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Uterine Fibroid Embolization

Uterine fibroid embolization is a relatively new procedure for the treatment of fibroids, and CRL's interventional radiologists in Charlottesville and Central Virginia have a broad range of expertise in performing this procedure with excellent results. Fibroid tumors of the uterus are common, benign lesions that can sometimes cause significant symptoms including heavy menstrual bleeding, pelvic pain and pelvic pressure.  Fibroid tumors, also known as myomas, are masses of fibrous and muscle tissue in the uterine wall. Traditional treatment for fibroids includes hysterectomy (surgical removal of the uterus) and myomectomy (surgical removal of the fibroids). 

The Procedure
Side Effects
Complications
Expected Results

THE PROCEDURE
Uterine fibroid embolization is currently offered at by CRL physicians at Martha Jefferson Hospital in Charlottesville and Central Virginia. The goal of fibroid embolization is to cut off the blood flow to the fibroid, causing it to shrink.  The procedure is minimally invasive, only requiring a tiny nick in the skin.  Interventional Radiologists, specially trained doctors who use X-rays and other imaging techniques to “see” inside the body, perform the procedure.  A small nick in the skin is made in the groin, through which a tiny tube called a catheter is inserted into an artery.  The catheter is guided through the artery to the uterus while the interventional radiologist watches the progress of the procedure using a moving X-ray. An arteriogram (x-rays using contrast) is then performed to evaluate the arterial anatomy.

When the catheter is in place, the interventional radiologist injects tiny particles into the artery that supplies blood to the fibroid tumor.  Because the fibroids are very vascular, the particles flow to the fibroids first.  The particles cut off the blood flow to the fibroid and cause it to get smaller.

The procedure is performed with the patient conscious, but sedated – drowsy and feeling little to no pain.  The procedure typically takes between 1.5 to 2 hours.  Fibroid embolization usually requires a hospital stay of one night with return to normal activities in 5 to 7 days.

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SIDE EFFECTS
Most patients will experience moderate to severe cramping after uterine fibroid embolization. The cramps are most severe during the first 12-24 hours after the procedure, and improve rapidly over the next several days. Post procedure cramping is controlled with intravenous pain medications typically given through a pump that allows self-administration of the medication. Many patients will also experience some nausea and possibly fever which is also controlled with medications. By the morning after the procedure, symptoms are typically substantially improved allowing discharge from the hospital on oral medications for pain, fever and inflammation. Patients are also given oral antibiotics to take for 5 to 10 days to help avoid infection. Symptoms typically resolve one to two weeks after the procedure.

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COMPLICATIONS
Complications from uterine fibroid embolization are anticipated in less than 3% of patients. Serious potential complications include injury to the uterus from decreased blood supply or infection. This is quite rare and hysterectomy to treat either of these complications occurs in less than 1% of patients. Early onset menopause is also a potential complication, occurring in 1- 3% of patients and appears to occur more commonly in women who are older than 45 when they have the procedure.

Potential catheter-related complications from uterine fibroid embolization include damage to the blood vessel, bleeding at the puncture site, and infection. The chance of any of these complications occurring is less than 1%. A very few women may experience an allergic reaction to the contrast that is used during the procedure ranging from mild itching to more severe reactions. Patients are continuously monitored during the procedure so that any allergic reactions can be detected and reversed.

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EXPECTED RESULTS
Results from fibroid embolization suggest that symptoms will improve in approximately 90% of patients with the large majority of patients experiencing marked improvement. Most patients also rate the procedure as very tolerable. Overall, fibroids will shrink to about half their original size six months after uterine fibroid embolization. Follow-up studies lasting several years have shown that it is rare for treated fibroids to regrow or for new fibroids to develop after uterine fibroid embolization.

Uterine fibroid embolization is not currently recommended in patients who wish future pregnancy. If future pregancy is desired and additional information is needed regarding minimally invasive treatment of uterine fibroids as well as evaluation of infertility, click here.

For more in-depth information call Martha Jefferson Hospital department of Interventional Radiology at 434-982-8363 or click here.

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