Uterine artery embolization is a minimally invasive treatment for uterine fibroids, noncancerous growths in the uterus. In uterine artery embolization — also called uterine fibroid embolization — a doctor uses a slender, flexible tube (catheter) to inject small particles (embolic agents) into the uterine arteries, which supply blood to your fibroids and uterus.
Uterine fibroids stimulate the formation of new blood vessels to the fibroid. During uterine artery embolization, the embolic agents are injected into these fibroid blood vessels. The goal is to block the fibroid vessels, starving the fibroids and causing them to shrink and die.
Why is uterine artery embolization done?
Uterine fibroids can cause severe symptoms in some women, including heavy menstrual bleeding, pelvic pain and swelling of the abdomen. Uterine artery embolization destroys fibroid tissue and eases these symptoms and it provides an alternative to surgery to remove fibroids (myomectomy).
One might choose uterine artery embolization if she is in the premenopausal stage and:
- She is having severe pain or heavy bleeding from uterine fibroids
- She wants to avoid surgery, or surgery is too risky for her
- She wants to keep her uterus
- Optimizing a future pregnancy is not her chief concern
What are the various risks associated with Uterine Artery Embolization?
Rarely, major complications occur in women undergoing uterine artery embolization. The risk of complications from uterine artery embolization is about the same as those for surgical treatment of fibroids. These may include:
- Infection - A degenerating fibroid can provide a site for bacterial growth and lead to infection of the uterus (endomyometritis). Many uterine infections can be treated with antibiotics, but in extreme cases, the infection may require a hysterectomy.
- Damage to other organs - Unintended embolization of another organ or tissue can occur, although it's not as high a risk as with surgery. Whether the patient is having embolization or surgery, disruption of the ovarian blood supply is a possibility because the ovaries and uterus share some blood vessels.
- Possible problems in future pregnancies - Many women have or continue healthy pregnancies after having uterine artery embolization. However, some evidence suggests pregnancy complications, including abnormalities of the placenta attaching to the uterus, may be increased after the procedure.
Reasons to avoid uterine artery embolization
Avoid uterine artery embolization if the patient is having:
- A history of pelvic radiation
- A history of kidney failure
- Possible pelvic cancer
- An active, recent or chronic pelvic infection
- Poorly controlled diabetes
- Inflammation of the blood vessels (vasculitis)
- An untreated bleeding disorder
- A severe allergy to contrast material containing iodine
Most fibroid sizes and locations can be treated with uterine artery embolization. Rarely a woman's uterus can be so big that it's difficult to treat with any method, and hysterectomy may be required.
How can the patient prepare for Uterine Artery Embolization?
Uterine artery embolization usually is performed by an interventional radiologist or a specialist in obstetrics and gynecology who has training in uterine artery embolization.
- On the evening before the procedure, don't eat and drink after midnight or after whatever time doctor advises. If the patient is taking medications, ask the doctor if he should stop taking them before or after the procedure.
- In the radiology procedure room, the patient will have an intravenous (IV) line placed in one of his veins to give the fluids, anesthetics, antibiotics and pain medications.
- After the procedure, typically the patient will be moved to a room for an overnight stay in the hospital and return home the next day.
What to expect from Uterine Artery Embolization?
During the procedure
The procedure includes:
- Anesthesia - Typically, the patient will receive a type of anesthesia that reduces pain and helps her relax but will leave her awake (conscious sedation).
- Blood vessel access - The doctor makes a small incision in the skin over the patient’s femoral artery, a large blood vessel that passes lengthwise through her groin. Then the doctor inserts a catheter into the artery and guides the catheter to one of the two uterine arteries. Generally, the doctor can access both uterine arteries through one incision.
- Blood vessel mapping and injection - An injected contrast fluid, usually containing iodine, flows into the uterine artery and its branches and makes them visible on the fluoroscope's monitor. The fibroids "light up" more brightly than other uterine tissue. The particles are carried by the blood flow to block the fibroid vessels. After injecting more contrast into the uterine artery, the doctor checks additional images to make sure that blood is no longer reaching the fibroids.
After the procedure
In the recovery room, the medical team monitors the patient’s condition and gives her medication to control any nausea and pain. When the effects of the anesthesia fade away, they take the patient to the hospital room for overnight observation.
- Position - The patient must lie flat for several hours to prevent pooling and clotting of the blood (hematoma) at the femoral artery site.
- Pain - The primary side effect of uterine artery embolization is the pain, which may be a reaction to stopping blood flow to the fibroids and a temporary drop in blood flow to normal uterine tissue. Pain usually peaks during the first 24 hours. To manage the pain, you receive pain medication.
- Observation - Post-embolization syndrome — characterized by low-grade fever, pain, fatigue, nausea and vomiting — is frequent after uterine artery embolization. Ongoing symptoms that don't gradually improve should be evaluated for more-serious conditions, such as an infection.
Most women return home the day after the procedure with a prescription for oral pain medication. Pain usually ends within a day or two, but in some women, it may last up to a few weeks.
Monitor the recovery for:
Vaginal discharge - The patient might have a watery or mucus-like vaginal discharge for a few weeks to a month after uterine artery embolization. The discharge should stop without treatment. In a few women, remnants of fibroids are passed through the vagina.