Uterine Fibroid Embolization (UFE)
Uterine fibroid embolization is a new therapy for the treatment of symptomatic uterine fibroids in many symptomatic women. The procedure is an alternative to hysterectomy and has a very high success profile as a treatment for bulk-related symptoms and bleeding related to fibroids. Modesto Interventional Radiology was the first Interventional Radiology service in the Central Valley to offer this therapy and is the most experienced. Our treatment plan is founded upon a close working relationship with experienced gynecologists and includes the personalized care of a staff radiologist and clinical coordinator. Our staff is very experienced in the UFE procedure and we tailor both care and follow-up to the needs of each patient.
Uterine Artery Embolization
Overview:
- 20-40% of women 35 and older have fibroids of significant size
- Most frequent indication for hysterectomy in pre-menopausal women
- 600,000 hysterectomies performed annually in US; 1/3rd due to fibroids
- Most common tumor of the female genital tract
- Prevalence in female population of childbearing age: 30% or higher
- 10-20% of women with fibroids require therapy
Diagnosis:
- Suspected on pelvic examination
- Confirmed with imaging (Ultrasound, MRI)
History:
- Embolization first performed 30 years ago
- 1990's French gynecologist first requested uterine fibroid Embolization (UFE) prior to hysterectomy
- Introduced into the USA in 1995 by Drs. McLucas and Goodwin
- As of 2002, 20,000 UFE procedures performed worldwide
The Fertility Issue:
- It is unclear how fertility is affected
- Multiple reports of successful pregnancies post embolization
- Large multi-center trial needed
Child-bearing Age: Exceptions:
- Poor candidate for myomectomy: fibroids are too large and/or numerous
- Failed myomectomy: symptoms reoccur or persist despite myomectomy
- Poor surgical candidate
Results:
- Technical success: 98%
- >87% effective in reducing bleeding
- >93% effective in alleviating pain associated with fibroids
- Expected decrease in fibroid volume is 50%
- Patient satisfaction post UFE is 94%
Just the Facts…
- Fibroid reoccurrence is exceedingly rare
- UFE is not harmful to the uterus
- In the setting of multiple fibroids, all are treated
Pre-embolization Evaluation:
- Gynecology evaluation
- Routine pre-angiography blood work
- Pelvic MRI or ultrasound for baseline sizing and localization of lesions
- Yearly pap smear
- Endometrial biopsy if bleeding is the primary problem
How Does It Work?
- Two uterine arteries supply the uterus
- Tiny microspheres decrease blood flow to these hypervascular tumors
- Starvation of fibroids results in shrinkage
- UFE Procedure
- Procedure time: 1 hr
- Patient asleep throughout entire procedure
- Normal activity in 5-7 days
- Procedure performed in radiology suite
- Patient comfort is a high priority
- Overnight observation for pain control
- Discharged to home the following morning
Post-Procedure Management:
- Same day release or overnight stay
Expected Clinical Course:
- Pelvic pain and discomfort which should progressively decrease and resolve over 2 weeks
- Fibroid size decreases over several months time
Uterine Cramping:
- All will experience a certain degree of uterine cramping following embolization
- Low grade cramping for 1 to 2 weeks.
Cost:
- Significantly less than hysterectomy or open myomectomy
- Covered by most insurances
Conclusion
- Uterine artery embolization is safe and effective for alleviating symptoms from fibroid disease
- >87% success at decreasing or resolving heavy bleeding or pressure symptoms
- >93% effective in reducing pain
- 94% patient satisfaction
- Effect on future fertility has not been thoroughly studied
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