Uterine Artery Embolization (UAE)

WHAT IS UTERINE ARTERY EMBOLIZATION?

Uterine artery embolization (UAE) is a procedure in which an interventional radiologist uses a catheter to deliver small particles that block the blood supply to the uterine body. The procedure is done for the treatment of uterine fibroids and adenomyosis.

UAE is a minimally invasive procedure and is also called “uterine fibroid embolization”. It has a shorter recovery time. It requires more repeat procedures.

USES OF UAE 

• For treating symptomatic fibroids
• To stop severe pelvic bleeding caused by trauma
• To stop severe bleeding caused by hemorrhage after birth
• To stop severe pelvic bleeding resulting from malignant gynecological tumors, such as adenomyosis.

BENEFITS OF UAE

• UAE  done under anesthesia is much less invasive than open or laparoscopic surgery.
• No surgical incision is required
• General anesthesia is not required
• Recovery time is much shorter
• Virtually no blood loss, and does not require a blood transfusion
• Patients of UAE ordinarily can resume their normal activities much earlier than those on surgery
• About 90% of women who treat their fibroid with UAE experience significant or total absence of fibroid-related symptoms. This is true of women who had heavy bleeding; urinary frequency, pelvic pain or pressure, and fibroid shrink (about 20% reduction in diameter).
• Follow-up studies over the years have shown that it’s rare for treated fibroid (with UAE) to re-grow or develop new ones. UAE is more permanent than the hormonal therapy option, in which the fibroid tumors grow back when the therapy is stopped.

RISKS

Uterine embolization procedure involves the use of a catheter inside a blood vessel and therefore may carry certain risks or complications. 

These risks include:

• Death from embolism, or sepsis, resulting from multiple organ failure.
• Damage to the blood vessel, causing bacterial infection and pus formation.
• Bruising or bleeding at the puncture site (hematoma), vaginal discharge containing pus, blood clots.
• The risk of infection may lead to severe health complications and lengthy hospitalization.
• An embolic may lodge in the wrong place, this complication can deprive normal tissue of its oxygen supply and causing damage to the other organs or parts of the body.
• An occasional patient may have an allergic reaction to the X-ray contrast material used during the UAE. It may range from mild itching to severe reactions that can affect breathing or blood pressure.
• Approximately 1 to 5, out of 100 women experience menopause after UAE. This is more common in women older than 45years.
• Ovarian damage resulting from embolic material imprinting to the ovary.
• Loss of ovarian function, infertility, and loss of orgasm.
• About 2-3 percent of women will pass pieces of fibroid tissue often after UAE, and may require D and C (dilation and curettage) procedure to make sure all the materials are removed to prevent bleeding and infection.
• Some women may eventually end up hysterectomy (surgery) because of infection or persistent symptoms after UAEs. The younger the patient the greater the tendency to develop new fibroids or recurrent symptoms.
• Physicians recommend that women who wish to have more children should consider the surgical method instead of the UAE; however, these questions remain unanswered.
• The uterine wall may be weakened due to UAE and may pose a problem during child delivery.
• Too much exposure to X-rays during UAE procedures might pose complications in future childbearing outcomes.
• Post-embolization syndrome, characterized by chronic pains, fever, nausea, vomiting, malaise, severe night sweating, and foul vaginal odor to infection.

LIMITATIONS OF UAE

Uterine artery embolization should not be performed:

1. In women who have symptoms from their fibroid tumors.
2. When cancer is a possibility.
3. When there is an inflammation of or infection in the pelvis.
4. In patients allergic to contrast material.
5. In pregnant women.
6. In those having a condition that affects their blood vessels [vascular diseases].

SPECIALTY: Interventional radiologist.

HOW TO PREPARE FOR UAE

Uterine artery embolization is usually carried out by an interventional radiologist. However, a specialist in obstetrics and gynecology who has training in UAE can perform it.

• Do not eat or drink in the evening before the procedure, after midnight, or after whatever time your doctor advises you.
• If you’re on medications, ask your doctor if you should stop taking them before or after the procedures.

EQUIPMENT USED FOR UAE

1. X-ray Equipment.

Consists of:

• Radiographic table.
• One or two x-ray tubes.
• A television-like monitor [located in the examination room].
• Fluoroscopy, which converts x-rays into video images, is used to watch and guide the progress of the procedures.

The video created by fluoroscopy is produced by the x-ray machine and a detector suspended over a table on which the patient lies.

1. A Catheter

A long and thin plastic tube of considerably small-diameter [about 1/8 inch in diameter].

1. Embolic Agents

Several different types of these are used in UAE. They act similarly, but they differ in their composition.

1. Polyvinyl alcohol, which is a plastic material resembling coarse sand.
2. ‘Gelfoam’, which is a gelatin sponge material.
3. Microspheres, which are polyacrylamide spheres with a gelatin coating.
4. An intravenous line [IV].
5. Ultrasound machine.
6. Devices that monitor your heartbeats and blood pressure.

