Uterine Artery Embolization

Overview 

Uterine artery embolization (UAE) is a minimally invasive procedure primarily used to treat vaginal bleeding caused by uterine fibroids, which are noncancerous tumors in the uterus. While UAE is commonly associated with fibroids, it can also address other causes of heavy bleeding, such as trauma, cancerous gynecological tumors, or postpartum hemorrhage. Although the terms uterine artery embolization (UAE) and uterine fibroid embolization (UFE) are often used interchangeably, UFE specifically refers to the treatment of fibroids, whereas UAE is a broader procedure that can treat various conditions leading to vaginal bleeding.

Reasons for undergoing the procedure  

The primary reason people undergo uterine artery embolization is to treat uterine fibroid tumors that are causing symptoms, such as:  

• Excessive menstrual flow.  
• Pressure on the Pelvis.  
• Constipation.  
• Painful sexual intercourse.  
• Urinating more frequently.

For further cases such trauma, malignant tumors, or heavy bleeding following childbirth, your doctor might suggest UAE.

It is not recommended to undergo UAE if you:  

• Have fibroids in the uterus but no symptoms.  
• Are expecting a child.  
• Experience pelvic pain.  
• Suffer from a medical condition affecting your blood vessels, arteries, or veins.  
• Experience an allergic reaction to UAE’s contrast dyes.

In UAE, the blood arteries that supply your uterus are injected with microscopic particles, similar in size to grains of sand. These particles are guided into your uterine arteries by fluoroscopy, a type of X-ray that produces moving images, via a thin, flexible tube known as a catheter. When these particles obstruct uterine blood vessels:  

• Excessive bleeding can be controlled by your provider.
• When a tumor or fibroid loses blood flow, they shrink.

Risks

Most surgical procedures carry certain risks, and uterine artery embolization (UAE) is no exception. The potential risks associated with UAE include: 

• Infection: Inserting a catheter may cause damage to nearby blood vessels or lead to infection.  
• Damage to healthy tissue: The embolic agent could inadvertently be placed in the wrong blood vessel, compromising blood flow to healthy tissue.  
• Allergic reaction: There is a risk of allergic reactions to the contrast dye used in X-rays or to the sedative medications administered during the procedure.  
• Loss of menstrual periods: About 1% to 5% of individuals may experience permanent cessation of their menstrual cycles following UAE.  
• Procedure failure: In some cases, symptoms may recur, necessitating a repeat UAE or a hysterectomy.  
• Infertility: There is a possibility of losing the ability to conceive after the procedure.  

Before the procedure  

Your doctor will advise UAE following a complete assessment and review of your medical history. They’ll run diagnostic testing to find out what’s causing your problems.

Several factors could occur prior to the operation, such as:  

• Your doctor will go over your medical history, allergies, prescriptions, and menstrual cycle. You’ll talk about your goals for getting pregnant as well, as being in the UAE may interfere with getting pregnant.  
• Your doctor will use hysteroscopy, ultrasound, or Magnetic Resonance Imaging (MRI) to identify the source of the bleeding in your uterus.  
• To check for the presence of cancer cells, a biopsy (tissue sample) of the inner lining of your uterus may be performed.  
• Your healthcare physician will advise you to cease using blood thinners, aspirin, and Nonsteroidal Anti-inflammatory Drugs (NSAIDs) before UAE.  
• It is not allowed to eat or drink anything prior to the treatment. You and your doctor will talk through the specifics of fasting instructions.  

During the procedure  

The majority of the time UAE is an outpatient operation that doesn’t need to be hospitalized. Usually, the entire process takes ninety minutes.

UAE is typically carried out as follows:  

• An interventional radiologist, who specializes in minimally invasive procedures using medical imaging, performs the procedure.  
• You will lie down on an examination table and be connected to monitors that track your vital signs, such as heart rate and blood pressure.  
• A local anesthetic is administered to numb the skin around your groin.  
• You will receive fluids and a sedative through an Intravenous (IV) line, which helps relax you and may make you feel drowsy.  
• A small puncture is made in the skin near your groin (femoral artery), and a thin needle is inserted.  
• Using X-ray imaging (fluoroscopy) and contrast dye, a catheter is guided to the uterine arteries. The dye helps visualize the blood flow to your uterus by glowing under the X-ray.  
• Once the catheter is correctly positioned, it releases embolic agents (typically made of gelatin or plastic) that block blood flow to the uterus.  
• The catheter is then removed, bleeding at the puncture site is controlled, and a bandage is applied.  

After the procedure  

After a uterine artery embolization, the majority of patients are able to leave the hospital in a few hours. After that, you should anticipate further items like:  

• Following the surgery, you might be urged to lie down for a few hours.   
• Your doctor could also prescribe painkillers and antibiotics for you to take at home.  
• A mucus-like or watery discharge is to be expected for a few weeks.  
• It is usual to experience moderate to severe pelvic cramps in the first 24 hours following UAE.  
• After the surgery, most patients are able to return to their regular activities in one to two weeks.  
• Your menstrual cycle might not start for a few cycles. There might not be as much blood when it does start up again. In the upcoming cycles, it will progressively rise to a point where it exhibits improvement over pre-procedure levels.

In the event of fibroids treatment, symptoms ought to go away in two to three weeks. Fibroid tissue can sometimes be passed through the vagina. Six months later, most people are completely relieved.  

Outcome 

After undergoing uterine artery embolization (UAE), you may experience pelvic pain, cramps, and discomfort for up to two weeks, with the most severe pain typically occurring within the first 24 hours. During this time, some individuals might pass fibroid tissue through the vagina. Up to 90% of patients are able to resume normal activities within 10 days post-procedure, although it may take up to three months to observe significant improvements in symptoms.

The overall prognosis following UAE is generally favorable. Research shows that approximately 92% of individuals have no symptoms of uncontrolled vaginal bleeding after 12 months. However, if UAE is performed to treat fibroids, there is a possibility of recurrence. Studies indicate that around 32% of individuals may experience fibroid symptoms again within five years, which could necessitate a second UAE to manage these symptoms. 

While there have been reports of successful pregnancies following UAE, the available data is limited, and the effects of the procedure on fertility are not fully understood. Therefore, UAE is recommended for individuals who do not wish to become pregnant. It’s essential to discuss any potential risks to fertility with your doctor to make an informed decision.