This is a new technique for the treatment of symptomatic fibroids.  It is a minimally invasive technique that is performed while the patient is conscious but sedated.  This procedure is performed by an interventional radiologist.  After local anesthetic is given, the femoral artery (just beneath the skin in the upper leg) is punctured with a small needle.  A tiny  tube (catheter) is inserted and navigated into the uterine artery under the guidance of a fluoroscopic imaging system.  Small plastic (polyvinyl alcohol) particles are then slowly released into the uterine arteries through the catheter.  These tiny particles block the blood supply to the uterine fibroids resulting in a decrease in their size and thus relief of associated symptoms.  At the end of the procedure the puncture site is cleaned and covered with a small Band-Aid.  The procedure takes 60-90 minutes.  Most patients require an overnight stay in the hospital, although some patients go home the day of the procedure.  Patients are completely recovered in 5 to 7 days.

While uterine artery embolization is new technique for the treatment of fibroids, the procedure has been used by interventional radiologist for decades for other reasons including post-partum hemorrhage (bleeding after childbirth) or otherwise uncontrollable bleeding from uterine cancer.  Embolization for treatment of fibroids has been performed for more that six years.  As of the end of 1998, 1,500 to 2,000 fibroid embolizations have performed world-wide.  In the United States embolization for fibroids was pioneered by interventional radiologists at the University of California at Los Angeles (UCLA) but is now available at our Fibroid Care Center.

A UCLA study of uterine artery embolization found a 50 percent average reduction in the size of the fibroids treated.  85 percent of patients report a decrease in bleeding and 90 percent report decrease in symptoms related to tumor pressing on adjacent tissue.  Greater than 90 percent of patients undergoing embolization require no further treatment.

Following embolization for fibroids, most patients experience some cramping, pain and nausea in the several hours after the procedure.  These post procedure symptoms are usually well controlled with the appropriate medications.

Although uterine artery embolization is a safe procedure there are some potential associated risks.  Complications occur in less than 3 percent of the patients.  One serious possible complication is infection.  In large studies, less that 1 percent of all patients undergoing the procedure have a complication serious enough to warrant a hysterectomy.

The average age of patients requiring uterine artery embolization is forty and thus most patients who undergo the procedure are finished with childbearing.  Therefore, the procedure's effect on fertility is difficult to study.  However in France, where the procedure has been performed longer that in the United States, over half a dozen patients have successfully carried pregnancies to term.  Six of the UCLA treated patients have become pregnant and have had normal vaginal or C-section deliveries after the embolization procedure.  Research is underway to study this issue further.

 

References in Medical Literature