Uterine Artery Embolization

At least 25% of all women develop benign uterine growths called fibroids. Usually fibroids do not cause symptoms, but in many cases they can cause excess menstrual bleeding, pain, heaviness and discomfort. When symptoms become severe, may women choose to have them removed. Procedures most often used to treat fibroids are hormonal therapy (which shrinks fibroids) in the form of a daily pill, myomectomy (surgical removal of fibroids) and hysterectomy (surgical removal of the uterus). Uterine artery embolization is an alternative and simpler procedure for the treatment of fibroids. Interventional radiologists have been using this embolization technique for over 20 years, but only in the last several years has it been used for the treatment of fibroids in the United States.

Suitable candidates for this procedure include: 1) age over 18, 2) documented fibroids symptomatic enough to justify surgery, 3) absence of pelvic infection, and 4) an evaluation by Dr. Carter verifying the absence of pregnancy and malignancy.

Advantages of the procedure over surgery include:

· Treats all fibroids simultaneously
· If the primary symptom is excessive bleeding, most
  cases experience a reduction within 24 hours.
· Allows preservation of an intact uterus
· No risks associated with general anesthesia
· Hospital stay is usually less than 24 hours.

Purpose:

The purpose of uterine artery embolization is to block the blood supply that feeds uterine fibroids. Blocking the blood supply or "embolization" of the uterine artery results in a shrinkage of the fibroid growths. The decreased size thereby diminishes the uncomfortable symptoms of heavy bleeding and pelvic pain often associated with fibroids.

Consultation with Dr. Carter:

You will meet with Dr. Carter to discuss the current status of your health, health history, allergies to drugs/solutions and fibroid symptoms you may be experiencing. Please use this time to discuss any issues regarding fibroid masses, alternative procedure, risks and complications. Remember to ask questions of what to expect from the uterine artery embolization procedure and your recuperation. Dr. Carter will perform the necessary evaluations, which may include ultrasound and help you to determine if this is the best procedure for you. Dr. Carter will then help you arrange to have this procedure done by the skilled interventional radiology team with which he works.

The Procedure:

The procedure is usually performed in the morning. You will be asked to arrive tow hours before the procedure and be advised not to eat for four hours before the scheduled procedure time. The procedure is performed in a special interventional room equipped with a fluoroscopy x-ray-imaging machine. The fluoroscopy machine provides a constant view for the interventional radiologist to observe the vessels and circulation in your pelvic region. An intravenous catheter (IV) will be placed in your arm, and you will be given a dose of prophylactic antibiotics. A urinary catheter will also be temporarily placed during the procedure. Your skin at the area of your right groin will be punctured with a needle, and a very thin, catheter will be inserted into your femoral artery. The catheter is navigated towards and into the uterine artery until it is positioned in an area where the artery divides into the multiple small arteries that feed the fibroid. At this point, pieces of polyvinyl alcohol are released (the size of tiny grains of sand,) and within moments the small arteries feeding the fibroid become clogged. The catheter is once again navigated to the opposite side where it is inserted into the uterine artery and the polyvinyl particles are released , clogging the small arteries feeding the fibroid. At this time the catheter is removed, the skin puncture closed and dressed with a bandage, and the procedure is complete. The average procedure takes 1 to 1 ½ hours.

Following the procedure you will be moved to a hospital room, where you will be monitored for pain symptoms. Following the procedure you will experience "cramping" similar to menstrual cramps which can range from barely noticeable to very painful in some patients. Most patients are released in the late afternoon and allowed to recuperate at home. After 12 hours, much of the discomfort of the procedure subsides, and what remains can be controlled by pain pills. Please arrange to be driven home by a family member. Do not plan on driving yourself home. You will be able to resume normal activities in 2 to 3 days.

Post procedure instructions:

Ibuprofen (Motrin, Advil, Nuprin) at 600 mg (equals three 200 mg tablets) every 6 hours as needed for 10 days. Ibuprofen is effective in pain relief, and will continue to decrease the amount of swelling and tissue reaction.

Recovery:

You can expect improvement almost immediately following the procedure in respect to bleeding and pelvic pain. Within six weeks, the lack of blood supply will result in shrinkage of the fibroid(s), while the uterus remains unharmed and intact.

Follow-up examinations:

Please make a follow-up appointment with Dr. Carter in 2 weeks following the procedure. If you experience any of the following unusual symptoms, contact Dr. Carter as soon as possible. One of the symptoms that may occur following the procedure is a fever, which can go as high as 102 degrees F. within the first 10 days. This fever producing reaction can be caused by the breakdown of products from the fibroid, and is more common when very large fibroid masses are embolized. If the fever persists after 10 days, notify Dr. Carter. A gray or brown vaginal discharge may start shortly after the procedure, but it is nothing to worry about, and merely indicates the elimination of breakdown products from the shrinking fibroid. Heavy periods may present for a few cycles after embolization, but this is not permanent, and will subside without treatment.