Uterine artery emoblization (UAE) - uterine fibroid embolization (UFE) is a new minimally invasive therapy for treatment of uterine fibroids. It is a safe alternative to hysterectomy for treatment of symptoms caused by uterine fibroids that has been shown to be effective in 90% of patients suffering from problems caused by uterine fibroids.

About Uterine Artery Embolization (UAE) - Uterine Fibroid Embolization (UFE)

Uterine fibroids are the most common tumor of the female reproductive tract. Over 150,000 hysterectomies are performed annually for symptomatic fibroids. These tumors occur in 20-40% of women over the age of 35 with the higher range of incidence being among African-American women. Up to 20% of women with fibroids have significant symptoms. These symptoms include: heavy bleeding, anemia, pelvic pain, pressure sensations, urinary frequency, constipation, infertility and sciatica caused by sacral plexus compression. Menopause will usually result in regression of the fibroids and their symptoms although only if hormonal replacement therapy is not used. Hysterectomy is curative albeit with attendant problems and morbidity related to a major surgical procedure. Several days of hospitalization are required and convalescence is usually six weeks or more. There is also the issue of long-term effects of hysterectomy and its effect on the integrity of the pelvic floor with a significant incidence of stress incontinence (40% higher in one clinical series). Gonadotropin releasing hormone agonists (Lupron)  have been advocated and are effective in reducing the size of uterine fibroids, but only temporarily. These agents produce rapid onset of menopausal symptoms without the option of hormone replacement therapy for palliation of symptoms. Osteoporosis is accelerated by this therapy. Myomectomy is an option that preserves the uterus and fertility, but is also a major surgical procedure with significant morbidity and risk of significant blood loss during the procedure. The latest therapy for uterine fibroids - Uterine Fibroid Embolization (UFE) - was developed as a result of trying to reduce blood loss during myomectomy.  There is also a high risk of recurrence of the symptoms as there are usually multiple tumors and this procedure is only effective if the correct ones are removed.

While uterine artery embolization has been used for a variety of indications including post partum hemorrhage and bleeding tumors for over twenty years, the initial experience with uterine fibroid embolization was reported by Jacques Ravina, at the Laraboisiere Hospital in Paris, France in 1995. His results were published in the medical journal Lancet. This initial small series was based on a group of patients who had preoperative embolization before surgical myomectomy and, for various reasons ended up not having the myomectomy. Almost all of these patients were serendipitously found to have complete relief of their symptoms without the surgical procedure. Subsequent larger series confirmed his results leading ultimately to the adoption of this procedure in the U.S. and other countries. The first series reported in this country was out of UCLA in 1997, reported in the Journal of Vascular and Interventional Radiology by Scott Goodwin. Since that time, thousands of uterine fibroid embolizations have been successfully performed across the U.S. with most reported series indicating an 85-90% clinical success with a low complication rate and low morbidity.

Even though UFE is a minimally invasive procedure, it is not without risk. Post procedure pain can be significant. Post infarction syndrome is treated with non-steroidal anti-inflamatory drugs (NSAIDS), narcotics, anti-emetics and acetaminophen. Amenorrhea develops post procedure in approximately 2% of patients under 45 and 15% of patients over 45. Hysterectomies for complications including endometritis and uterine infarction are rare, reported in less than 0.7% of patients. There have been four deaths reported in the world literature out of many thousands of procedures.

At Wake Radiology Interventional Services we first see you in our outpatient clinic located in our Cary office.  There you will have a brief exam and your history will be reviewed.  The procedure, the options and the risks and complications will be discussed in detail.  If you wish to proceed, we will schedule "imaging studies" of your pelvis which typically include MRI or ultrasound.

To schedule or discuss uterine artery embolization (UAE) - uterine fibroid embolization (UFE), please call us at our office at (919) 854-2180.

Note: We do not perform pelvic exams in our office.  We ask that you have had a pelvic exam within three months before this procedure including a pap-test cancer screening procedure.  If you do not have a Gynecologist, we will be happy to assist you in locating one.

Before the Procedure:

• Bring items of clothing, toiletries, etc. for an overnight stay at the hospital.
• Do not eat or drink anything after midnight the night before your procedure.  Take your usual medications the morning of the procedure.

After the procedure:

As the uterine fibroids die, a number of symptoms which fall into the category of post-embolization syndrome will be present in varying degrees of severity and for varying lengths of time. The following describes these symptoms and their management in post-UFE patients.

Pain:

• Can be significant, especially during the first 6-8 hours.
• Toradol non-narcotic anti-inflammatory is used during and 5 days post procedure.
• Narcotics (Morphine or synthetic narcotics) will be given during and immediately after the procedure intravenously. A patient-demand infusion pump is used until the morning after the procedure. At this point a prescription for oral medications will be given for home use. These medications are for pain not responding to the non-steroidal anti-inflamatory drugs (NSAIDS). The dose of these medications should be reduced over the first few days after the procedure and are rarely needed beyond one week. These medications cause nausea and constipation. You cannot drive a car or make important decisions while taking these drugs. You should take a daily laxative while taking these medications, drink plenty of fluids and eat lots of fruits and vegetables to avoid problems with constipation.
• Tylenol is to be taken as directed on the bottle for the first week after treatment. This is mainly for fever, but also helps with pain control.

Fever:

• It is common to run a fever below 101º F after the procedure for a week or so.
• Please check your temp. daily for the first week.
• Infection uncommonly occurs after UFE but can be a very serious problem if not properly addressed.  If you have a temperature over 101º or fever with shaking chills, we ask that you seek medical attention immediately.  If you are unable to contact us, please go to the emergency room ASAP. 

Nausea:

• Usually due to narcotics.
• Treated with intravenous medications at the hospital.

Uterine Cramping:

• Normal after the procedure. Treated with NSAIDs; narcotics if severe.
• Should decrease over the days following treatment.
• May be associated with passage of small clots or tissue from the dying fibroids.
• Notify us if cramping is becoming more severe or lasting more than a week after the procedure.

Symptoms Associated with Uterine Fibroids:

• As symptoms vary in individuals, so does the length of time it takes for them to respond to the embolization.
• Bleeding usually decreases during the first period after treatment and continues to decrease thereafter. Inter-menstrual spotting is not uncommon and is related to the fibroids breaking down.
• The fibroids will feel softer and will cause less pressure after the procedure, but will not actually begin shrinking until several months after the procedure. Maximal shrinkage occurs at about one year.
• Cramping during periods should be less, but this may take several cycles before you see a substantial change.
• Early Ovarian failure (Menopause) is an extremely uncommon complication following UFE in patients under the age of 45.  As patient age increases, the risk of early ovarian failure increases.
• Women can and have become pregnant after UFE.  The effect of UFE on  the health of the fetus is not known at this time, although there are a number of reports of uncomplicated pregnancies following this procedure.

Follow Up

• Initial follow up with Wake Radiology Interventional Services - We will call you to schedule this appointment. 
• Your Gynecologist at three months after the procedure.