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Uterine artery embolization

Definition

Uterine artery embolization (UAE) is a procedure to treat fibroids without surgery. Instead, the doctor (a radiologist) uses special imaging methods to treat your uterine fibroids. During the procedure, the blood supply of the fibroids is cut off, causing the fibroids to shrink.

Alternative Names

Uterine fibroid embolization; UFE; UAE

Description

UAE is done in the radiology department of a hospital. Usually local anesthesia is used. You will be awake but unable to feel pain. (This is called conscious sedation.) The procedure takes about 60 to 90 minutes.

The procedure is usually done this way:

• You will receive a sedative, a medicine that will make you relaxed and sleepy.
• A local anesthetic (pain-killer) will be applied to your skin around your groin. This will numb the area so you do not feel pain.
• Your radiologist will make a 1/4-inch-long incision (cut) in your skin. Then the radiologist will insert a catheter (a thin tube) into your femoral artery. This artery is at the top of your leg. Next the radiologist will thread the catheter into your uterine artery. This artery supplies blood to the uterus.
• Small plastic or gelatin particles will be 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 then die.
• UAE will be done in both your left and right uterine arteries.

Why the Procedure Is Performed

Uterine artery embolization is an effective way to treat fibroids that are not very large. Sometimes women have UAE done after childbirth to treat very heavy vaginal bleeding.

Women who may want to become pregnant in the future should NOT have this procedure.

Risks

Uterine artery embolization is generally safe. Ask your doctor about these possible problems.

A risk for any anesthesia is having a bad reaction to the anesthetic that is used.

The risks for any invasive procedure are:

• Bleeding
• Infection
• Bruising

The risks of uterine artery embolization are:

• Injury to an artery or to the uterus
• Complications with a future pregnancy. Some of these are intrauterine growth restriction (a condition that causes the baby to grow more slowly than usual in the uterus), preterm delivery (the baby is born early), bleeding after delivery, problems with the placenta, and miscarriage.
• Pregnancy is not recommended after this procedure
• Early menopause

Before the Procedure

Always tell your doctor or nurse:

• If you could be pregnant
• What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription

Before your UAE:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help.

On the day of your UAE :

• You will usually be asked not to drink or eat anything for 6 to 8 hours before this procedure.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Women usually stay in the hospital overnight after UAE. Some women are able to go home a few hours after treatment, but this is less common.

You will receive pain medicine. You will be asked to lie flat for 4 to 6 hours after the procedure.

Pelvic cramps are common for the first 24 hours after the procedure. They may last for 2 weeks. Cramps may be severe and may last more than 6 hours at a time.

The treated fibroid tissue may pass through your vagina.

Outlook (Prognosis)

Uterine artery embolization usually works well to decrease pain, pressure, and bleeding from fibroids. Up to 30% of women who have UAE done:

• Need to have the procedure again within 1 or 2 years
• Have a hysterectomy within 5 years after the procedure

References

Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007 Jan 25;356(4):360-70.

Katz VL. Benign gynecologic lesions : Vulva, vagina, cervix, uterus, oviduct, ovary. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 18.

Volkers NA, Hehenkamp WJ, Birnie E, Ankum WM, Reekers JA. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial. Am J Obstet Gynecol. 2007 Jun;196(6):519.e1-11.

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