VASCULAR & IR
Uterine Fibroid Embolization
Minimally Invasive, Highly Effective, and Widely Available
Interventional Radiology treatment is often underutilized. Uterine fibroids are very common non-cancerous (benign) growths that develop in the muscular wall of the uterus. They can range in size from very tiny (a quarter of an inch) to larger than a cantaloupe. Occasionally, they can cause the uterus to grow to the size of a five-month pregnancy. In most cases, there is more than one fibroid in the uterus.
Twenty to forty percent of women ages 35 and older have uterine fibroids of a significant size. African American women are at a higher risk for fibroids: as many as 50 percent have fibroids of a significant size. Uterine fibroids are the most frequent indication for hysterectomy in pre-menopausal women and, therefore, are a major public health issue. Of the 600,000 hysterectomies performed annually in the United States, one-third of these are due to fibroids.
Most fibroids do not cause symptoms only 10 to 20 percent of women who have fibroids require treatment. Depending on size, location and number of fibroids, symptoms may include:
Heavy, prolonged menstrual periods and unusual monthly bleeding, sometimes with clots, which can lead to anemia
Pelvic pain and pressure
Pain in the back and legs
Pain during sexual intercourse
Bladder pressure leading to a frequent urge to urinate
Pressure on the bowel, leading to constipation and bloating
Abnormally enlarged abdomen
About the Procedure
Uterine fibroid embolization (UFE), also known as uterine artery embolization, is performed by an interventional radiologist, a physician who is trained to perform this and other types of embolization and minimally invasive procedures. It is performed while the patient is conscious, but sedated and feeling no pain. It does not require general anesthesia.
The interventional radiologist makes a tiny nick in the skin, less than one-fourth of an inch, in the groin and inserts a catheter into the femoral artery. Using real-time imaging, the physician guides the catheter through the artery and then releases tiny particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroid tumor. This blocks the blood flow to the fibroid tumor and causes it to shrink.
Fibroid embolization usually requires a hospital stay of one night. Pain-killing medications and drugs that control swelling are typically prescribed following the procedure to treat cramping and pain. Many women resume light activities within a few days and the majority of women are able to return to normal activities within seven to ten days.
On average, 85-90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms.
The procedure is effective for multiple fibroids and large fibroids.
Recurrence of treated fibroids is very rare. Short and mid-term data show UFE to be very effective with a very low rate of recurrence. Long-term (10-year) data are not yet available, but in one study in which patients were followed for six years, no fibroid that had been embolized re-grew.
Other UFE Facts
An estimated 13,000-14,000 UFE procedures are performed annually in the U.S. (as of 2004).
The embolic particles are approved by the FDA specifically for UFE, based on comparative trials showing similar efficacy with less serious complications compared to hysterectomy and myomectomy (the surgical removal of fibroids).
Embolization of the uterine arteries is not new. While embolization to treat uterine fibroids has been performed since 1995, interventional radiologists have used it successfully for more than 20 years to treat heavy bleeding after childbirth.
Embolization of fibroids was first used as an adjunct to help decrease blood loss during myomectomy. To the surprise of the initial users of this method, many patients had spontaneous resolution of their symptoms after only the embolization and no longer needed the surgery.
UFE is covered by most major insurance companies and is widely available across the country.
Most women with symptomatic fibroids are candidates for UFE and should obtain a consult with an interventional radiologist to determine whether UFE is a treatment option for them. An ultrasound or MRI diagnostic test will help the interventional radiologist to determine if the woman is a candidate for this treatment.
Many women wonder about the safety of leaving particles in the body. The embolic particles most commonly used in UFE have been available with FDA approval for use in people for more then 20 years. During that time, they have been used in thousands of patients without long-term complications.
Effect on Fertility
There have been numerous reports of pregnancies following uterine fibroid embolization, however prospective studies are needed to determine the effects of UFE on the ability of a woman to have children. One study comparing the fertility of women who had UFE with those who had myomectomy showed similar numbers of successful pregnancies. However, this study has not yet been confirmed by other investigators.
