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Uterine Artery Embolization (UAE)

Uterine Artery Embolization
Advantages
Disadvantages
Risks
Contraindications
History
Resources

The procedure:

Uterine Artery Embolization (UAE), also called Uterine Fibroid Embolization (UFE), is a minimally invasive surgical procedure used to treat uterine fibroids. This surgery uses a technique called embolization which blocks the flow of blood through the vessels around the fibroids depriving them of the oxygen they need to grow. The oxygen deprivation results in the fibroids shrinking. Although a relatively new treatment for fibroids, UAE has been used for years to control heavy bleeding after childbirth. Fibroid embolization is performed by an interventional radiologist who works in consultation with your gynecologist. The procedure takes about an hour. UAE is not recommended for women who are planning future pregnancies, because its effects on fertility are not conclusively known.

UAE involves making a small incision and guiding a catheter through the femoral artery in the groin to one of the uterine arteries and injecting tiny plastic spheres, about the size of sand grains. Using a moving X-ray (fluoroscopy), the physician guides the catheter through the artery to the uterus. An arteriogram (a series of images taken while radiographic dye is injected) is done to provide a map of the blood supply to the uterus and fibroids during the procedure. Tiny particles of tris-acryl gelatin or polyvinyl alcohol (PVA) are injected through the catheter and lodge in the smaller arteries that branch out to the fibroids and choke off the blood supply. They remain permanently in the uterine arteries. With their blood supply cut off, the fibroids begin to shrink. Doctors repeat the process on the opposite uterine artery to treat all of the fibroids in the uterus.

Patients are conscious but sedated for the procedure. Local anesthesia is used at the site of the incision to block pain. An overnight stay in the hospital is generally required but UAE can be done as an outpatient procedure. Patients are given pain and anti-inflammatory medications for discomfort and cramping following the procedure. Some patients may experience "post-embolization syndrome" which is described as having flu-like symptoms, such as a low grade fever, malaise, and mild nausea. Post-embolization syndrome can occur within a few hours or up to a few days after embolization. Side effects usually subside in a few days. Women resume light activities a few days after Uterine Artery Embolization and generally resume normal activity a week to ten days after the treatment.
Patients return for follow-up visits as scheduled by their physician. It usually takes two to three months for the fibroids to shrink enough so that symptoms such as pain and pressure improve. It is common for heavy bleeding to improve during the first menstrual cycle following the procedure. A pelvic ultrasound or MRI is usually taken three to six months after the embolization to confirm that the fibroids have shrunk.

The advantages of Uterine Artery Embolization (UAE) are:

  • Minimally invasive procedure
  • No need for general anesthesia
  • Treats all fibroids simultaneously
  • Short recovery period (1-2 weeks)
  • No abdominal scars
  • Minimal blood loss
  • Complications infrequent
  • Uterus preserved, normal menstrual cycles usually resume after the procedure

The benefits of Uterine Artery Embolization (UAE) are:

  • 85% of women who have uterine artery embolization experience either significant reduction or complete resolution of their fibroid-related symptoms
  • Fibroids often shrink to half their original size 6 months after UAE
  • It is rare for fibroids to regrow or for new fibroids to develop after UAE

The disadvantages of Uterine Artery Embolization (UAE) are:

  • Moderate to severe pain and cramping in the first several hours or days following the procedure
  • Bruising around the incision site
  • Post-embolization syndrome, causing nausea and fever
  • Up to 2% of procedures are technically unsuccessful
  • 10-15% of procedures do not respond despite technical success
  • No tissue is obtained for pathologic diagnosis

The risks of Uterine Artery Embolization (UAE) are:

  • A 1% chance of injury to the uterus, potentially leading to hysterectomy
  • Damage to blood vessels
  • Infection
  • Entering early-onset menopause (This happens to 1-5% of women. It appears to occur more commonly in women who are over 45 when they have the procedure.)
  • Allergy to x-ray contrast material (iodine)
  • Passage of fibroid tissue (2-3% of women may pass small pieces of fibroid tissue after uterine artery embolization.)
  • Fertility: The question of whether uterine artery embolization reduces fertility has not yet been conclusively answered

Uterine Artery Embolization is not recommended for women with:

  • Asymptomatic fibroids
  • Suspicion of cancer
  • Renal insufficiency (kidney disease)
  • Infection or pelvic inflammatory disease
  • Pregnant women
  • Women who wish to have more children

History of Uterine Artery Embolization

Since the 1970's, embolization has been used to treat people with bleeding from ulcers, tumors, and trauma. It has also been used to stop the bleeding that can sometimes occur after childbirth. Uterine Artery Embolization was first used as a technique to limit blood loss during surgical removal of fibroids, and performed well before the surgery. However, 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. UAE was introduced as a treatment for fibroids in 1992 in Paris by Dr. Jacques-Henri Ravina, a gynecologist. The treatment was first performed in the U.S. at the University of California at Los Angeles (UCLA). There are now many such centers around the world performing UAE to treat uterine fibroids

Uterine Artery Embolization resources on the internet:

http://www.radiologyinfo.org/content/interventional/ufibroid-embol.htm
Description about the uterine artery embolization procedure can be found on this public information Web site developed and funded by the American College of Radiology (ACR) and the Radiological Society of North America (RSNA).

http://www.sirweb.org/patPub/uterineTreatments.shtml#uf
General information about UAE can be found on the website of the Society of Interventional Radiology.

http://www.rand.org/pubs/monograph_reports/MR1158/
A review the literature and research data about uterine artery embolization

http://www.mayoclinic.org/uterine-fibroids/uterine-artery-embolization.html
Information about uterine artery embolization can be found on the Mayo clinic website.

Click here to see an overview of all uterine fibroid treatments
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