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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.

For the treatment of symptomatic uterine fibroids.

Leiomyomata (uterine fibroids) are commonly found in women by the age of 35. If they get large enough, they can cause symptoms of pelvic pain and pressure on adjacent abdominal organs. The traditional treatment of uterine fibroids has been hysterectomy in women who have completed their childbearing. 

Uterine artery embolization (UAE) for other reasons, such as bleeding after childbirth or prior to surgery on the urterus, has proven highly successful with few side effects. A consequence of these uterine artery embolizations has been the observation that uterine fibroids would sometimes also diminish in size. Several clinical studies of uterine artery embolization have been reported from France, Great Britain and the United States, involving women with large uterine leiomyomas.  Uterine artery embolization in these series has shown a significant reduction in size of the individual fibroids and consequently the entire uterus without involving a surgical procedure. 

How its Done

The procedure is performed by an Interventional Radiologist during an angiogram. A catheter is placed into the main artery of the leg and guided through the arterial tree into the arteries that supply the uterus. Tiny, plastic particles are then injected blocking the supply of blood to the uterus and to the fibroids. The catheter is then removed and the patient stays at bed rest for 6 hours. After this time period, they are free to move about, and, if they are having no other side effects from the embolization, can leave the hospital.

What To Expect After the Procedure

Most women, however, 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. 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.  More Details of what to expect at home.
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Risks of the Procedure

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 surgical procedures.

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. For this procedure, the worse area that these could end up in would be in your foot. However, since superselective catheters are being used, non-target embolization is generally limited to the pelvis, if it occurs at all, where generally there are no sequelae. 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. 

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 the 3 series referenced above in the literature, this complication occurred in 2% of patients. 
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Treatment Failure

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.
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Long-term Effects

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. The risk to the baby's well being in regards to intrauterine growth retardation or other problems 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, that 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.  However, the answer to this question is not known. 
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