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Uterine Fibroid Embolization (UFE)
Uterine Fibroid Embolization (UFE) is a safe and effective minimally invasive treatment for uterine fibroids (What are Uterine Fibroids?). UFE was first used to treat the symptoms of fibroids in the early 1990's. A group of physicians in France initially used UFE in an attempt to decrease the blood loss that occurs during myomectomy (surgical removal of fibroids performed with general anesthesia). They were surprised to find that after UFE, while awaiting surgery, many of the women's symptoms improved and surgery was no longer needed. They found that the UFE caused shrinkage of the fibroids resulting in resolution of their symptoms. They began to use UFE alone to treat woman with fibroids with great success. Soon thereafter, physicians around the world began to use UFE as a primary tool to treat fibroid symptoms.
Potential Advantages of UFE
Using UFE has many advantages over other treatment options. For example, UFE:
- Treats all fibroids simultaneously
- Has outstanding success rates
- Results in low complication rates
- Preserves the uterus
- Avoids surgical risks
- Avoids risks associated with general anesthesia
- Is performed on an outpatient basis instead of a 4-5 night hospital stay
- Still allows for the full range of other treatment if the UFE procedure is not successful
How is UFE Performed?
UFE usually takes about 1-2 hours to perform and recovery usually lasts 4-6 hours. During UFE, the patient is lightly sedated unlike during surgery when general anesthesia is used. UFE is performed on both the right and left uterine arteries to ensure that all blood supply to the fibroid is blocked.
During the procedure, a small tube called a catheter is inserted into an artery at the top of the thigh after numbing the skin with a local anesthetic. With x-ray guidance, the catheter is advanced into one of the two arteries that supply the uterus. At this point, tiny spheres – about 0.5-0.9 mm in diameter and made of a plastic similar to contact lens plastic – are injected into the uterine artery. These particles pass into smaller and smaller arteries until they lodge themselves into the arteries that feed the fibroids. Once lodged, they block (embolize) the blood supply to the fibroids, thereby depriving them of nutrients that they require to grow. These particles are essentially biologically inert and cannot travel anywhere other than where they are placed.
This procedure is then repeated by guiding the the small catheter into the artery feeding the other side of the uterus; in a similar fashion, particles are again injected to ensure that all blood flow to the fibroid is blocked. When the fibroid blood supply is blocked on the second side, the catheter is removed from the artery and the tiny nick in the skin and artery through which this catheter was inserted is closed.
Is UFE Safe?
Many scientific papers have been written documenting the safety of UFE. Serious complications are rare after UFE.
Recovery After UFE
The UFE procedure itself is essentially painless. However, after the procedure, patients may experience uterine cramping similar in character and location to what they experience with their regular periods. The main difference is that the cramps may be more sustained and somewhat more intense than typically noticed with their periods. In order to control this discomfort, intravenous medications are prescribed for the patient while they are recovering.
Patients should expect some cramping and discomfort when they get home, but significant cramping is unusual beyond 3-5 days after UFE. Medication prescribed for the patient are sufficient to make the first few days home comfortable.
All patients are expected to be up and walking around by the day after the procedure. Light exercise may be resumed within a few days. Half of the patients are back to their usual level of activity by 8 days and back to work by 10 days following UFE. This shortened recovery time is unlike that seen after surgery, when half the patients are back to their usual level of activity by 30 days and back to work by 40 days.
Expected Results after UFE
Data accumulated around the world demonstrate that UFE has been outstanding in controlling the symptoms associated with fibroids. By six months after UFE, 90% of women with heavy menstrual bleeding report that their bleeding is substantially better or back to normal. Eighty to eighty-five per cent of women with pelvic pain and pressure also demonstrate similar levels of satisfaction after UFE.
Typically, we find that fibroids shrink 50-70% by volume. Because fibroids increase the size of the uterus, the shrinkage in fibroids after UFE leads to a 50% reduction in the size of the uterus as well.
What Are Fibroids?
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