From the Guidelines
Uterine embolization for fibroids is performed by introducing a catheter into the uterine arteries through a transfemoral or transradial arterial approach, and then injecting embolic material to cause arterial occlusion, ischemic necrosis, and involution of fibroids. This procedure is typically indicated for patients experiencing bulk symptoms and heavy menstrual bleeding, as it has been shown to cause persistent decreases in pain, heavy menstrual bleeding, and an average decrease in uterine fibroid size of >50% at 5 years 1. The embolic material used can include gelatin, microspheres, or coils, and the procedure is usually performed under moderate sedation and local anesthesia.
Key Steps in the Procedure
- The patient receives moderate sedation and local anesthesia to minimize discomfort during the procedure
- A small incision is made, typically in the groin area, to access the femoral artery
- A thin catheter is inserted and guided through the arterial system to the uterine arteries using real-time X-ray imaging (fluoroscopy)
- Tiny particles are injected to block the blood vessels that supply the fibroids, cutting off blood flow and causing them to shrink over time
- The procedure typically takes 1-3 hours, and most patients stay in the hospital for one night for pain management
Outcomes and Benefits
- Significant improvement in fibroid symptoms within 3-6 months
- Persistent decreases in pain, heavy menstrual bleeding, and an average decrease in uterine fibroid size of >50% at 5 years 1
- Lower risk of blood transfusion and shorter hospital stays compared to myomectomy
- Lower rates of new fibroid formation compared to myomectomy 1
- Improved quality of life scores and lower reintervention rates compared to MRgFUS 1
From the Research
Uterine Embolization Procedure
Uterine embolization, also known as uterine artery embolization (UAE), is a minimally invasive procedure used to treat uterine fibroids 2. The procedure involves injecting embolic agents into the uterine arteries to block blood flow to the fibroids, causing them to shrink.
Embolic Agents Used
Different embolic agents can be used for UAE, including:
- Polyvinyl alcohol (PVA) particles 3, 4, 5
- Tris-acryl gelatin microspheres (TAGM) 3, 4, 5, 6
- Acrylamido polyvinyl alcohol microspheres (a-PVAM) 6
Procedure Outcomes
Studies have compared the outcomes of UAE using different embolic agents, including:
- Decrease in uterine volume and dominant tumor volume 3
- Fibroid infarction rate and complete infarction rate 3, 4
- Symptom severity score and health-related quality-of-life score 5, 6
- Complications and pain scores 3, 5
Comparison of Embolic Agents
Comparative studies have shown that:
- PVA and TAGM have similar effects on symptom severity score and health-related quality-of-life score 5, 6
- TAGM may be slightly superior to PVA in terms of overall quality of life at 3 months after UAE 6
- PVA may result in a greater inflammatory response and higher rates of rescue analgesic use compared to TAGM 5