Background Information:

What are the other Names for the Procedure?

• Embolization of Uterine Fibroid
• UFE (Uterine Fibroid Embolization)
• Uterine Artery Embolization (UAE)

What is Uterine Fibroid Embolization radiology procedure? (General Explanation)

• Uterine Fibroid Embolization (UFE) is a minimally-invasive procedure to treat fibroid tumors found in the uterus
• Fibroid tumors are also known as myomas. These tumors originate from the muscular wall of the uterus and most of the fibroid tumors are benign. They cause a heavy menstrual bleeding, pressure, and pain in the pelvic region
• In Uterine Fibroid Embolization procedure, fluoroscopy is used to deliver small particles (embolic agents) into the fibroids, which basically block the arteries that provide blood to the fibroids. As a result, the fibroids shrink and the bleeding and pain stops

What part of the Body does the Procedure involve?

The uterus in the pelvic region is involved in Uterine Fibroid Embolization procedure.

Why is the Uterine Fibroid Embolization radiology procedure Performed?

• Uterine Artery Embolization procedure is performed to stop pelvic bleeding in cases of trauma, malignant tumors, and hemorrhage after childbirth
• The Uterine Fibroid Embolization procedure is a specific form of Uterine Artery Embolization that is performed to treat fibroid tumors causing bleeding, pressure, and pelvic pain

What is the Equipment used? (Description of Equipment)

Following equipment is used in Uterine Fibroid Embolization procedure:

• Fluoroscopy:
  • Fluoroscopy uses X-rays technology to produce images in real time
  • It consists of an examination table, an x-ray tube, and a television-like monitor
  • The video produced by fluoroscopy is transferred to the television monitor and real-time images can be seen as the procedure is being performed      
• Catheter: It is a long, thin plastic tube used to deliver embolic agents to the bleeding site
• Embolic agents: These agents could be made of plastic or sponge material, and are microspheres and are used to block the artery supplying blood to the fibroids

What are the Recent Advances in the Procedure?

There have been no recent advances to the Uterine Fibroid Embolization procedure.

What is the Cost of performing the Uterine Fibroid Embolization radiology Procedure?

The cost of Uterine Fibroid Embolization procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Uterine Fibroid Embolization procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/25694762 (assessed on 3/9/15)

http://www.ncbi.nlm.nih.gov/pubmed/25638750 (assessed on 3/9/15)

http://www.ncbi.nlm.nih.gov/pubmed/25597366 (assessed on 3/9/15)

Prior to Uterine Fibroid Embolization radiology procedure:

How does the Uterine Fibroid Embolization radiology procedure work?

The Uterine Fibroid Embolization procedure works in the following manner:

• Uterine fibroids receive good blood supply from the arteries that also provides nutrition. It may also cause severe bleeding sometimes
• The UFE procedure involves inserting a catheter into the uterine artery, which provides blood supply to the uterine fibroids
• Embolic agents are injected through a catheter into the uterine artery to block it from supplying blood to the fibroid(s). This leads to shrinkage of the fibroids and helps relieve the symptoms

How is the Uterine Fibroid Embolization radiology procedure Performed?

The Uterine Fibroid Embolization is performed in the following manner:

• The patient is positioned in a supine position on the examination table. The vital signs, such as blood pressure, pulse, and heart rate, are monitored using various devices
• An IV line is inserted into the patient’s arm vein. It is used to give IV fluids and sedation
• The catheter insertion area in the groin is cleaned, shaved, sterilized, and surgically draped
• A local anesthetic is used to numb the catheter insertion area
• Fluoroscopy is used to locate the femoral artery in the groin area
• A catheter is inserted into the femoral artery and contrast material is injected in order to find a way to the uterine artery
• Once the catheter is placed in the uterine artery, an embolic agent is placed in both the left and right uterine arteries
• After the procedure is over, the catheter is removed and pressure applied to avoid any kind of bleeding. No sutures are necessary as skin incision is very small
• The patient is usually admitted to the hospital after the procedure for pain control and observation

Where is the Procedure Performed?

Uterine Fibroid Embolization is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

An interventional radiologist performs the Uterine Fibroid Embolization procedure.

How long will the Procedure take?

The Uterine Fibroid Embolization procedure takes about 90 minutes to complete.

Who interprets the Result?

An interventional radiologist interprets the results of the Uterine Fibroid Embolization and may discuss the same with a gynecologist.

What Preparations are needed, prior to the Procedure?

Following preparations are needed prior to the Uterine Fibroid Embolization procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Do inform the medical professional if you have a history of any medical conditions such as a heart disease, asthma, diabetes, or kidney disease
• An MRI scan or ultrasound of the uterus is performed as part of the procedure to confirm the diagnosis of fibroid tumors and examine its size and other parameters
• A gynecologist may perform biopsy of the endometrium to rule out cancer
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• Patients may be asked to stop taking any blood thinner medications, such as aspirin’s, NSAIDs, heparin, or warfarin, several days before the procedure
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the x-ray
• Women should notify the physician if they are pregnant or breastfeeding their child, as many such procedures may not be performed on pregnant women
• Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations before the preparation sessions
• The patient may be asked to avoid eating or drinking several hours before the procedure

What is the Consent Process before the Procedure?

