Uterine Fibroid Embolization (UFE)

By: Wake Forest Baptist Health

- Uterine artery embolization is a technique which was first created in the 1970s to treat women that had significant bleeding after giving birth. The technique of the procedure is basically to insert a small tube or catheter into the arteries that supply the uterus. Most women have one blood vessel on each side of the uterus, and so an interventional radiologist will insert a catheter into the artery in their hip. Using x-rays, they will then guide that catheter into each artery of the uterus. When they're in the right position, they will then inject a particle, or beads, which will then block off the blood flow to that artery.

Multiple studies have been done over the past 20 years to compare the effectiveness of uterine artery embolization versus myomectomy. As many studies have illustrated, they are essential equivalent in effectiveness. Research shows that approximately 90% of women have improvement in their clinical symptoms after uterine artery embolization and myomectomy. Since the early 1990s when uterine artery embolization was developed as a technique to treat uterine fibroids, it has grown is now used throughout the world. There have been numerous research studies comparing the effectiveness of uterine artery embolization with myomectomy as well as hysterectomy. It is now considered by the American College of Obstetrics and Gynecology to be an equivalent option to myomectomy. In fact, while in office as Secretary of State, Condaleezza Rice underwent uterine artery embolization to treat her uterine fibroids. She had the procedure done on a Friday and was back to work on Monday.

The procedure is uterine artery embolization because what the interventional radiologist is doing is blocking off the arteries to the uterus. Commonly though, this is referred to as uterine fibroid embolization because people view this as a procedure to treat fibroids not necessarily just to block off the uterine arteries. Embolization is basically just a fancy term for saying blocking off of a blood vessel. There are many different materials that we can use to block off blood vessels. We can use glue. We can use something called gel foam. For uterine artery embolization, we use an FDA-approved product, which is a gelatin micro sphere; and what that means is it's a very tiny, almost microscopic, particle that when infused into the uterine artery will block off blood flow.

The procedure is done in an interventional radiology procedural room. The procedure typically takes about two hours. The way that we do is that we make a small little incision, about this big, over the artery that's over the right hip. Because all the arteries connect, we can put a catheter into this artery; and using our x-rays, we can guide it into the arteries that feed the uterus. Most women have one artery on each side of the uterus, so the typical technique is to place the catheter into the artery over the right hip.

Uterine Fibroid Embolization (UFE)

Using our x-rays we'll guide that catheter up and over into the left uterine artery. Once we're in the correct place, then we will infuse our particles to block off blood flow to that artery. Then we'll come back and then block off the blood flow in the right uterine artery; and when we've done that, we'll remove the catheter and put a little patch over the hole that we made in the artery. At the end, the patient will leave the interventional radiology procedure room with just a bandaid.

Most patients report that the procedure itself is not particularly painful. I'll numb the skin up over the right hip, and that will sting for a couple seconds, just like any numbing medication does; but then you typically do not feel much throughout the rest of the procedure. You cannot feel the catheter moving around, and you can't feel the particles being infused. Near the end of the procedure however, once the blood supply to the uterus has been reduced, the uterus responds by cramping. This is a predictable response to the treatment, and many patients state that near the end of the procedure they start to have cramping and nausea.

We know this is coming, and so we provide them with significant pain medication and nausea medication. We then keep the patient in the hospital overnight for observation to make sure that their pain is controlled and their nausea is controlled. The majority of women report that, after the case, the pain and nausea builds that first day and then gets much better over night. By the next morning, most patients are out of bed, eating and drinking and ready to go home. Typically once the woman leaves the hospital, the cramping and the nausea gets better each day. Most women state by about day 7, they feel completely back to normal. The main benefit of uterine fibroid embolization, relative to the surgical options, is that it is much less invasive.

Women typically are only in the hospital for one day, and the recovery time is typically only about one week. In addition, there's no surgical incision. The woman also retains her uterus and has the chance of having more children in the future. Uterine artery embolization is also successful in approximately 90% of women.

If it is unsuccessful, it does not prevent a woman from having a hysterectomy later. In fact, it makes the procedure easier.

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