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The UFE/UAE Procedure
Uterine
Fibroid Embolization (UFE) is a new treatment option for fibroids.
Arterial embolization involves blocking the flow of blood to the
fibroid. A fibroid starved of blood will gradually decrease in
size, resulting in a decrease in the symptoms associated with this
condition (Fig. 3). Many women who have undergone arterial
embolization report immediate improvement in their symptoms.
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 Fig.3
The first two pictures show a normal
uterus and one that has fibroids. The three pictures at the
bottom show the progressive shrinkage of the fibroid, after
embolization has been performed. Some fibroids completely
disintegrate and are absorbed by the body; others shrink down to a
small size that does not cause any further symptoms. |
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During a uterine fibroid
embolization (UFE), an interventional radiologist inserts a
catheter (very small plastic tube, with a width of a angel
hair spaghetti) into a blood vessel in
the groin. Using special x-ray images (fluoroscopy) as a
guide, the catheter is threaded up to the uterine artery as
seen in Fig. 4
Fig.4
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Once the uterine vessel is located,
a substance consisting of tiny particles (polyvinyl alcohol or
Embosphere) is injected as seen in Fig. 5. The injected
substance embolizes (blocks) the flow of blood to the
uterus and fibroid(s). This process is repeated on the
opposite side of the uterus to ensure the complete
embolization of the fibroid vessels (Please see procedural
movie at the end of this website). The
entire procedure takes approximately one to two hours. Patients
usually can go home within 24 hours after the procedure
and resume normal activities within four to seven days. |
Fig 5.
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UFE/UAE
Animation |
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Low Speed |
High Speed |
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With Permission from Boston Scientific |
Benefits
Data
suggests that UFE results in an average
decrease in fibroid size by 40-65 percent as seen in Figures
6 and 7.
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85-90 percent of patients
reported significant improvement of abnormal uterine
bleeding |
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80-95 percent of patients
reported significant improvement of
abdominal distention, pelvic pain and bladder compression
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Recovery time is significantly shorter for embolization
(usually 3-10 days) than for myomectomy or hysterectomy
(usually 4-8 weeks). |
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Preservation of the uterus has cosmetic, sexual and
psychological advantages |
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Preservation of fertility
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Very low recurrence rate of fibroids |
Fig. 6.A 38 year-old woman presented with a
three-year history of increasing symptoms of heavy and
painful periods, urinary frequency, pelvic pressure and increasing
abdominal girth secondary to a large uterine fibroid of 20-week
pregnancy size (arrows). The urinary bladder (colored yellow) is
compressed by the fibroid causing frequent urination. The patient
sought the advice of a physician for relief of her symptoms. She was
given the options of either hysterectomy or endometrial
ablation (cryomyolysis). She opted for the latter. However, five
months after the cryomyolys, her symptoms persisted and her
fibroids failed to shrink as seen in this illustration. Through the media
she heard of a procedure called uterine fibroid
embolization as an alternative to hysterectomy. Subsequently she
underwent UFE procedure, which was successful and completely
relieved her symptoms.
Fig. 7: An MRI of pelvis one year after the UFE
procedure on this patient (described in Fig. 6) shows near-complete
resolution of the previous large fibroid into a small scar (arrow)
with normal appearing uterus with preserved size and shape. The
urinary bladder (colored yellow) also appears normal corresponding
to resolution of her frequent urination. Later, she became pregnant and had
a full-term healthy baby.
Over 95 percent of patients are
discharged onse day after UAE with prescriptions for medications to
reduce post-surgery pain and the symptoms of post-embolization
syndrome (described below). Most patients return to normal
activity and work within five to ten days of the procedure.
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