Uterine fibroid embolization

Minimally invasive procedure for uterine fibroids and adenomyosis

Uterine fibroid embolization

Trisacryl gelatin microspheres used in uterine fibroid embolization

ICD-10	0V573ZZ
ICD-9	68.24
OPS-301	5-382.10

Uterine Fibroid Embolization (UFE), also known as Uterine Artery Embolization (UAE), is a minimally invasive interventional radiology procedure. It involves the selective occlusion of the uterine artery using embolic agents to treat uterine fibroids, adenomyosis, and other conditions involving abnormal uterine blood flow.

Overview

The procedure is designed to reduce symptoms associated with uterine fibroids, such as menorrhagia (heavy menstrual bleeding), pelvic pain, and bulk symptoms like urinary frequency and constipation. Unlike hysterectomy or myomectomy, UFE preserves the uterus, making it a preferred option for women desiring uterus preservation.

Microspheres used for embolization. Similar particles are employed in UFE.

Indications

UFE is primarily indicated for:

• Uterine fibroids: Benign growths in the uterus causing significant symptoms.
• Adenomyosis: A condition where endometrial tissue grows into the uterine wall.
• Postpartum hemorrhage (PPH): Severe bleeding after childbirth.
• Uterine arteriovenous malformations (AVMs): Abnormal connections between arteries and veins.

Procedure

The procedure is performed by an interventional radiologist under fluoroscopy:

1. Access: A catheter is inserted through the femoral artery or radial artery.
2. Angiography: Contrast dye is injected to visualize the uterine arteries.
3. Embolization: Embolic agents such as trisacryl gelatin microspheres or polyvinyl alcohol microspheres are delivered to block blood flow to the fibroids.

Comparison of embolic materials used in UFE: polyvinyl alcohol and trisacryl gelatin microspheres.

Embolic Agents

Embolic agents include:

• Trisacryl gelatin microspheres: Precise, uniform particles.
• Polyvinyl alcohol (PVA) particles: Traditional embolic material with variable sizes.

Polyvinyl alcohol microspheres used in uterine artery embolization.

Imaging Guidance

Fluoroscopy and angiography are essential for identifying the uterine arteries and confirming successful embolization. Cross-sectional imaging may be performed post-procedure to assess fibroid shrinkage.

Anatomy of uterine arteries (labeled).

Benefits

• Preserves the uterus
• Shorter recovery time compared to surgery
• Effective symptom relief in 85-90% of cases
• Outpatient procedure in most cases

Risks and Complications

Complications are rare but can include:

• Post-embolization syndrome: Fever, pain, and nausea
• Premature ovarian failure (1-5% risk, higher in women over 45 years)
• Infection or abscess formation
• Non-target embolization causing ischemia to surrounding organs

Post-Procedure Care

Patients typically experience mild cramping and fatigue, managed with oral pain medications. Most patients return to normal activities within 7-10 days. Follow-up imaging is performed to assess fibroid shrinkage and symptom improvement.

Comparison with Other Treatments

UFE offers a minimally invasive alternative to:

• Hysterectomy: Complete removal of the uterus.
• Myomectomy: Surgical removal of fibroids.

While hysterectomy is definitive, UFE is preferred for uterus preservation. Myomectomy is an option for women planning future pregnancies, though UFE is being increasingly studied for its effects on fertility.

See Also

• Interventional radiology
• Fibroid treatment options
• Adenomyosis management