Uterine Fibroid Embolisation UFE

Uterine fibroids (Leiomyoma) are the most common benign tumour affecting the reproductive tract of women. It is twice as common in Afro-Caribbean Women of child bearing age. Uterine fibroids are often asymptomatic but they can cause severe symptoms, which include menorrhagia (heavy periods), pain, pelvic pressure and infertility. Although there are surgical options for uterine fibroids uterine fibroid embolisation (UFE) has been demonstrated to be safe and effective, produces symptom relief similar to hysterectomy with fewer complications. UFE has become the first line treatment for uterine preserving therapies.

UFE has been shown to reduce pain and bulk symptoms (pressure and abdominal distension) and menorrhagia in most cases. Hysterectomy has previously considered the definitive treatment but a number of less invasive treatments have been emerging; medical management, laparoscopic myomectomy, endometrial ablation, focused ultrasound and UFE. UFE has emerged as one of the most important of these uterine sparing options.

An Interventional Radiologist and Gynaecologist should manage patients being considered for UFE collaboratively. The gynaecologist can explain other treatment options and rule out other potential pathological conditions. The Interventional Radiologist will explain the procedure and arrange for a number of investigations. You will most likely have had a ultrasound examination (abdominal and transvaginal) but to paln your treatment and ensure that UFE is the right procedure for you a Magnetic Resonance (MRI) imaging of the pelvis which will also include a small injection to assess the blood supply.

Certain fibroid subtypes deserve special comment. Intracavitary fibroids lie in the cavity and are likely to be expelled in a few weeks after UFE and Peduculated subserosal fibroids with a narrow attachment have a small risk of detachment. Contraindications to UFE include pregnancy, malignancy and infection.

What is Uterine Fibroid Embolisation (UFE)?

UFE is a minimally invasive surgical technique performed typically by interventional radiologists in a special room called an angiography theatre. Special catheters are inserted via an artery in a single groin or both groins and guided to the arteries that supply the uterus (womb) using X-rays (fluoroscopy). These vessels are usually enlarged because the fibroids have a large blood supply, blocking these vessels (embolisation) with tiny particles leads to the fibroid infarction (death). The exact particles used depend on each interventional radiologist but they all essentially do the same job.

When is a Uterine Fibroid Embolisation (UFE) performed?

UFE should be considered in any women with symptomatic fibroids of child bearing age how wishes not to loose their uterus (womb). UFE has been shown by two randomized controlled trials Embolisation versus hysterectomy (EMMY) and Randomised Trial of Embolisation versus Surgical Treatment for fibroids (REST) to have similar symptom relief, quality of life and patient satisfaction as surgery. UFE was associated with a quicker recovery and less complications although there was a higher re-intervention rate. Early studies demonstrated successful control of menorrhagia (heavy periods) in 92% and improvement in the bulk / pressure symptoms at 12 months in 88-96%.

What happens during a Uterine Fibroid Embolisation (UFE)?

The procedure will take place in an angiography theatre and you will lie flat on your back. You will have monitoring devices attached to your chest and finger and you will be given oxygen. A small cannula will be inserted to allow strong painkillers and sedation to be administered. You will also have a special pain controlling system connected called a PCA (patient controlled analgesia) which will help control the pain after the procedure. Your groin will be swabbed with antiseptic and you will be covered with sterile drapes.

Local anaesthetic will be injected in the skin in your groin and a needle will be inserted into the artery. Sometimes both groins are used. A fine plastic tube called a catheter is placed into the artery. The interventional radiologist uses special X-ray equipment (fluoroscopy) to guide the catheter into the arteries, which are feeding the fibroids. A special dye, called a contrast agent, is injected down the catheter into these uterine arteries, and this may give you a hot feeling in the pelvis. Fluid containing thousands of tiny particles is injected through the catheter into these arteries to block them. The catheter is removed and pressure applied to the groin to stop bleeding or a closure device is applied.

Following the procedure most patients will have moderate pain for several hours, the pain is due to ischaemia (lack of blood). This pain can be controlled to some degree with non-steroidal anti-inflammatory drugs and intravenous opiates administered via your PCA machine. The main symptom after 5 days is malaise, loss of appetite, nausea and low grade grade fever known as post embolisation syndrome. This happens in 10% of patients and can last a week or so.

How should I prepare?

You will need to be an inpatient for at least one night. You will be asked not to eat for six hours before the procedure. A nurse may place a urinary catheter into your bladder. You need to have a small needle put into a vein in your arm for a sedative and painkillers to be given. An anti-inflammatory suppository may be given. A special painkiller injection device will be attached so that you can administer safe doses of painkillers after the procedure by pressing a button (patient-controlled analgesia; PCA).