Uterine Fibroid Embolization

Uterine fibroids are the source of severe symptoms in some women, including heavy menstrual bleeding, pelvic pain and swelling in the abdomen. Uterine artery embolization kills fibroid tissue and eases these symptoms. It provides an alternative to surgery to remove fibroids (myomectomy).

Uterine artery embolization is a minimally invasive treatment of fibroid tumors, also known as myomas, that are benign tumors arising from the muscular wall of the uterus. It is extremely rare for them to turn cancerous. During fibroid embolization, an interventional radiologist uses a small, flexible tube (catheter) to inject very small particles (embolic agents) into the uterine arteries, which supply blood to the fibroids and uterus. The goal is to block the blood vessels to the fibroid(s), starving the fibroids and causing them to shrink and die.

You might choose uterine artery embolization if you're premenopausal and:

  • You have severe pain or heavy bleeding from uterine fibroids
  • You want to avoid surgery, or surgery is too risky for you
  • You want to keep your uterus
  • Optimizing a future pregnancy isn't a significant concern

Most fibroid sizes and locations can be treated with uterine artery embolization. However, extremely large fibroids can be so big that they cause complications and require a different method to remove them.

Some fibroids that are primarily inside the uterus (pedunculated submucosal) may be expelled vaginally following the procedure. Finally, if the fibroids have already lost their blood supply (degenerated), uterine artery embolization won't provide any benefit.

What to expect during the procedure

  • Anesthesia. Typically you'll receive anesthesia that reduces pain and helps you relax, but leaves you awake (conscious sedation).
  • Blood vessel access. The doctor makes a small puncture in the skin over your femoral artery, a large blood vessel that passes through your groin, typically on the right. Then your doctor inserts a small catheter (flexible tube) into the artery and guides the catheter to one of the two uterine arteries. Typically, the doctor can access both uterine arteries, left and right, through one puncture site.
  • Blood vessel mapping and injection. Contrast fluid is injected into the uterine artery and its branches and makes them visible on the imaging screen. The fibroids absorb more contrast and "light up" more brightly than other uterine tissue. The interventional radiologist identifies the right area of the uterine artery and then injects the blood vessel with tiny particles made of plastic or gelatin. The particles are carried by the blood flow until they block the fibroid vessels.
    After injecting more contrast into the uterine artery, the doctor checks additional images to make sure blood is no longer reaching the fibroids. The same steps are then repeated in the second uterine artery, and additional arteries as needed.

After the procedure

In the recovery room, your care team monitors your condition and gives you medication to control any nausea and pain.

  • Position. You must lie flat for a few hours to prevent a possible hematoma (bruise) at the femoral artery puncture site.
  • Pain. The primary side effect of uterine artery embolization is pain, which may be a reaction to blocking blood flow to the fibroids and a temporary drop in blood flow to adjacent 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.
    Post-embolization syndrome symptoms peak about 48 hours after the procedure and usually resolve on their own within a week. Ongoing symptoms that don't gradually improve should be evaluated for more-serious conditions, such as an infection.
    Recovery is generally rapid, and complications are rare.

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