Uterine artery embolization

  • Definition
    • Uterine artery embolization (UAE) is a procedure to treat fibroids without surgery. Uterine fibroids are noncancerous (benign) tumors that develop in the uterus (womb).

      During the procedure, the blood supply of the fibroids is cut off. This typically causes the fibroids to shrink.

  • Alternative Names
    • Uterine fibroid embolization; UFE; UAE

  • Description
    • UAE is done by a doctor called an interventional radiologist.

      You will be awake but you will not feel pain. This is called conscious sedation. The procedure takes about 1 to 3 hours.

      The procedure is usually done this way:

      • You receive a sedative. This is medicine that makes you relaxed and sleepy.
      • A local painkiller (anesthetic) is applied to the skin around your groin. This numbs the area so you do not feel pain.
      • The radiologist makes a tiny cut (incision) in your skin. A thin tube (catheter) is inserted into your femoral artery. This artery is at the top of your leg.
      • The radiologist threads the catheter into your uterine artery. This artery supplies blood to the uterus.
      • Small plastic or gelatin particles are 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 die.
      • UAE is done in both your left and right uterine arteries through the same incision. If needed, more than 1 fibroid is treated.
  • Why the Procedure Is Performed
    • UAE is an effective way to treat symptoms caused by some types of fibroids. Discuss with your health care provider whether this procedure is likely to be successful for you.

      Women who have UAE may:

      • Have symptoms including bleeding, low blood count, pelvic pain or pressure, waking up at night to urinate, and constipation
      • Have already tried medicines or hormones to reduce symptoms
      • Sometimes have UAE after childbirth to treat very heavy vaginal bleeding
  • Risks
    • Uterine artery embolization is generally safe.

      Risks of any invasive procedure are:

      • Bleeding
      • A bad reaction to the anesthetic or medicine that is used
      • Infection
      • Bruising

      Risks of uterine artery embolization are:

      • Injury to an artery or to the uterus
      • Failure to shrink the fibroids or effectively treat the symptoms
      • Possible problems with a future pregnancy. Women who want to become pregnant should carefully discuss this procedure with their health care provider, since it may reduce the chances of a successful pregnancy.
      • Lack of menstrual periods
      • Problems with ovarian function or premature menopause
      • Failure to diagnose and remove a rare type of cancer that can grow in fibroids (leiomyosarcoma). Most fibroids are noncancerous (benign), but leiomyosarcomas occur in a small number of fibroids. Embolization will not treat or diagnose this condition and can lead to delayed diagnosis, and possibly a worse outcome once it is treated.
  • Before the Procedure
    • Always tell your doctor or nurse:

      • If you could be pregnant, or you plan to become pregnant in the future
      • What medicines you are taking, including medicines, supplements, or herbs you bought without a prescription

      Before UAE:

      • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
      • Ask your doctor which medicines you should still take on the day of your surgery.
      • If you smoke, try to stop. Your health care provider can give you advice and information to help you quit.

      On the day of UAE:

      • You may be asked not to drink or eat anything for 6 to 8 hours before this procedure.
      • Take the medicines your doctor told you to take with a small sip of water.
      • Arrive on time at the hospital as instructed.
  • After the Procedure
    • You may stay in the hospital overnight. Or you may go home the same day.

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

      Follow any other instructions about taking care of yourself after you go home.

      Moderate to severe abdominal and pelvic cramps are common for the first 24 hours after the procedure. They may last for a few days to 2 weeks. Cramps may be severe and may last more than 6 hours at a time.

      Most women recover quickly and are able to return to normal activities within 7 to 10 days. Sometimes portions of the treated fibroid tissue may pass through your vagina.

  • Outlook (Prognosis)
    • Uterine artery embolization works well to decrease pain, pressure, and bleeding from fibroids in most women who have the procedure.

      UAE is less invasive than surgical treatments for uterine fibroids. Many women may return more quickly to activities than after surgery.

      Most studies show that some women require additional procedures to completely treat their symptoms. These procedures include hysterectomy (surgery to remove the uterus), myomectomy (surgery to remove the fibroid) or repeating the UAE.

  • References
    • American College of Obstricians and Gynecologists Practice Bulletin: Alternatives to hysterectomy in the management of leiomyomas. Number 96, August 2008. Obstet Gynecol. 2008;112:387-400.

      Bradley L, Uterine fibroid embolization: a viable alternative to hysterectomy. Obstet Gynecol. 2009:127-135.

      Goodwin SC, Spies JB, Worthington-Kirsch R, et al. Uterine artery embolization for treatment of leiomyomata: long-term outcomes from the FIBROID registry. Obstet Gynecol. 2008; 111:22-33.

      Munro MG. Uterine leiomyomas, current concepts: pathogenesis, impact on reproductive health, and medical, procedural, and surgical management. Obstet Gynecol Clin N Am. 2011;38:703-731.

      Nucci MR, Quade BJ. Uterine mesenchymal tumors. Crum, CP, Nucci MR, Lee KR, eds. In: Crum: Diagnostic Gynecologic and Obstetric Pathology. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 20.

      Ravina JH, Herbreteau D, Ciraru-Vigneron N, et al. Arterial embolisation to treat uterine myomata. Lancet. 1995;346(8976):671-672.

      Tulandi T, Salamah K. Fertility and uterine artery embolization. Obstet Gynecol. 2010;115:857-860.