THE UTERINE ARTERY EMBOLIZATION [UAE] PROCEDURES 

Note that the procedures take place in the Cath room.

Before The Procedure

• You will be positioned on the procedure table.
• You will have an intravenous line placed in one of your veins, to give you the fluids, anesthetics, antibiotics, and pain medications.
• You will be connected to monitors that track your heart rate, blood pressure, oxygen level, and pulse.
• Your body area where the catheter is to be inserted will be sterilized and covered with a surgical drape.

During The Procedure

• Your radiologist will numb the area with a local anesthetic.
• A very small skin incision is made at the site.
• The radiologist will then insert a catheter into the femoral cavity and guides [using the guidance of an x-ray] the catheter to one of the two uterine arteries.
• A contrast fluid [usually containing iodine] is injected that flows into the uterine artery and its branches and makes them visible on the fluoroscopic monitor.
• The radiologist identifies the right area of the uterine artery and ignites the tiny particles [made up of plastic or gelatin] into the blood vessels. The particles followed the blood flow to block the fibroid vessels.
• The radiologist will inject more contrasts into the uterine and checks additional images to ensure that blood is no longer reaching the fibroids.
• The radiologist repeats the same steps in the second uterine artery, to release an embolic agent and block the blood flow.
• After the procedure, the radiologist will remove the catheter.
• He then applies pressure to stop the bleeding.
• The tiny opening in the skin is covered with a dressing.
• Your intravenous line [IV] is the last thing that will be removed before you go home.
• After The Procedure

While in the recovery room, your care team will monitor your condition. Necessary medications are given to control pain and nausea. 

You will be taken to your hospital room, where the effects of the anesthesia fade away. You may spend a night in the hospital, for observation.

• While on the hospital bed for observation, you must lie flat for several hours to prevent pooling of the blood [hematoma] at the femoral artery site.
• Share your health development with the healthcare workers. Pain is the primary side effect of UAE. The pain usually peaks up in the first 24 hours. You will receive pain medication to relieve the pain.
• Post-embolization syndrome [characterized by a low-grade fever. Pain, nausea, fatigue, or vomiting] is common after UAE. These symptoms are at the peak within 48 hours [2 days] after the procedures and later resolve on their own, within 7 days [1 week]. 

Stubborn symptoms that refuse to fade away, such as infection should be reported to your doctor for evaluation and treatment.

• By the next day, your urinary catheter is removed, and you should take a walk around. 

Recovering from the UAE is usually rapid, and complications are rare.

RESULTS

UAE typically improves reliefs of symptoms significantly,

• Some researches show that UAE has granted relief in most symptoms in the first three months after the procedure. In some women, reliefs are more significant five years after treatment. 

Uterine artery embolization continues to reduce symptoms such as heavy blood loss, urinary incontinence, and abdominal enlargement. The results seem to be comparable to that of myomectomy, in which the fibroids are surgically removed and the uterus repaired.

• Menstruation in most cases continues to maintain a normal cycle. If you miss any period, they may probably resume normally within a few months. 

A small number of women report menopause after UAE. The risks appear to be highest among women above 45 years old. This number is however small.

• Although the risk of menopause is low, subtle ovarian damage can make pregnancy difficult. There is also pregnancy complication involving abnormal placement of the placenta. 

Despite this risk, most women have had successful pregnancies after uterine artery embolization. 

SUCCESS RATE OF UAE

Uterine artery embolization is a very effective procedure with a fairly accurate success rate of 85%. Most women who go through the procedure have a remarkable improvement in their symptoms and degree in size of their uterine fibroids.

FAQs

• Can fibroids grow back after embolization?

Follow-up studies over several years have shown that it is rare for treated fibroids to regrow or for new fibroids to develop after UAE. This is because all fibroids present in the uterus; even early-stage modulus that may be too small to see on imaging exams are treated during the procedures.

• How long is recovery from fibroid uterine embolization?

There are no limitations after the procedures. It characteristically takes a week to 10 days to recuperate from UAE. In the first few days, pelvic pain and pressure from the procedures can be noteworthy.

• Do you lose weight after fibroid uterine embolization?

Women always ask if they will lose weight while having UAE, and the reply is that you will almost certainly shack redundant pounds if you treat your fibroids. If you have fibroids, you are most likely carrying extra weight. Eliminating the fibroids or dwindling them with UAE can habitually lead to weight loss.

• Is uterine artery embolization safe?

UAE is generally not dangerous. Inquire your physician as regards these potential harms. A danger for any anesthesia is having a dire retort to the anesthetic that is used.

• What is the cost of uterine artery embolization?

The costs were totaled and compared with the use of the unpaired, to test and to estimate the cost differentiation between UAE and abdominal myomectomy. The results were that the estimated hospital cost for UAE was $3,193, which was notably lower than the $5,598 projected for abdominal myomectomy