Uterine Artery Embolization
SUMMARY:
Uterine fibroids are benign tumors of the uterine smooth muscle which occur in 20 to 50% of adult females. When large enough, they cause a pelvic pain and fullness, heavy menstruation (menorrhagia) and anemia, urinary frequency, and constipation. They often regress in size at menopause. Therapy for symptomatic fibroids involves surgery, either myomectomy or hysterectomy sometimes performed laparoscopically. Hormonal treatment can also be used.
Recent reports from France and the United States have documented a decrease in uterine and fibroid size, and in patient's symptomatology following uterine artery embolization with small particles (PVA). This was originally attempted pre-operatively to decrease the risk of operative hemorrhage, but the notion that it might replace operative therapy was entertained when symptomatic relief was documented.
The technique of embolization is not new. It has been widely utilized for over 20 years to arrest bleeding in many organ systems. The indication for relief of fibroid symptomatology however, is new.
PROCEDURE:
A pre-embolization pelvic ultrasound be carried out prior to this procedure to confirm the presence of fibroids. Bilateral uterine artery embolization will be performed in a single setting. The bilateral femoral arterial approach. Each uterine artery will be selectively catheterized and embolized with small PVA particles followed by placement of a stainless steel coil to obliterate the uterine arterial flow.
Post procedural recovery will involve overnight admission and IV patient controlled analgesia pump for pain management. Oral analgesia will be provided at discharge.
Ultrasound follow-up will be obtained at 3, 6 and 12 months post embolization.
The procedure takes on average approximately 1 hour to perform. The post procedural recovery period is on average approximately 1 week.
Risks of the procedure are low. The overall risk of complications is less than 1%. These include hematoma formation at the site of groin puncture, contrast reaction, or post procedural infection.
The radiation exposure is equivalent to the radiation dosage received with two barium enema examinations. It should have no lasting significance.
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