UFE is a non-surgical way of treating fibroids by blocking off the arteries that feed the fibroids, the uterine arteries, and making the fibroids shrink. It is performed by an interventional radiologist, and is an alternative to an operation. UFE was first performed in 1995, and since then over 200,000 women have had the procedure performed, world-wide.
Previously, most fibroids have been treated by an operation, generally a hysterectomy, where the womb is removed altogether.
Procedure
A specially trained doctor called an interventional Radiologist performs UFE. Interventional radiologists have special expertise in using X-ray equipment, and also in interpreting the images produced. They need to look at these images while carrying out the procedure. Consequently, interventional radiologists are the best trained people to insert needles and fine catheters into blood vessels, through the skin, and place them correctly.
You need to be an in-patient in the hospital. You will probably be asked not to eat for four hours beforehand, though you may be told that it is alright to drink some water. You may receive a sedative to relieve anxiety. If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium, the dye used for kidney x-rays and CT scanning, then you must also tell your doctor about this.
You will lie on the X-ray table, generally flat on your back. The skin near the point of insertion, probably the groin, will be swabbed with antiseptic, and then most of the rest of your body covered with a theatre towel.
The skin and deeper tissues over the artery in the groin will be anaesthetized with local anesthetic, and then a needle will be inserted into this artery. Once the interventional radiologist is satisfied that this is correctly positioned, a guide wire is placed through the needle, and into this artery. Then the needle is withdrawn allowing a fine, plastic tube, called a catheter, to be placed over the wire and into this artery.
The interventional radiologist will use the X-ray equipment to make sure that the catheter and the wire are then moved into the correct position, into the other arteries which are feeding the fibroid. These arteries are called the right and left uterine arteries. A special X-ray dye, called contrast medium, is injected down the catheter into these uterine arteries, and this may give you a hot feeling in the pelvis. Once the fibroid blood supply has been identified, fluid containing thousands of tiny particles is injected through the catheter into these small arteries which nourish the fibroid. This silts up these small blood vessels and blocks them so that the fibroid is starved of its blood supply
Both the right and the left uterine arteries need to be blocked in this way. At the end of the procedure, the catheter is withdrawn and the Interventional Radiologist then presses firmly on the skin entry point for several minutes, to prevent any bleeding.
The procedure itself may become painful. However, there will be a nurse, or another member of staff, standing next to you and looking after you.
Some uterine fibroid embolization do not take very long, perhaps half an hour. Other embolization procedures may be more involved, and take rather longer, perhaps an hour.
Complications
Uterine fibroid embolization is a safe procedure, but there are some risks and complications that can arise, as with any medical treatment.
There may occasionally be a small bruise, called a haematoma, around the site where the needle has been inserted, and this is quite normal. Most patients feel some pain afterwards. This ranges from very mild pain to severe cramp, period-like pain. It is generally worst in the first 12 hours, but will probably still be present when you go home.
Most patients get a slight fever after the procedure. This is a good sign as it means that the fibroid is breaking down. A few patients get a vaginal discharge afterwards, which may be bloody. This is usually due to the fibroid breaking down. Usually, the discharge persists for approximately two weeks from when it starts, although occasionally it can persist intermittently for several months. If the discharge becomes offensive and if it is associated with a high fever and feeling unwell, there is the possibility of infection and you should contact your interventional radiologist and GP and ask to see your gynecologist urgently.
The most serious complication of uterine fibroid embolization is infection. This happens to perhaps two in every hundred women having the procedure. The signs that the uterus is infected after embolization include great pain, pelvic tenderness and a high temperature. Lesser degrees of infection can be treated with antibiotics, and perhaps a small operation on the womb, a “D and C” or hysteroscopy. If severe infection has developed, it is generally necessary to have an operation to remove the womb, a hysterectomy.
Approximately 8% of women have spontaneously expelled a fibroid, or part of one, usually between six weeks to twelve months afterwards. If this happens, you are likely to feel period like pain and have some bleeding.
A very few women have undergone an early menopause, the change of life, after this procedure.
What are the results of uterine fibroid embolization?
There are now many good, long term studies of the results of uterine fibroid embolization. Over 90% of women will be relieved of their symptoms after UFE and reduction in uterine and fibroid volumes of over 60% are expected. Incomplete death of the fibroids can lead to failure of the treatment in 5-10% of cases and re occurrence of fibroid symptoms can occur in up to 25%.
Some women, who could not become pregnant before the procedure because of their fibroids, have become pregnant afterwards.
UFE is considered a safe procedure, designed to improve your medical condition and save you having a larger operation. There are some risks and complications involved, and because there is the possibility of a hysterectomy being necessary, you do need to make certain that you have discussed all the options available with your doctors.