March, 2002 - Advanced Radiology Introduces Uterine Fibroid Embolization

Uterine fibroid embolization treats fibroids without the physical and emotional impact of hysterectomy. Instead, fibroids shrink away using a non-surgical procedure which limits their blood supply. Most women experience decreased bleeding immediately; often during their first menstrual cycle following the procedure.

Fibroids are benign, non-cancerous tumors of the uterus which often cause pelvic pain and heavy menstrual bleeding. Fibroids often fail to respond to hormonal therapy requiring more invasive surgical treatment. Types of surgery include either myomectomy (surgical resection of individual fibroids) or hysterectomy (surgical removal of the uterus). Patients who undergo myomectomy have a 30-45% recurrence rate of fibroids and 25% require further surgery. Hysterectomy is a definitive solution yet requires a 2-3 day hospital stay, a 5-6 week recovery and carries the usual risks of major abdominal surgery including blood loss and infection.

Fibroid embolization is usually done in a hospital by an Interventional Radiologist, a physician who is specially trained to perform this and other minimally invasive procedures. Embolization means to block the blood supply. This technique has been used for decades to shrink tumors elsewhere in the body and is now being applied to the treatment of fibroids with great success.

The main advantage of uterine fibroid embolization is that only the fibroid blood supply is cut off and the normal healthy uterus is preserved. Success rates approach 85% with a less than 1% complication rate.

The Interventional Radiologist makes a small nick in the skin (less than one-quarter of an inch) at the crease at the top of the leg to access the femoral artery, and inserts a tiny tube (catheter) into the artery.

Local anesthesia is used so the needle puncture is not painful. The Interventional Radiologist steers the catheter through the artery to the uterus using X-ray imaging (fluoroscopy) to guide the catheter's progress. An arteriogram (a series of images taken while radiographic dye is injected) is performed to provide a road map of the blood supply to the uterus and fibroids.

Then tiny plastic or gelatin sponge particles, the size of grains of sand, are slowly injected into the vessels. The particles flow to the fibroids first, wedge in the vessels and cannot travel to other parts of the body. Over several minutes, the arteries are slowly blocked. The embolization is continued until there is nearly complete blockage of the blood flow in the vessel.

The procedure is then repeated on the other side so the blood supply is blocked in both the right and left uterine arteries. Some physicians block both uterine arteries from a single puncture site, while others puncture the femoral artery at the top of both legs. After the embolization, another arteriogram is performed to confirm the results. The skin puncture where the catheter was inserted is cleaned and covered with a bandage. As a result of the restricted blood flow, the tumor (or tumors) begin to shrink.

Fibroid embolization usually requires a hospital stay of one night, although some women do go home the same day. About six to eight hours of bed rest is typical after the procedure. Pain-killing medications and drugs that control swelling typically are prescribed following the procedure to combat cramping, which is a common side effect. Fever also is an occasional side effect, and is usually treated with acetaminophen. Total recovery generally takes one to two weeks.

RESULTS
The results of studies that have been published or presented at scientific meetings report that 78 percent to 94 percent of women who have the procedure experience significant or total relief of bleeding and other symptoms, with the large majority of patients considerably improved. The procedure has been successful even when multiple fibroids are involved.

Most patients have rated the procedure as "very tolerable." The expected average reduction in the volume (size) of the fibroids is 50 percent after three months, with a reduction in the overall size of the uterus of about 40 percent.

The long-term outcome is not known as only short-term follow-up is available. It is not yet known if the fibroids can re-grow, however no recurrences have occurred in women who have been followed for up to six years.

FERTILITY
The majority of patients who have fibroid embolization are finished with childbearing and few women have tried to subsequently become pregnant, making fertility difficult to study. More than a dozen pregnancies have been reported, however, and patients who have had uterine arteries embolized for other reasons, such as bleeding after childbirth, have successfully become pregnant. Research is underway to study this issue.

There have been a few women whose menstrual periods have stopped after the procedure, which would result in infertility.

SIDE EFFECTS/COMPLICATIONS
Fibroid embolization is considered to be very safe, however, there are some associated risks, as there are with almost any medical procedure. Most patients experience moderate to severe pain and cramping in the first several hours following the procedure; some experience nausea and, possibly, fever. These symptoms can be controlled with appropriate medications. Most symptoms are substantially improved by the next morning, however, there may be some pain and cramping for several days or more. Many women report returning to work within a week of having the procedure.

Complications occur in fewer than 3 percent of patients. Serious possible complications include injury to the uterus from decreased blood supply or infection. This is uncommon and hysterectomy to treat either of these complications occurs in less than 1 percent of patients. Injury to other pelvic organs is possible but has not yet been reported and the chance of other significant complications is less than 1 percent.

Long-term complications are not expected, although questions about potential side effects remain. It is not known what effect, if any, fibroid embolization has on the menstrual cycle. The overwhelming majority of women who have had embolization have had decreased bleeding with normal menstrual cycles. There have been a few women, most of whom are near the age of menopause, whose menstrual periods have stopped after the procedure. It is uncertain whether these cases are a result of decreased ovarian function resulting from the procedure. Based on this limited information, it appears that the procedure may cause a loss of menstrual cycles (premature menopause) in a very small number of patients.

INSURANCE
Many insurance companies are covering uterine fibroid embolization procedures.

Please call 410-368-3009 to see if you would benefit from uterine fibroid embolization.