Uterine artery embolization is a procedure in which an

interventional radiologist Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs bo ...

uses a

catheter In medicine, a catheter (/ˈkæθətər/) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgi ...

to deliver small particles that block the

blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...

supply to the uterine body. The procedure is done for the treatment of

uterine fibroid Uterine fibroids, also known as uterine leiomyomas or fibroids, are benign smooth muscle tumors of the uterus. Most women with fibroids have no symptoms while others may have painful or heavy periods. If large enough, they may push on the bl ...

s and adenomyosis. This minimally invasive procedure is commonly used in the treatment of uterine fibroids and is also called uterine fibroid embolization.

Medical uses

Uterine artery

embolization Embolization refers to the passage and lodging of an embolus within the bloodstream. It may be of natural origin ( pathological), in which sense it is also called embolism, for example a pulmonary embolism; or it may be artificially indu ...

is used to treat bothersome bulk-related symptoms or abnormal or heavy uterine bleeding due to

uterine fibroids Uterine fibroids, also known as uterine leiomyomas or fibroids, are benign smooth muscle tumors of the uterus. Most women with fibroids have no symptoms while others may have painful or heavy periods. If large enough, they may push on the bl ...

or for the treatment of adenomyosis. Fibroid size, number, and location are three potential predictors of a successful outcome. Long-term patient satisfaction outcomes are similar to that of surgery. There is tentative evidence that traditional surgery may result in better fertility. Uterine artery embolization also appears to require more repeat procedures than if surgery was done initially. It has shorter recovery times. Uterine artery embolization is thought to work because uterine fibroids have abnormal vasculature together with aberrant responses to hypoxia (inadequate oxygenation to tissues). Uterine artery embolization can also be used to control heavy uterine bleeding for reasons other than fibroids, such as postpartum

obstetrical hemorrhage Obstetrical bleeding is bleeding in pregnancy that occurs before, during, or after childbirth. Bleeding before childbirth is that which occurs after 24 weeks of pregnancy. Bleeding may be vaginal or less commonly into the abdominal cavity. Bleedi ...

. and adenomyosis. According to the American Journal of Gynecology, uterine artery embolization costs 12% less than hysterectomy and 8% less than myomectomy.

Adverse effects

The rate of serious complications is comparable to that of

myomectomy Myomectomy, sometimes also called fibroidectomy, refers to the surgical removal of uterine leiomyomas, also known as fibroids. In contrast to a hysterectomy, the uterus remains preserved and the woman retains her reproductive potential. Indica ...

or hysterectomy. The advantage of somewhat faster recovery time is offset by a higher rate of minor complications and an increased likelihood of requiring surgical intervention within two to five years of the initial procedure. Complications include the following: * Death from embolism, or

sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...

(the presence of pus-forming or other pathogenic organisms, or their toxins, in the blood or tissues) resulting in multiple organ failure * Infection from tissue death of fibroids, leading to endometritis (infection of the uterus) resulting in lengthy hospitalization for administration of intravenous antibiotics * Misembolization from microspheres or polyvinyl alcohol particles flowing or drifting into organs or tissues where they were not intended to be, causing damage to other organs or other parts of the body such as ovaries, bladder, rectum, and rarely small bowel, uterus, vagina, and labia. * Loss of ovarian function, infertility, and loss of orgasm * Failure – continued fibroid growth, regrowth within four months * Menopause – iatrogenic, abnormal, cessation of menstruation and follicle stimulating hormones elevated to menopausal levels * Post-embolization syndrome – characterized by acute and/or chronic pain, fevers, malaise, nausea, vomiting and severe night sweats; foul vaginal odor coming from infected, necrotic tissue which remains inside the uterus; hysterectomy due to infection, pain or failure of embolization * Severe, persistent pain, resulting in the need for morphine or synthetic narcotics * Hematoma, blood clot at the incision site; vaginal discharge containing pus and blood, bleeding from incision site, bleeding from vagina, fibroid expulsion (fibroids pushing out through the vagina), unsuccessful fibroid expulsion (fibroids trapped in the cervix causing infection and requiring surgical removal), life-threatening allergic reaction to the contrast material, and uterine adhesions

Procedure

The procedure is performed by an interventional radiologist under conscious sedation. Access is commonly through the

radial Radial is a geometric term of location which may refer to: Mathematics and Direction * Vector (geometric), a line * Radius, adjective form of * Radial distance, a directional coordinate in a polar coordinate system * Radial set * A bearing f ...

femoral artery The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or profunda femoris artery and descends along the anteromedial part of the thigh in the f ...

via the wrist or groin, respectively. After anesthetizing the skin over the artery of choice, the artery is accessed by a needle puncture using

Seldinger technique The Seldinger technique, also known as Seldinger wire technique, is a medical procedure to obtain safe access to blood vessels and other hollow organs. It is named after Sven Ivar Seldinger (1921–1998), a Swedish radiologist who introduced th ...

. An access sheath and guidewire are then introduced into the artery. In order to select the uterine vessels for subsequent embolization, a guiding catheter is commonly used and placed into the uterine artery under X-ray

fluoroscopy Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and function ...

guidance. Once at the level of the uterine artery an

angiogram Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is performe ...

with contrast is performed to confirm placement of the catheter and the embolizing agent (spheres or beads) is released. Blood flow to the fibroid will slow significantly or cease altogether, causing the fibroid to shrink. This process can be repeated for as many arteries as are supplying the fibroid. This is done bilaterally from the initial puncture site as unilateral uterine artery embolizations have a high risk of failure. With both uterine arteries occluded, abundant

collateral circulation Collateral circulation is the alternate circulation around a blocked artery or vein via another path, such as nearby minor vessels. It may occur via preexisting vascular redundancy (analogous to engineered redundancy), as in the circle of Wil ...

prevents uterine necrosis, and the fibroids decrease in size and vascularity as they receive the bulk of the embolization material. The procedure can be performed in a hospital, surgical center or office setting and commonly take no longer than an hour to perform. Post-procedurally if access was gained via a femoral artery puncture an occlusion device can be used to hasten healing of the puncture site and the patient is asked to remain with the leg extended for several hours but many patients are discharged the same day with some remaining in the hospital for a single day admission for pain control and observation. If access was gained via the radial artery the patient will be able to get off the table and walk out immediately following the procedure. The procedure is not a surgical intervention, and allows the uterus to be kept in place, avoiding many of the associated surgical complications.

References

External links

*http://www.merciafibroidclinic.com/
Informational resource to help understand uterine fibroids and minimally invasive treatment options, Uterine Fibroid Embolization
{{DEFAULTSORT:Uterine Artery Embolization Interventional radiology Anatomical pathology Obstetrical and gynaecological procedures