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    History of Uterine Artery Embolization

    Embolization is a type of procedure that is commonly performed by interventional radiologists to occlude blood vessels. It has been successfully used in arteries in virtually every part of the body to stop bleeding, block abnormal blood vessels, and treat tumors. Embolization of the uterine arteries has successfully been used for nearly 20 years to stop life-threatening bleeding after childbirth.

    In the late 1980's, French Gynecologist Jacques Ravina utilized percutaneous transcatheter embolization to occlude the uterine arteries in women who started to bleed after gynecologic surgery. Later, in an effort to reduce the occurrence of bleeding from the surgical management of fibroids, he began to embolize the uterine arteries before surgery.

    Interestingly, the women who had their uterine arteries embolized weeks before their scheduled operations soon began to cancel these procedures, as their symptoms of bleeding and pain were relieved after the embolization. Also, it was noted that there was a reduction in size and volume of the fibroids. This serendipitous discovery revolutionized the management of uterine fibroids.

    Uterine Arterial Embolization for Uterine Fibroids

    Uterine artery embolization (UAE) to treat uterine fibroids has been performed for more than six years. This minimally invasive interventional radiology procedure is performed in a fluoroscopy suite. Using sterile technique, a tiny nick is made in the skin of the groin to allow access to the femoral artery so that a catheter (a very long, thin flexible tube) can be placed into the artery, as shown below. The interventional radiologist guides the catheter into both the left and the right arteries supplying the uterus, using X-ray imaging ang iodine-based "X-ray dye". Through the catheter, small particles (usually either polyvinyl alcohol (PVA) particles or gel microspheres) are injected into the uterine arteries to occlude them, thus halting blood flow to the fibroids. This deprives the fibroids of oxygen and nutrients, causing them to shrink over time. However, the normal uterine muscle is not affected. When the procedure is complete, the cathete is removed and the artery puncture site is occluded by applying manual pressure to the artery or by using a mechanical device to seal the puncture.



    Embolization of the blood flow in this manner causes the fibroids to shrink. UAE is effective regardless of the fibroid size and can treat all types of fibroids.

    Invariably all women develop some nausea, vomiting, fever, pelvic pain, and/or cramping after UAE. The severity of the pelvic pain and cramping is variable and is best managed by combinations of intravenous and oral pain medications. The nausea and vomiting is treated with anti-emetic (anti-nausea) medications and fever is managed by anti-pyretic (fever lowering) medications.

    UAE is a procedure that has been shown to provide relief from the symptoms directly attributed to uterine fibroids. To date the procedure has been effective and durable; however, long term follow-up data is not yet available. As with all procedures, the potential advantages and disadvantages should be considered. For UAE this includes the effect it may have on future fertility, long-term ovarian function, and the durability of symptom control. Although there are anecdotal reports of successful pregnancies after UAE, women should be aware that UAE may have a negative impact on their fertility. The standard of care for women with fibroids requiring therapy who desire fertility has been myomectomy. A prospective, randomized, long-term study to compare myomectomy to UAE in women desiring fertility needs to be done before this issue can be fully resolved.

    The clinical data demonstrate that UAE controls the symptoms attributed to uterine fibroids with a low rate of complications. Bleeding, for example, is controlled in 85 to 90% of women after UAE. Symptoms caused by large fibroid size (pelvic pain and pressure; back, leg and flank pain or pressure; and urinary bladder compression) are controlled in 80 to 90% of women after UAE. Marked reduction in fibroid volume and uterine volume has been shown on follow-up imaging six months after UAE. No recurrences have been reported with follow-up to 30 months. Complications such as bacteremia, sepsis, uterine abscess, uterine infarction and premature menopause develop in approximately 5% of the women undergoing UAE. Less than 1-2% of cases are complicated by infection requiring treatment with intravenous antibiotics. Rarer cases of infection and uterine infarction requiring a hysterectomy have been reported.

    There is a growing body of scientific literature validating uterine artery embolization.

    Additional information can also be found on the Society of Interventional Radiology web site.







    		 

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