|
Uterine artery embolization
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. This causes 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 you will not feel pain. This is called conscious sedation. The procedure takes about 45 - 60 minutes.
The procedure is usually done this way:
- You receive a sedative. This ismedicine that makes you relaxed and sleepy.
- A local anesthetic (painkiller) is applied to the skin around your groin. This numbs the area so you do not feel pain.
- The radiologist makes a tiny incision (cut) in your skin. A catheter (a thin tube) is inserted into your femoral artery. This artery is at the top of your leg.
- The radiologist threads the catheter into your uterine artery. This artery supplies blood to the uterus.
- Small plastic or gelatin particles are 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 die.
- UAE is done in both your left and right uterine arteries, using only one incision. If needed, more than one fibroid is treated.
Why the Procedure Is Performed
UAE is an effective way to treat symptoms caused by fibroids.
- Symptoms can include bleeding, low blood count, pelvic pain or pressure, waking up at night to urinate, and constipation.
- Before having UAE, it is likely that your fibroids were treated with medicines or hormones.
- Sometimes women have UAE after childbirth to treat very heavy vaginal bleeding.
Risks
Uterine artery embolization is generally safe.
Risks of any invasive procedure are:
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 with their health care provider. Other options to treat their fibroid-related symptoms may be considered.
- Menstrual periods may not return after uterine artery embolization.
Before the Procedure
Always tell your doctor or nurse:
- If you could be pregnant, or plan to be pregnant in the future.
- What medicines you are taking, including medicines, supplements, or herbs you bought without a prescription
Before UAE:
- You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
- Ask your doctor which medicines you should still take on the day of your surgery.
- If you smoke, try to stop. Your doctor or nurse can give you advice and information to help you quit.
On the day of UAE:
- You may be asked not to drink or eat anything for 6 - 8 hours before this procedure.
- Take the medicines your doctor told you to take with a small sip of water.
- Arrive on time at the hospital as instructed.
After the Procedure
You may stay in the hospital overnight. Or you may go home the same day.
You will receive pain medicine. You will be instructed to lie flat for 4 - 6 hours after the procedure.
Follow any other instructions about taking care of yourself after you go home.
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 may return more quickly to activities than after surgery.
As with other treatments for uterine fibroids, some women may require more procedures or a hysterectomy in the future.
References
American College of Obstricians and Gynecologists Practice Bulletin: Alternatives to hysterectomy in the management of leiomyomas. 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.
Munro MG. Uterine leiomyomas, current concepts: pathogenesis, impact on reproductive health, and medical, procedural, and surgical management. Obstet Gynecol Clin N Am. 2011;38:703-731.
Tulandi T, Salamah K. Fertility and uterine artery embolization. Obstet Gynecol. 2010;115:857-860.
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.
