Uterine Fibroid Embolization (UFE)

[http://www.fibroidfocus.com/AboutFibroids/UterineFibroidEmbolization.aspx ] Uterine Fibroid Embolization (UFE) (also now as Uterine Artery Embolization or UAE) is a relati!el" new non# sur$ical and less in!asi!e wa" to treat s"mptomatic fibroid tumors. %Embolization% is simpl" a medical therm that means cuttin$ off the blood suppl". Embolization has been used for man" "ears for man" reasons other than fibroid tumors. Embolization has been used to treat li!er tumors& idne" tumors& and internal bleedin$ secondar" to a !ariet" of causes. 'he application of embolization& howe!er& specificall" to treat fibroids was introduced in France in the earl" ())*+s and has become an extremel" popular non#sur$ical alternati!e for the treatment of s"mptomatic uterine fibroid tumors. 'o date& tens of thousands UFEs ha!e been performed worldwide and this procedure has been shown to be a safe and effecti!e treatment option for man" women pla$ued b" fibroid tumors.Fibroid embolization is usuall" performed b" a speciall" trained doctor called an interventional radiologist. 'he uterine fibroid embolization (UFE) procedure is performed in a special state#of#the#art an$io$raph" suite li e the one at ri$ht. 'his room is similar to an operatin$ room but contains a lar$e camera unit and multiple monitors that are used b" ,r. Fischer to perform the procedure. ,urin$ the UFE& a tin" puncture is made in the s in usuall" at the top of the ri$ht le$ near the ri$ht hip. A tin" spa$hetti#li e tube (called a catheter) is inserted into the arter" at the top of the le$ ( nown as the common femoral arter") and is carefull" $uided usin$ a mo!in$ x#ra" (fluoroscop") picture into each of the arteries feedin$ the uterus (-ee Fi$. ( below).

.nce a satisfactor" position of the tube has been obtained in each of the uterine arteries& tin" sand#li e $elatinous particles called embospheres are in/ected throu$h the tube and into the tin" arteries feedin$ the uterine fibroid tumors. 'he particles are carried b" the blood flow into the smaller and smaller branches of the uterine arter" feedin$ the fibroids until e!entuall" the" are lar$er than the arter" throu$h which the" are tr"in$ to pass. 'he particles then become %stuc % within the arter" and stac on top of one another until blood suppl" to the fibroids has been si$nificantl" reduced or eliminated (-ee Fi$. 0 below).

'he fibroids are depri!ed of the blood suppl" and nutrients that the" need to sur!i!e and therefore shrin and die. Usuall" both the left and ri$ht uterine arteries can be treated throu$h a sin$le puncture site in the s in that is so small that it does not re1uire a stitch. 'he procedure is painless and re1uires onl" local anesthetic (li e a shot at the dentist office) at the puncture site in the top of the ri$ht le$ thou$h usuall" intra!enous sedation is also administered to relie!e anxiet" and help the patient relax. 'he procedure does not re1uire $eneral anesthesia or the patient to be put completel" to sleep. After fibroid embolization& most patients are ept in the hospital o!erni$ht for obser!ation. ,urin$ this time& the patient recei!es an" pain medication and/or other dru$s that ma" be necessar" to control the crampin$ and pel!ic pain& which often de!elop shortl" after the procedure and are a normal and expected part of what is referred to as the %post# embolization s"ndrome.%

2n addition to pel!ic pain and crampin$& other post#embolization s"ndrome s"mptoms include nausea and/or !omitin$& $eneral feelin$s of malaise (a lac of ener$")& and low#$rade fe!ers. 3hile these s"mptoms are most se!ere the first 04# hours followin$ the procedure and are usuall" well controlled with medications& the post embolization s"mptoms usuall" last in a less se!ere form for fi!e to se!en da"s after the procedure. 'he ma/orit" of women under$oin$ fibroid embolization are dischar$ed the mornin$ after the procedure on a medication re$imen to help control an" s"mptoms the" ma" ha!e at home. 5ost women return to their normal dail" acti!ities in about one wee . -tudies show that approximatel" 6* to )78 of women who ha!e this procedure experience si$nificant or total relief from their s"mptoms caused b" the fibroid tumors. Furthermore& this procedure is able to treat most t"pes of fibroids at once and recurrence of treated fibroids after embolization is relati!el" uncommon. 9atient ( : :EF.;E

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Fibroid embolization is also considered to be !er" safe thou$h& as with an" procedure& there are associated ris s. 'he most common complications or side effects are considered minor and are usuall" related to bruisin$ or swellin$ at the arterial puncture site at the top of the le$. A !er" small number (( to 78) of patients ha!e experienced premature o!arian failure and premature menopause after fibroid embolization. 'his is more li el" to occur in perimenopausal women in their late 4*+s or older who are nearin$ menopause. A !er" small number of patients ha!e experienced infection as a result of fibroid embolization. 5ost of the time& infection can be controlled with antibiotics& althou$h se!ere infections re1uirin$ h"sterectom" ha!e been reported (less than (8). 5"omectom" and h"sterectom" also carr" si$nificant ris s includin$ infection& bleedin$& or the de!elopment of abdominal/pel!ic adhesions& which cause or$ans in the abdomen and pel!is to fuse to$ether. Adhesions and scarrin$ ma" also lead to infertilit". .!erall& ma/or complication rates for uterine fibroid embolization ha!e been shown to be lower than those of open h"sterectom" and m"omectom". 3hile the Food and ,ru$ Administration does not re$ulate the practice of medicine& it does appro!e de!ices and medications used durin$ procedures. All of the de!ices& e1uipment& and medications used for UFE are appro!ed b" the Food and ,ru$ Administration.