Uterine artery embolization

Answer 1

Definition

Uterine artery embolization (UAE) is a procedure to treat fibroids without surgery. Instead, the doctor (a radiologist) uses special imaging methods to treat your uterine fibroids. During the procedure, the blood supply of the fibroids is cut off, causing the fibroids to shrink.

Alternative Names

Uterine fibroid embolization; UFE; UAE

Description

UAE is done in the radiology department of a hospital. Usually local anesthesia is used. You will be awake but unable to feel pain. (This is called conscious sedation.) The procedure takes about 60 to 90 minutes.

The procedure is usually done this way:

• You will receive a sedative, a medicine that will make you relaxed and sleepy.
• A local anesthetic (pain-killer) will be applied to your skin around your groin. This will numb the area so you do not feel pain.
• Your radiologist will make a 1/4-inch-long incision (cut) in your skin. Then the radiologist will insert a catheter (a thin tube) into your femoral artery. This artery is at the top of your leg. Next the radiologist will thread the catheter into your uterine artery. This artery supplies blood to the uterus.
• Small plastic or Gelatin particles will be injected through the catheter into the blood vessels that supply blood to the fibroids. These particles block the blood supply to the tiny arteries that carry blood to the fibroids. Without this blood supply, the fibroids shrink and then die.
• UAE will be done in both your left and right uterine arteries.

Why the Procedure Is Performed

Uterine artery embolization is an effective way to treat fibroids that are not very large. Sometimes women have UAE done after childbirth to treat very heavy vaginal bleeding.

Women who may want to become pregnant in the future should NOT have this procedure.

Risks

Uterine artery embolization is generally safe. Ask your doctor about these possible problems.

A risk for any anesthesia is having a bad reaction to the anesthetic that is used.

The risks for any invasive procedure are:

• Bleeding
• Infection
• Bruising

The risks of uterine artery embolization are:

• Injury to an artery or to the uterus
• Complications with a future pregnancy. Some of these are intrauterine growth restriction (a condition that causes the baby to grow more slowly than usual in the uterus), preterm delivery (the baby is born early), bleeding after delivery, problems with the placenta, and miscarriage.
• Pregnancy is not recommended after this procedure
• Early menopause

Before the Procedure

Always tell your doctor or nurse:

• If you could be pregnant
• What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

Before your UAE:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help.

On the day of your UAE :

• You will usually be asked not to drink or eat anything for 6 to 8 hours before this procedure.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Women usually stay in the hospital overnight after UAE. Some women are able to go home a few hours after treatment, but this is less common.

You will receive pain medicine. You will be asked to lie flat for 4 to 6 hours after the procedure.

Pelvic cramps are common for the first 24 hours after the procedure. They may last for 2 weeks. Cramps may be severe and may last more than 6 hours at a time.

The treated fibroid tissue may pass through your vagina.

Outlook (Prognosis)

Uterine artery embolization usually works well to decrease pain, pressure, and bleeding from fibroids. Up to 30% of women who have UAE done:

• Need to have the procedure again within 1 or 2 years
• Have a hysterectomy within 5 years after the procedure

References

Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007 Jan 25;356(4):360-70.

Katz VL. Benign gynecologic lesions : Vulva, vagina, cervix, uterus, oviduct, ovary. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 18.

Volkers NA, Hehenkamp WJ, Birnie E, Ankum WM, Reekers JA. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial. Am J Obstet Gynecol. 2007 Jun;196(6):519.e1-11.

Answer 2

Definition

Uterine artery embolization (UAE) is a procedure to treat fibroids without surgery. Uterine fibroids are noncancerous (benign) tumors that develop in the uterus (womb).

During the procedure, the blood supply of the fibroids is cut off, causing the fibroids to shrink.

Alternative Names

Uterine fibroid embolization; UFE; UAE

Description

UAE is done by a doctor called an interventional radiologist.

You will be awake but unable to feel pain. (This is called conscious sedation.) The procedure takes about 45 - 60 minutes.

The procedure is usually done this way:

• You will receive a sedative, a medicine that will make you relaxed and sleepy.
• A local anesthetic (pain-killer) will be applied to your skin around your groin. This will numb the area so you do not feel pain.
• The radiologist will make a 1/8-inch-long incision (cut) in your skin. Then the radiologist will insert a catheter (a thin tube) into your femoral artery. This artery is at the top of your leg. Next the radiologist will thread the catheter into your uterine artery. This artery supplies blood to the uterus.
• Small plastic or gelatin particles will be injected through the catheter into the blood vessels that supply blood to the fibroids. These particles block the blood supply to the tiny arteries that carry blood to the fibroids. Without this blood supply, the fibroids shrink and then die.
• UAE will be done in both your left and right uterine arteries, using only one incision (cut). If needed, multiple fibroids can be treated.

Why the Procedure Is Performed

UAE is an effective way to treat symptoms caused by fibroids.

• Symptoms may include bleeding, low blood count, pelvic pain or pressure, waking up at night to urinate, and constipation.
• Treatment of the fibroids with medications or hormones will almost always have been tried before you have this procedure.
• Sometimes women have UAE after childbirth to treat very heavy vaginal bleeding.

Risks

Uterine artery embolization is generally safe.

The risks for any invasive procedure are:

• Bleeding
• Having a bad reaction to the anesthetic or medicine that is used.
• Infection
• Bruising

The risks of uterine artery embolization are:

• Injury to an artery or to the uterus
• Possible problems with a future pregnancy. There may be a higher risk for problems with the placenta during a pregnancy and delivery. Women who may want to become pregnant in the future should discuss this issue with their health care provider.
• Menstrual periods may not return after uterine artery embolization.

Before the Procedure

Always tell your doctor or nurse:

• If you could be pregnant
• What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

Before your UAE:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help.

On the day of your UAE:

• You will usually be asked not to drink or eat anything for 6 - 8 hours before this procedure.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Women usually stay in the hospital overnight after UAE. Some women are able to go home the same day.

You will receive pain medicine. You will be asked to lie flat for 4 - 6 hours after the procedure.

Pelvic cramps are common for the first 24 hours after the procedure. They may last for a few days to 2 weeks. Cramps may be severe and may last more than 6 hours at a time.

Most women recover quickly and are able to return to normal activities within 7 - 10 days. The treated fibroid tissue may pass through your vagina.

Outlook (Prognosis)

Uterine artery embolization works well to decrease pain, pressure, and bleeding from fibroids in most women who have the procedure.

It is less invasive than surgical treatments for uterine fibroids. Many women are likely to return more quickly to actives after surgery.

As with other treatments for uterine fibroids, some women may require more procedures or a hysterectomy in the future.

References

ACOG Practice Bulletin: Clinical management guidelines for obstetricians-gynecologists. Number 96, August 2008. Obstet Gynecol. 2008;112:387-400.

Bradley L, Uterine Fibroid Embolization: a viable alternative to hysterectomy. Obstet Gynecol. 2009:127-135.

Goodwin SC, Spies JB, Worthington-Kirsch R et al. Uterine artery Embolization for treatment of leiomyomata: long term outcomes from the FIBROID registry. Obstet Gynecol. 2008; 111:22-33.

Tulandi T, Salamah K, Fertility and Uterine Artery Embolization. Obstet Gynecol. 2010;115:857-860.

Volkers NA, Hehenkamp WJ, Birnie E, Ankum WM, Reekers JA. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial. Am J Obstet Gynecol. 2007 Jun;196(6):519.e1-11.

Reviewed By

Review Date: 10/12/2010

A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine (2/7/2009).