Uterine fibroid embolization (UFE) also referred to as uterine artery embolization is a minimally invasive interventional radiology treatment for fibroid tumors in the uterus. Between 20 and 40% of women older than 35 years have fibroids.
Fibroids are benign growths in the muscular wall of the uterus. Fibroids are not malignant or cancerous. These growths can vary in size. A majority of the women having fibroids do not have any manifesting symptoms, while others could show clinical features such as heavy bleeding during the menstrual period. In such cases, periods may last much longer than usual. Fibroids are also capable of causing pain or a feeling of pressure or heaviness in the lower pelvic area (the area between the hip bones), the back or the legs. Some women experience pain during sexual intercourse. Others have a constant feeling that they need to urinate, while some may also feel a pressure in the bowel. Other symptoms include constipation or bloating of the abdomen.
Uterine fibroid embolization is principally performed to treat the symptoms caused by fibroid tumors, and to stop severe bleeding caused by malignant gynecological tumors or hemorrhage associated with childbirth. It is advised, that the patient ought to discuss with the doctor, gynecologist and the interventional radiologist to decide whether uterine fibroid embolization is right for them.
Many surgeons and experts are of the opinion that the ideal candidate for Uterine fibroid embolization is a pre-menopausal woman with symptoms of fibroid tumors, who no longer desires to become pregnant, but chiefly wants to avoid having a hysterectomy (in which the uterus is surgically removed.)
Uterine fibroid embolization is usually performed by an interventional radiologist. This is a physician trained to perform various types of embolization and minimal invasive procedures. Anesthesia is not required in this procedure. It is performed while the patient is conscious, but is sedated and feels absolutely no pain.
In this Uterine fibroid embolization surgery, x-ray equipment, a catheter and a variety of synthetic materials and medications called embolic agents are used. A catheter is a long, slim plastic tube, as thick as a spaghetti strand.
The radiologist uses a fluoroscope (a device used for viewing images in real time) to see the patient’s uterus and blood vessels. He then makes an incision less than 1/4-inch wide in the skin over the groin and inserts a catheter into the femoral artery. The radiologist then guides the catheter to one of the two uterine arteries. He injects a contrast fluid (normally containing iodine) which flows into the artery and arterial branches and makes them visible on the radiologist’s monitor.
The idea is to block blood flow to the fibroids which eventually causes them to shrink. The radiologist identifies the vessels leading to the fibroids and maps them, then injects tiny particles into those branches. These particles are made of plastic or gelatin. Once the radiologist is sure that blood is no longer flowing to the fibroids, he then places the catheter into the other uterine artery and repeats the above steps.
At the end of the procedure, the catheter is removed and pressure applied to stop any bleeding. The opening in the skin is covered with a dressing (no sutures are required).
Preparing for the uterine fibroid embolization is an extremely important step a patient needs to take. It involves injecting foreign particles into the body, thus, the patient should let the doctor know beforehand if they are allergic to any medications, shellfish, contrast agents, iodine, or gelatin. Patients should decide with their doctors what type of sedation will work best. Most doctors use conscious sedation, i.e. the patient will be awake during the procedure but will feel groggy.
UFE is performed as an outpatient procedure, in a hospital, and will require about a few hours to a 24-hour stay. On the evening before the procedure, don’t eat or drink after midnight. After the patient arrives at the hospital, they will be prepared for the procedure by the Radiology staff, this includes initiating the sedation and other medication discussed earlier.
After the procedure, the staff monitors the patient’s condition and administers IV medication to control pain and nausea. When the effects of the anesthesia die away, the hospital staff wheels the patient to the room for continued observation.
Patients are advised to lie flat for several hours to prevent pooling and clotting of the blood at the femoral artery site. The primary side effect of uterine artery embolization is pain. Patients may experience intense cramping because of the decreased blood supply to the uterus and fibroids. This is a reaction to stopping blood flow to the fibroids. It will subside 2-3 days.
Pain usually increases during the first 24 hours. The surgeons and staff will be on hand to administer the required medications. Patients may also experience post-embolization syndrome. In this condition, extreme fatigue, fever, nausea and vomiting is common.
Gradually, IV medications are replaced with oral pain medications. The urinary catheter is removed, and patients are encouraged to get up and walk. Recovery is usually quick, and complications are extremely rare.
Most patients are able to go home the morning after the surgery and only need to take oral pain and anti-inflammatory medications for the next few days. Recovery depends on the patient, some might feel normal within a few days and return to regular activity within a week or so, while others may have pain or discomfort for a few weeks.
As with other procedures, there are some limitations for Uterine Fibroid Embolization as well. The surgery should not be performed in women who have no symptoms from their fibroid tumors, when cancer is a possibility, or when there is inflammation or infection in the pelvis. Pregnant women are also adviced toavoid going in for uterine fibroid embolization.
It should also not be performed in women whose kidneys are not working adequately, a condition known as renal insufficiency. A woman who is allergic to contrast material containing iodine should receive another treatment option.
At present, women find it difficult to learn about uterine fibroid embolization or make arrangements to have the procedure in some parts of the country. Not all gynecologists are familiar with this relatively new method of treating uterine fibroids and rely instead on the conventional approach surgery.
The main benefit of this procedure is that it is minimally invasive, as compared to an open surgery done to remove uterine fibroids or surgically removing the uterus itself (hysterectomy). Patients usually resume their usual activities weeks earlier than if they had a hysterectomy Moreover, no surgical incision is needed, only a small nick in the skin that does not have to be stitched closed.
Loss of blood during uterine fibroid embolization is minimal and the time for recovery is much shorter than for hysterectomy. Medical evidence says that it is rare for treated fibroids to re-grow or for new fibroids to develop after uterine fibroid embolization. In addition, 85 per cent of women who have uterine fibroid embolization experience significant reduction and even complete resolution of their fibroid-related symptoms.
Finally, uterine fibroid embolization is a more lasting solution than hormone therapy. When hormonal treatment is ceased, the fibroid tumors usually grow back. Even with laser treatment of uterine fibroids re-growth has been a problem.
On the other hand, there are certain risks associated with uterine fibroid embolization. Placing a catheter inside a blood vessel carries certain dangers, including damage to the vessel or bruising at the puncture site, and infection. As long as the radiologist is an experienced professional, this risk is reduced to almost zero.
Majority of women find that normal menstrual cycles are resumed after uterine fibroid embolization. However, in a small minority of women, menopause occurs shortly after the procedure, more commonly so among women over 45.
Women are usually concerned and want to know whether uterine fibroid embolization reduces fertility. Unfortunately, this question has not been answered yet, though a number of healthy pregnancies have been recognized in women who have had uterine fibroid embolization. Because of this uncertainty, doctors recommend, that a woman wishing to have more children, should consider surgical removal of the individual tumors.
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