Uterine artery embolization

PATIENT SELECTION
Uterine artery embolization (UAE) is an alternative to hysterectomy and is performed for women who have lifestyle limiting symptoms due to uterine fibroids.  Symptoms include heavy uterine bleeding requiring frequent changing of pads or tampons or bleeding that results in social embarrassment or bleeding requiring blood transfusions.  Bulk symptoms such as pelvic pain, frequent urination, urinary urgency or constipation are also indications for uterine artery embolization.  Most women treated with UAE are beyond their childbearing years but women desiring to maintain fertility can be treated with UAE if other alternative treatments are not possible or have been unsuccessful.

PRE-PROCEDURE WORKUP
Patients who are candidates for UAE are evaluated in our clinic by an interventional radiologist.  We also require evaluation by a gynecologist.  If a patient does not have a gynecologist or her gynecologist is unwilling to discuss uterine artery embolization, we can arrange an appointment with one of our staff gynecologists.  A recent pap smear is necessary and in some cases an endometrial biopsy is also required.  We obtain MRI scans pre-procedurally on all patients to insure that the symptoms can be attributed to fibroids and not another disease process.

POTENTIAL RISKS
We discuss in detail with the patient potential risks and alternatives to the procedure.  Risks include (but are not limited to) premature menopause, serious infection, bleeding and non-target embolization.  The incidence of serious complications is approximately 0.5%.  10% of women do not achieve symptomatic improvement and may go on to require hysterectomy.  Occasionally infarcted fibroids will pass vaginally weeks or months following the procedure.  This is not usually a serious problem.

DAY OF PROCEDURE
On the day of the procedure, the patient is admitted through our access center and is taken to the pre-operative holding area.  Intravenous antibiotics and anti-inflammatory drugs are administered and standard blood tests are performed.  The procedure is performed in an operating room with special x-ray imaging equipment.  The staff consists of the interventional radiologist, a scrub nurse, a circulating nurse, a sedation nurse and two x-ray technologists.  A catheter is placed through the femoral artery in the right groin with local anesthesia.  It is then advanced into one of the uterine arteries.  Particles are then injected through the catheter to block off the blood vessels supplying the uterine fibroids.  The catheter is then advanced through the same groin site into the uterine artery on the other side and particles once again injected.  Throughout the procedure the patient's family is informed of the progress of the procedure by our nurse liaison.

POST-PROCEDURE
Following uterine artery embolization the patient is admitted to the hospital overnight.  Most patients experience moderate pelvic discomfort and flu-like symptoms such as nausea and low grade fever.  This is generally improved within 24 hours and the patient is dismissed home on oral pain medication, anti-nausea medication, an anti-inflammatory drug and a stool softener.  Activity is limited to no heavy lifting for 3 days.  Most patients can return to work within a week.  There may be some vaginal discharge for the first month.  Pads only should be used in the first month due to the possibility of infection from tampons.  Bleeding symptoms are often improved in the first month.  Bulk symptoms, however, may not resolve for several months following the procedure.  MRI scan is obtained at 3 months.