 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
UTERINE FIBROID EMBOLIZATION
For more in depth information, visit our dedicated Uterine Fibroid Embolization web site.
BACKGROUND
Uterine fibroids are benign growths that develop in the muscular wall of the uterus. While most fibroids do not cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding. From 25 to 40 percent of women age 35 and older have uterine fibroids of a significant size. African-American women are at higher risk for fibroids: as many as 50 percent have fibroids of significant size. Fibroids vary in size from smaller than a grape to larger than a cantaloupe. Submucosal fibroids are just beneath the endometrial lining of the uterus and are frequently symptomatic, causing very heavy and prolonged periods. Intramural fibroids are within the wall of the uterus. These are the most common fibroids and can result in heavier menstrual flows and pelvic pain or pressure. Subserosal fibroids form on the outer surface of the uterus. These usually do not affect menstrual flow but can cause symptoms of pain and pressure if they grow large enough to compress adjacent organs such as the bladder or rectum.
TREATMENTS
Medical Therapy: Most fibroids do not cause symptoms and do not require treatment. When symptoms do occur, drug therapy is usually the first treatment employed.This might include birth-control pills, or other hormonal therapy, or non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen. In many patients, drug therapy alone will control symptoms adequately. Some hormonal therapies do have side-effects and other risks when used long-term so they are generally temporary. Symptoms often recur and fibroids often grow back after therapy is discontinued.Hysterectomy: In a hysterectomy, the uterus is removed in an open surgical procedure. The operation is performed under general anesthesia and requires a hospital stay of three to four days. The average recovery period is about six weeks. Some women are candidates for a newer laparoscopic procedure. The recovery time for this procedure is considerably shorter.
Myomectomy: Myomectomy is a surgical procedure where visible fibroids are removed from the uterine wall. Myomectomy may be performed laparoscopically, trans-vaginally via hysteroscopy, or by a traditional lower abdominal incision. Myomectomy, like UFE, leaves the uterus in place and may preserve the ability to have children. Depending on the size, number, and location of the fibroids, myomectomy may be performed as an outpatient procedure or require hospitalization for several days. While myomectomy is effective in controlling symptoms, 20-25% of patients experience recurrence and the procedure is less successful in patients with multiple fibroids.
UTERINE FIBROID EMBOLIZATION
Embolization of uterine fibroids is a non-surgical treatment performed by Interventional Radiologists for women suffering from symptomatic uterine fibroids. The procedure is minimally invasive with a much shorter recovery time than traditional surgical therapies such as hysterectomy and myomectomy.Embolization of the uterine arteries has been performed for many years to stop life-threatening bleeding following childbirth in order to prevent a hysterectomy. In 1991, physicians in France began performing uterine artery embolization prior to hysterectomy in order to reduce blood loss during surgery. Many women had complete resolution of their fibroid symptoms and canceled their surgery.
Uterine fibroid embolization (UFE) is performed using intravenous sedation and local anesthesia utilizing interventional radiology catheter techniques rather than surgery or laparoscopy. An interventional radiologist places a tiny catheter measuring less than 2 mm in diameter into the large artery in the groin. Using X-ray guidance, the catheter is then directed into the arteries supplying the uterus and angiograms are obtained by injecting X-ray dye through the catheter.
After the blood supply to the uterus is delineated, tiny particles are injected into the artery to stop blood flow to the fibroids and uterus. The procedure generally takes 60 to 90 minutes. Following the procedure, most patients are admitted overnight for observation and pain control with intravenous and oral medications.Following the procedure, most women experience post embolization syndrome, which is known to occur after embolization procedures anywhere in the body. Symptoms of post-embolization syndrome include pain, nausea, vomiting and fever. Nearly all women will have pain. The level of pain experienced is extremely variable and does not correlate with the efficacy of the procedure. Post-procedure pain nearly always resolves in 24 hours.
Results: UFE is technically successful in 98% to 100% of cases. After uterine fibroid embolization, approximately 90% of patients with abnormal bleeding and 85% of patients with bulk-related symptoms related to fibroids will have complete or significant relief of their symptoms. Follow up of fibroids with ultrasound shows a reduction in size of 50% to 70% at one year. Uterine fibroid embolization is effective for multiple fibroids.Recurrence of fibroids after embolization is very rare. Long term data (10 year) is not yet available, but in one study in which patients were followed for six years, no fibroid that had been embolized regrew.UFE has been met with a high degree of patient satisfaction. In one study 88% to 94% of patients surveyed were either satisfied or very satisfied with their procedure and it's results.
Complications: The complications rate of UFE has been low. Complications related to angiography such as bleeding, injury to the artery, allergy to X-ray dye, occur in less than one percent of patients.A small number of patients of may experience infection following the procedure which usually can be managed with antibiotics. There is a less than one percent chance of injury to the uterus which could require hysterectomy. These complication rates are lower than those of hysterectomy and myomectomy.Early menopause can be precipitated by UFE and has been shown to occur in approximately one percent of all cases. The risk is highest in women more than 45 years of age.Sexual dysfunction, sometimes reported after hysterectomy, has been described in only one case following UFE.Passage or expulsion of the shrunken fibroids through the cervix and vagina may occur in five percent of patients and can happen up to a year following the procedure. Rarely, expelled fibroids can become lodged at the cervix and lead to an infection of the uterus. The expelled fibroid can usually be removed during a speculum exam.The radiation dose of uterine fibroid embolization is similar to other routine X-ray exams. No increased cancer risk has been shown to date.
Fertility: The effect of UFE on fertility has not been definitively studied. Most investigators have reported cases of women who have become pregnant following UFE. Studies have shown that women who have undergone the uterine artery embolization (UAE) for bleeding after childbirth have had no problems with fertility. A recent study comparing the fertility of of women who had UFE with those who had myomectomy showed similar numbers of successful pregnancies for both groups. However, the long term effects on the ability of a woman to have children after UFE have not been fully determined.
For more in depth information, visit our dedicated Uterine Fibroid Embolization web site.
Links: Home Page | Our Doctors | Varicose Veins | Uterine Fibroid Embolization | Angiograms | Angioplasty | Verterbroplasty | Stent Grafts | TIPS | Dialysis Access | Venous Access | Chemo-Embolization | Clinic Location | Appointments | Insurance | Our Team | Site Map
