Interventional Radiology
Uterine Fibroid Embolization
Uterine fibroids are the most common tumors of the female genital tract, affecting approximately 30 to 40 percent of the female population, primarily under the age of 40. African-American women run a higher risk of fibroids with as many as 50 percent of women developing fibroids of significant size. Fibroids are noncancerous and while they do not always cause symptoms, their size and location can lead to pain and heavy bleeding for some women. In some cases, they can grow to the size of a five-month pregnancy. The exact causes for fibroid development are unclear, but they have been linked to both a genetic predisposition and a susceptibility to hormone stimulation.
What is uterine fibroid embolization?
Uterine artery embolization is a fairly new approach to treating fibroids. The procedure attempts to shrink tumors by blocking the arteries that supply blood to the fibroids. For some women, the procedure can serve as an alternative to hysterectomy.
While fibroid embolization to treat uterine fibroids has been available for approximately six years, it is not routinely performed at most medical centers. The procedure originated as a result of the successful results obtained from embolization of arteries in the uterus and
has been used by interventional radiologists for more than 20 years to treat heavy bleeding after childbirth. It has had a 90 percent clinical success rate in treating fibroids.
Who is a candidate for uterine fibroid embolization?
Approximately 30 percent of patients may have symptoms that require some form of treatment. Symptoms include heavy, prolonged menstrual periods, increase in menstrual cramps, pelvic pain, pain in the back, flank or legs; pain during intercourse; pressure on the urinary tract resulting in increased urination; pressure on the bowel leading to constipation and bloating; and abnormally enlarged abdomen. Before uterine fibroid embolization is considered, several standard modes of therapy should be tried or examined. The first line of treatment involves hormone therapy to suppress the growth of the fibroids. The drawbacks to hormone therapy are that once therapy is stopped, the fibroids tend to come back. Additionally, not everyone responds to therapy and it can have negative side effects. Patients who have just a few fibroids may be candidates for myomectomy, a procedure that removes the individual fibroids, leaving the uterus intact. The problem is that the fibroids often return. Patients who have a large number of fibroids that can't be controlled by myomectomy are candidates for hysterectomy or uterine fibroid embolization.
How is the procedure performed?
The procedure is performed while the patient is conscious, but sedated. The physician inserts a catheter into the femoral artery and steers it into the uterus using fluoroscopy to guide the catheter. Once the catheter reaches the point where the artery divides into multiple vessels that supply blood to the fibroids, an arteriogram is performed to provide a clear roadmap. The interventional radiologist then injects tiny plastic gelatin sponge particles into the vessels that supply the fibroids where they become wedged, blocking the flow of blood. The procedure is then repeated on the other side so that blood supply is blocked in both the right and left uterine arteries. The restricted blood flow causes the tumors to shrink, on average, up to 50 percent over the next three to six months. Some may completely constrict. Fibroid embolization usually requires a hospital stay of one night. Swelling and cramping are common side effects following surgery.
Total recovery generally takes one to two weeks.
