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Vascular and Interventional Radiology |
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UAE
Post Op Post Procedure The contents of this web page are provided for informational purposes only. This material is not to be used for diagnosis or treatment without the active participation of a medical doctor. |
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Post Procedure Information for Patients After Uterine Artery Embolization Immediately After the Procedure Almost every patient will spend the night in the observation unit. This is still considered an outpatient procedure as your total time in the hospital is less than 24 hours. Some patients with very mild post embolization syndrome will go home the same afternoon. The primary symptoms of post embolization syndrome that will limit ability to do well at home are pain and nausea and vomiting. Initially we will use intravenous narcotics and anti-nausea medications. You will control how much pain medication you receive using a Patient Controlled Analgesia (PCA) Pump. We will also start you on an oral pain medication like Vicodin as well as an anti-inflammatory medication like Naproxen. Once your symptoms are controlled with oral medications and you are able to drink well enough to maintain a good urine output you can go home. What To Expect At Home After the Procedure Most women will experience, to varying degrees, some form of post-embolization syndrome. The most commonly reported symptom of the syndrome is pelvic pain, which persists for a minimum of 2-3 days and may be present for as long as a week or two after the procedure. Post-embolization syndrome also causes other symptoms that are generally described as flu-like (fever, malaise). Like post-operative pain, it is most severe in the hours and days immediately following the procedure and diminishes with time. It is generally well controlled by the use of pain medications. Unlike post-operative pain it will not limit your activity. Limitations on exercise or work will not be imposed after the first 2 days. You may do whatever you feel up to doing. The size of the fibroids
and the uterus will diminish slowly with time with the maximum
effect seen within the first 6 months, and, typically, within 2-3
months. Initially, however, your uterus may actually increase in
size swelling will occur secondary to the trauma of
embolization. Menstrual cycles will be interrupted and will
be abnormal for a period of 3-4 months. Most women,
but not all, will have return of normal menses. The first six hours are generally spent in bed to allow the artery in your leg to recover from the procedure. At that point in time you may get up and move around but I still prefer that you keep your activity level minimal. After the first 24 hours, you may move about your normal everyday activities provided that they are not too active and you avoiding lifting or carrying objects above 10 pounds. You can go to the store and buy groceries but don't go spend the day at the mall. By 48 hours you can resume all of your usual activities and do anything you feel like doing. I will ask that you do not use tampons for the first month after your procedure and that you avoid intercourse until any post-embolization drainage stops. You will may take medications after the procedure for 7 days. A Non-Steroidal Anti-Inflammatory Drug (usually Naproxen or Ibuprofen) to help control the inflammation that occurs after embolization. You will also have prescriptions for a narcotic pain medicine (Tylenol #3 or Vicodin) and Phenergan to take as needed for nausea. These medications can be changed depending upon your preferences or allergies. Risks of the Procedure -OR- When to call me. On the day of the procedure, the risks involved relate primarily to the fact that you are undergoing an arteriogram with delivery of particles that are designed to block blood flow. The most common complication that occurs after an angiogram is to have a hematoma or collection of blood form around the entry site into the artery. Less commonly, the arterial puncture sites may not heal normally and you can develop a pseudoaneurysm or arterial-venous fistula. Damage to the artery supplying the leg can also affect function of the leg and can cause pain, particularly in the foot. In general, these complications occur in only 1-2% of patients and even the worse complications are generally readily fixable with simple non-surgical and surgical procedures. Call me: If your leg hurts or feels weak; If you develop a knot or swelling in your groin or a particularly large bruise; If you aren't sure. A simple ultrasound will answer any questions. Non-target embolization is also another complication that could occur. This occurs when the particles that are intended for the uterus end up in some other part of the body. However, since super-selective catheters are being used, non-target embolization is generally limited to the pelvis, if it occurs at all. Non-target embolization can cause pain or loss of function or tissue death in areas other than the uterus, if it occurs. This complication would be very rare. Patients can also have allergic reactions to medications given during the procedure, such as antibiotics, sedatives, pain medications or the contrast material used. Call me: If you have pain or difficulty emptying your bladder or bowels; If you develop a rash; If you have symptoms that don't appear related to your uterus or menstrual cycle. Delayed complications
arising from this procedure would be more likely related to
tissue cell death within the uterus or the fibroids (or elsewhere
in the case of non-target emboli). This could lead to the
formation of localized areas of infection (abscess) that could
require drainage tube placement or even hysterectomy to treat. In
three series in the literature, this complication occurred in 2%
of patients. Some women have developed a chronic endometritis
after embolization that manifests as a chronic vaginal drainage.
Symptoms of infection generally don't develop until 7-10 days
post procedure and chronic endometritis may not be diagnosed
until 2-3 months post procedure. Generally most women feel
noticeably better by post procedure day 3 and really feel great
by around day 14. Call
me: If you are not following
this general pattern of improvement; If you have high,
persistent fevers (101.5 F); If your pain is getting
worse; If you are feeling worse; If your mentrual
cycle has not started to normalize by month 3; If you have
continual discharge after month 2. Approximately 15% of
patients either have no effect from the embolization or the
entire embolization cannot be performed secondary to the presence
of small or difficult to catheterize uterine arteries. In this
instance, you would require surgery for definitive therapy. The
response rate is also variable. On average, fibroids shrink in
size, approximately 50-60%. Some patients have less of a
response; others have more. In general, the entire uterine volume
diminishes roughly 40%. These changes occur slowly with time and
take on average 2-3 months to be seen. If no effect has
occurred within 6 months, then none probably will. The application of uterine artery embolization to the treatment of uterine fibroids is a relatively new procedure and therefore long-term data is not available. The longest follow-up to date reported in the series from France has been 5 years. Based on the information we have, most women will resume their normal menstrual cycle. Pregnancy can occur after embolization and women have successfully carried children to normal birth. Other women have had complicated pregnancies or miscarriages. The risk to the baby's well being in regards to intrauterine growth retardation or other problems are not known. At this point in time, the effects of uterine artery embolization upon pregnancy outcome are not known. The advantage of hysterectomy over uterine artery embolization is that the entire fibroid can be examined under the microscope. The occurrence or presence of cancer within the fibroid is very rare, but has been demonstrated in other patients. The diagnosis is very difficult to make, even if the entire fibroid is available for microscopic evaluation. Therefore, pre-embolization percutaneous biopsy of your fibroids would not be useful in excluding the presence of cancer. Because the presence of unknown cancer is so rare, the potential risk is not felt to be a reason not to perform this procedure. Post-embolization follow-up with your gynecologist for annual exams will still be required. The other issue that is not
known about uterine artery embolization is what the recurrence
rate is for fibroids. In the surgical series, when patients have
their fibroids removed, preserving their uterus, recurrence of
fibroids has been shown to occur. Theoretically, this should
occur at a lower rate with embolization because the entire uterus
is treated. Current data suggests that this may be
true. Interventional Radiology Clinic 210 616-7780 Alternative: (210) 575-8155 as for Dr. Middlebrook or the Interventional radiologist on-call. Administrative Office: (210) 616-7796 M-F; 8-5:00
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