Less than 2 percent of patients have entered menopause as a result of UFE. This is more likely to occur if the woman is in her mid-forties or older and is already nearing menopause.
UFE is a very safe method and, like other minimally invasive procedures, has significant advantages over conventional open surgery. However, there are some associated risks, as there are with any medical procedure. A small number of patients have experienced infection, which usually can be controlled by antibiotics. There is also a less than one percent chance of injury to the uterus, potentially leading to a hysterectomy. These complication rates are lower then those of hysterectomy and myomectomy.
Other Treatments for Fibroids
Gynecologists perform hysterectomy and myomectomy surgery. Hysterectomy is the removal of the uterus and is considered major abdominal surgery. It requires three to four days of hospitalization and the average recovery period is six weeks. Depending on the size and placement of the fibroids, myomectomy can be an outpatient surgery or require two to three days in the hospital. However, myomectomy is usually major surgery that involves cutting out the biggest fibroid or collection of fibroids and then stitching the uterus back together. Most women have multiple fibroids and it is not physically possible to remove all of them because it would remove too much of the uterus. While myomectomy is frequently successful in controlling symptoms, the more fibroids the patient has, generally, the less successful the surgery. In addition, fibroids may grow back several years later. Myomectomy, like UFE, leaves the uterus in place and may, therefore, preserve the womans ability to have children.
What to Expect Before, During, and After the Procedure
Before: After your gynecologist has determined that fibroids are the cause of your symptoms, a consultation with an interventional radiologist is necessary. This is a separate appointment on a day prior to your procedure where the procedure will be explained in detail and any questions you may have can be answered. After your consultation, the procedure can then be scheduled. UFE is best done in the two weeks following a period, but can be performed at any time. UFE is generally performed in the morning. You will be asked not to eat breakfast and to arrive at Reston Hospital Center at a certain time. Prior to the procedure an IV will be started in the radiology recovery room, as this is necessary to administer fluids and sedation. You will also have an opportunity to speak with your physician again.
During: UFE will be performed in a nearby interventional radiology suite. Intravenous sedation is utilized so the procedure should be painless. The skin over the artery in the groin is cleansed with a sterile betadine solution. Using local anesthesia, the interventional radiologist will introduce a small catheter into the artery using x-ray guidance. The catheter will then be advanced through the arteries of the uterus and the embolization procedure performed. Most patients do not feel discomfort during the procedure. The catheter will then be removed and pressure is held over the artery for a short time to ensure proper healing.
After: You will then return to the interventional radiology recovery room for observation. A hospital bed will be arranged and you will stay overnight for recovery and control of any post-procedure cramping or pain. The following morning you will be seen by your interventional radiologist and should be discharged from the hospital.
Follow-Up: You will need to come back for two checkups: one that is two days after the exam and another one week after UFE. We would also like to see you in follow up one month after UFE. You should also see your gynecologist two or three months later. We will arrange an MRI six months after UFE. It often takes two or three months for your periods to become normal after UFE.
Who Will Perform My Procedure?
Your procedure will be performed by one of the interventional radiologists at Reston Hospital Center. All three are sub-specialty trained in interventional radiology. This team has performed thousands of interventional procedures and hundreds of embolizations. Our clinical service also includes three technologists and four nurses. The interventional radiologists at Reston Hospital Center are part of Reston Radiology Consultants, P.C. (RRA).
Where Is My Procedure Performed?
All procedures are performed at Reston Hospital Center. In addition to the medical staff, experienced and highly qualified technologists and nurses are involved in your care during your procedure and afterwards.
What Does Insurance Cover UFE?
Most insurance companies in this area will cover the cost of UFE, as it is not an experimental procedure. Over four thousand have been performed in the United States. We can assist you in determining whether your insurance company will cover the cost of this procedure.