of UAE.
Uterine Artery Embolization
The interventional 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.
Uterine Artery Embolization
Artery Blockage in UAE
The interventional 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
As a result of the restricted blood flow, the tumor (or tumors) begin
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. VIA
physicians have the largest experience with embolization procedures
in Northern Kentucky and have pioneered the use of UAE for the treatment
fibroids. In addition, the physicians of VIA were 4/’;[participants
in the national Uterine Fibroid Registry, a large multicenter study
to further investigate uterine fibroid disease and its treatment.
What Are Some Common Uses Of The Procedure?
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
How Should I Prepare For The 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.
What Does The Equipment Look Like?
Several different types of particles are available for uterine
fibroid embolization. These include polyvinyl alcohol (a material
resembling coarse sand), gelatin sponge (Gelfoam), and microspheres.
All of these types of embolization agents have been shown to be safe
and effective for uterine fibroid embolization. Regardless of the
type of particles used, they wedge in the uterine vessels, avoiding
the risk that they will travel to distant parts of the body.
How Does The Procedure Work?
Uterine Artery Embolization
By blocking blood flow to the fibroids, uterine fibroid embolization
in effect "starves" them of the blood they need to grow.
When deprived of blood, the tumor masses die, and then develop
into scar tissue and shrink in size. The symptoms they previously
caused become less bothersome or disappear altogether. Multiple
fibroids may be treated at the same session by uterine fibroid
embolization, and even very large ones can be effectively treated
by this procedure.
How Is The Procedure Performed?
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 between 60 and 90 minutes.
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
What Will I Experience During The Procedure?
Most patients having uterine fibroid embolization remain overnight
in the hospital for pain control and observation. Patients typically
experience pelvic cramps for several days after uterine fibroid
embolization, and possibly mild nausea and low-grade fever as well.
The cramps are most severe during the first 24 hours after the
procedure, and improve rapidly over the next several days. While
in the hospital, the discomfort usually is well controlled with
a narcotic pump, which dispenses intravenous pain medication. Oral
pain medication will be provided when you are discharged home the
following day. Most patients will recover from the effects of the
procedure within one to two weeks after uterine fibroid embolization,
and will be able to return to their normal activities.
It usually takes two to three months for the fibroids to shrink
enough so that bulk-related symptoms such as pain and pressure improve.
It is common for heavy bleeding to improve during the first menstrual
cycle following the procedure.
Most women are able to return to work one to two weeks after uterine
fibroid embolization, but occasionally patients take longer to recover
Who Interprets The Results And How Do I Get Them?
The interventional radiologist who performs your procedure will
interpret the results and will work with your gynecologist or primary
care physician to ensure proper follow-up care.
Fibroid embolization was first studied in the United States by Scott Goodwin,
M.D., of the University of California Los Angeles, who reported his results
in 1997. Since that time, a number of interventional radiologists have studied
the procedure and have reported similar success with the technique reported
by Dr. Goodwin.
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.
What Are The Benefits Vs. Risks?
- Minimally invasive: Uterine fibroid embolization (UFE) is less
invasive than either open surgery to remove fibroid tumors, or
surgically removing the uterus itself. Patients ordinarily can
resume their usual activities weeks earlier than if they had a
hysterectomy. Blood loss during uterine fibroid embolization is
minimal, the recovery time is much shorter than for hysterectomy,
and general anesthesia is not required.
- Relief of symptoms: Follow-up studies have shown that approximately
85 percent of women who have their fibroids treated by uterine
fibroid embolization experience either significant reduction or
complete resolution of their fibroid-related symptoms. This is
true both for women with heavy bleeding, and for those with bulk-related
symptoms such as pelvic pain or pressure. Overall, fibroids will
shrink to half their original size six months after uterine fibroid
- Durable effect: Follow-up studies lasting several years have
shown that it is rare for treated fibroids to regrow or for new
fibroids to develop after uterine fibroid embolization. This is
because all fibroids present in the uterus, even small early-stage
masses that may be too small to see on imaging studies, are treated
during the procedure. UFE is a more permanent solution than another
option, hormone therapy, because when hormonal treatment is stopped
the fibroid tumors usually grow back. Regrowth also has been a
problem with laser treatment of uterine fibroids.
- Catheter-related risks: Any procedure that involves placement
of a catheter inside a blood vessel, including uterine fibroid
embolization, carries certain risks. These risks include damage
to the blood vessel, bruising or bleeding at the puncture site,
and infection. When performed by an experienced interventional
radiologist, the chance of any of these events occurring during
uterine fibroid embolization is less than one percent.
- Allergy to x-ray contrast material: An occasional patient may
have an allergic reaction to the x-ray contrast material used during
uterine fibroid embolization. These episodes range from mild itching
to severe reactions that can affect a woman's breathing or blood
pressure. Women undergoing uterine fibroid embolization are carefully
monitored by a physician and a nurse during the procedure, so that
any allergic reactions can be detected immediately and reversed.
- Passage of fibroid tissue: From two percent to three percent
of women may pass small pieces of fibroid tissue after uterine
fibroid embolization. This occurs when fibroid tissue located near
the lining of the uterus die and partially detaches. Women with
this problem may require a procedure called D & C (dilatation
and curettage) to be certain that all the material is removed so
that bleeding and infection will not develop.
- Early onset menopause: In the majority of women undergoing uterine
fibroid embolization, normal menstrual cycles resume after the
procedure. However, in approximately one percent to five percent
of women, menopause occurs shortly after uterine fibroid embolization.
This appears to occur more commonly in women who are older than
45 years when they have the procedure.
- Need for hysterectomy: Although the goal of uterine fibroid embolization
is to cure fibroid-related symptoms without surgery, some women
may eventually need to have a hysterectomy because of infection
or persistent symptoms. The likelihood of requiring hysterectomy
after uterine fibroid embolization is low—less than one percent.
- X-ray exposure: Women are exposed to x-rays during uterine fibroid
embolization, but exposure levels usually are well below those
where adverse effects on the patient or future children would be
- Future fertility: The question of whether uterine fibroid embolization
reduces fertility has not yet been answered, though a number of
healthy pregnancies have been documented in women having the procedure.
Because of this uncertainty, physicians may recommend that a woman
with symptom-producing fibroids who wishes to have more children
consider surgical removal of the individual tumors rather than
uterine fibroid embolization. A majority of women who have uterine
fibroid embolization are no longer interested in childbearing.
In some women, however, fibroid tumors are the cause of infertility
and the best treatment may be to embolize them. For each individual
it is difficult to predict whether the uterine wall will be weakened
enough by uterine fibroid embolization to pose a problem during
delivery of an infant. It may well be worthwhile to do an ultrasound
study in a pregnant woman who has had the procedure so as to assess
the state of the uterus.
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
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 patients.
What Are The Limitations Of Uterine Fibroid Embolization?
Uterine fibroid embolization (UFE) should not be done in women
who have no symptoms from their fibroid tumors; when cancer is a
possibility; or when there is inflammation or infection in the pelvis.
Uterine fibroid embolization also should be avoided in pregnant women
and when the kidneys are not working properly—a condition known
as renal insufficiency. A woman who is very allergic to contrast
material containing iodine should receive another treatment option.
At present, it remains difficult for women in some parts of the
country to learn about uterine fibroid embolization or make arrangements
to have the procedure. Not all gynecologists are familiar with this
relatively new method of treating uterine fibroids, and rely instead
on the conventional approach—surgery.