Uterine Fibroid Embolization

Uterine fibroid embolization is a new minimally invasive therapy for treatment of uterine fibroids. It is a safe alternative to hysterectomy for treatment of symptoms caused by uterine fibroids which has been shown to be effective in 90% of patients suffering from problems caused by uterine fibroids.

At Regional Vascular Associates we offer an outpatient clinic for initial consultation and follow up as well as one of the most experienced teams in the area. We perform our procedures at Durham Regional Hospital where every effort is made to make this procedure as easy for you as is possible.

To set up an appointment, contact us here.

For more information:
Visit SIR website on UFE
http://www.ask4ufe.com
http://fibroids1.com

While uterine artery embolization has been used for a variety of indications including post partum hemorrhage and bleeding tumors for over twenty years, the initial experience with uterine fibroid embolization was reported by Jacques Ravina, at the Laraboisiere Hospital in Paris, France in 1995. His results were published in Lancet. This initial small series was based on a group of patients who had preoperative embolization before surgical myomectomy and, for various reasons ended up not having the myomectomy. Almost all of these patients were serendipitously found to have complete relief of their symptoms without the surgical procedure. Subsequent larger series confirmed his results leading ultimately to the adoption of this procedure in the U.S. and other countries. The first series reported in this country was out of UCLA in 1997, reported in the Journal of Vascular and Interventional Radiology by Scott Goodwin. Since that time, thousands of uterine fibroid embolizations have been successfully performed across the U.S. with most reported series indicating an 85-90% clinical success with a low complication rate and low morbidity.

Durham Radiology Associates offer UFE procedures at Durham Regional Hospital, all performed by board certified interventional radiologists with subspecialty training/certification in interventional radiology. The procedure is performed in the Vascular/Interventional suite on state-of-the-art digital vascular equipment. The uterine arteries are sub-selectively catheterized, angiography is performed and particles called Embospheres® are injected during careful fluoroscopic monitoring of the results. The procedure takes between one and two hours to perform. Most patients are kept overnight for observation and pain control and are discharged the following morning.

Even though UFE is a minimally invasive procedure, it is not without risk. Post procedure pain can be significant. Post infarction syndrome is treated with ibuprophen, narcotics, anti-emetics and acetaminophen. Amenorrhea develops post procedure in approximately 2% of patients under 45 and 15% of patients over 45. Hysterectomies for complications including endometritis and uterine infarction are rare, reported in less than 0.7% of patients. There have been four deaths reported in the world literature out of many thousands of procedures.

MRI imaging prior to UFE offers many advantages. It is less operator dependent, assesses size of fibroids more accurately, is much better at showing adnexal masses and is the only imaging test that will show adenomyosis. Post procedure, all complications are well demonstrated by MRI. Gadolinium enhanced studies can be used to evaluate for incompletely infarcted tumors that have not responded. We prefer to obtain MRI’s before and 3 months after all UFE’s. If symptoms suggesting a complication develop after the procedure, MRI is the technique of choice for fast and accurate diagnosis. Having a “baseline” MR is very helpful.

To schedule or discuss uterine fibroid embolization, please call us at our RVA office 471-0215.

Patient Instructions Before Procedure:

1. Take Ibuprophen 800 mg. (four of the OTC tablets) three times per day for one week before the procedure.
2. Do not eat or drink anything the night before the procedure.
3. Take your usual medications the morning of the procedure with a sip of water.
   

Patient Instructions After the Procedure:

As the uterine fibroids die, a number of symptoms which fall into the category of post-embolization syndrome will be present in varying degrees of severity and for varying lengths of time. The following describes these symptoms and their management in post-UFE patients.

Pain:

• Can be severe, especially during the first few days.
• Ibuprophen 800 mg. three times per day is started one week before the procedure and continued for at least one week after the procedure. After this point this drug can be used as required for pain at lower doses.
• Narcotics (Dilaudid, Percocet, Vicodan, Morphine) will be given during and immediately after the procedure intravenously. A patient-demand infusion pump is used until the morning after the procedure. At this point a prescription for oral medications will be given for home use. These medications are for pain not responding to the Ibuprophen. The dose of these medications should be reduced over the first few days after the procedure and are rarely needed beyond one week. These medications cause nausea and severe constipation. You cannot drive a car or make important decisions while taking these drugs. You should take a daily laxative while taking these medications, drink plenty of fluids and eat lots of fruits and vegetables to avoid problems with constipation.
• Tylenol is to be taken as directed on the bottle for the first week after treatment. This is mainly for fever, but also helps with pain control.

Fever:

• It is common to run a fever below 101º F after the procedure for a week or so.
• Please check your temp. daily for the first week.
• Temperature over 101º or fever with shaking chills indicates a serious infection and we ask that you seek medical attention immediately. If you are unable to contact your physician, please come to the emergency room ASAP. This can be a very serious problem if not addressed properly.

Nausea:

• Usually due to narcotics.
• Treated with intravenous medications at the hospital.
• Phenergan 25 mg. can be taken by mouth every six hours for nausea after discharge.

Uterine Cramping:

• Normal after the procedure. Treated with Ibuprophen, narcotics if severe.
• Should decrease over the weeks following treatment.
• May be associated with passage of small clots or tissue from the dying fibroids.
• Notify Physician if cramping is becoming more severe or lasting more than a week or so after the procedure.

Symtoms Associated with Uterine Fibroids:

• As symptoms vary in individuals, so does the length of time it takes for them to respond to the embolization.
• Bleeding usually decreases during the first period after treatment and continues to decrease thereafter. Intermentstrual spotting is not uncommon and is related to the fibroids breaking down.
• The fibroids will feel softer and will cause less pressure after the procedure, but will not actually begin shrinking until several months after the procedure. Maximal shrinkage occurs at about one year.
• Cramping during periods should be less, but this may take several cycles before you see a substantial change.
• Ovarian failure (menopause) is seen in about 1% of patients if under the age of 45. Over 45, the chance increases to about 14%.
• Women can and have become pregnant after UFE.

Follow Up Physician Appointments: (please schedule these at your convenience soon after discharge)

• Regional Vascular Associates office in one month after the procedure
• Your gynecologist at three months after the procedure
• RVA at six months.
  

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