A physician will request your consent for the Uterine Fibroid Embolization procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Uterine Fibroid Embolization procedure:

• Uterine fibroid embolization is a minimally invasive procedure with fewer complications than a laparoscopic surgery or hysterectomy
• There is only a very short recovery period after the procedure
• This procedure is very effective in resolving symptoms related to fibroids, such as urinary frequency, menstrual heavy bleeding, pelvic pain, and pressure-like pain
• Uterine Fibroid Embolization is a permanent procedure as fibroids do not develop in size after this procedure, as opposed to a hormonal therapy
• Only a small incision is needed for catheter insertion, as opposed to laparoscopy surgery for hysterectomy

Following are the risks of the Uterine Fibroid Embolization procedure:

• The catheter inserted into the uterine artery can damage the artery and cause severe bleeding
• The skin incision that is made for catheter insertion can lead to an infection after the procedure
• The contrast material used during the procedure may cause severe allergic reaction in some individuals
• In a small percentage of patients, menopause may occur after the procedure. This is more commonly seen in women older than 45 years
• In some cases, when fibroids get detached from the uterine wall, they may pass in small pieces. A dilatation and curettage may be required to remove all the pieces and ensure that no bleeding recurs or causes an infection
• Sometimes, the symptoms are not relieved after the Uterine Fibroid Embolization. In such cases, a hysterectomy may be required
• There has not been enough research undertaken to determine, if the UFE procedure could cause any weakness in the uterine wall. Women are recommended to go through a C-section during child delivery in order to avoid the risk of rupturing the uterine wall
• Also, current recommendations are to take contraception for six months after the procedure
• The effect of UFE procedure is not known on future pregnancies. Thus the procedure is usually not performed in women who are planning to get pregnant. Surgeries are recommended in these patients to remove the fibroids

What are the Limitations of the Uterine Fibroid Embolization radiology procedure?

Following are the limitations of the Uterine Fibroid Embolization procedure:

• The procedure is not recommended for patients who are pregnant
• A surgical removal of the fibroid is usually recommended over UFE for women who are planning to get pregnant in the future
• This procedure is not performed in patients who do not have any symptoms from the fibroid tumors
• This procedure cannot be performed in patients with infection in the pelvis, or if there is any possibility of having cancer in the pelvic area

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is a Uterine Fibroid Embolization procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life after the procedure?
• What are the costs involved?

During the Uterine Fibroid Embolization radiology procedure:

What is to be expected during the Uterine Fibroid Embolization radiology procedure?

The following may be expected during the Uterine Fibroid Embolization procedure:

• The patient will feel a slight pinprick when the IV line is inserted
• In cases where sedation is used, the patient may feel sleepy and relaxed during the procedure
• Patients may feel a slight discomfort and pressure when the catheter is inserted
• A warm feeling may be felt when the contrast material is injected
• After the procedure is completed, patients are taken to the recovery area

What kind of Anesthesia is given, during the Procedure?

Moderate sedation or general anesthetic may be used during the Uterine Fibroid Embolization procedure.

How much Blood will you lose, during the Procedure?

Since it is a minimally invasive procedure, the blood loss involved during the procedure is minimal.

What are the possible Risks and Complications during the Uterine Fibroid Embolization radiology procedure?

• Catheter inserted in the uterine artery can damage the artery and cause severe bleeding during the procedure
• In some individuals, the contrast material used during the procedure may cause severe allergic reactions
• In a small percentage of patients (usually women over 45 years), menopause may occur after the procedure

What Post-Operative Care is needed at the Healthcare Facility after the Uterine Fibroid Embolization radiology procedure?

• No specific post-operative care is needed at the healthcare facility after the Uterine Fibroid Embolization procedure
• However, patients may be placed under observation for a period of time

After the Uterine Fibroid Embolization radiology procedure:

What is to be expected after the Uterine Fibroid Embolization radiology procedure?

The patient will be admitted to the hospital after the Uterine Fibroid Embolization procedure for pain control and observation.

• Pelvic cramps, nausea, and low-grade fever are commonly experienced for a few days after the procedure
• Menstrual bleeding after the procedure will be much less during the first cycle, though it will gradually increase. However, it will be much improved compared to before the procedure
• Patients may have 1-2 menstrual periods after the procedure
• Pain due to large fibroids takes about a month to decrease, as the fibroids shrink. The symptoms may take about 6 months to completely disappear
• Patients are prescribed pain medications after the hospital discharge

When do you need to call your Physician?

Patients may need to contact their physician in the following situations, after the Uterine Fibroid Embolization procedure:

• If pelvic cramps do not resolve after several days or get worse with time
• If the patient experiences severe nausea and vomiting that is not controllable with medications
• If any signs of infection is noticed at the catheter insertion site such as redness, warmth, and inflammation accompanied by high fever

What Post-Operative Care is needed at Home after the Uterine Fibroid Embolization radiology procedure?

• No specific postoperative care is needed at home after the Uterine Fibroid Embolization procedure
• Patients should avoid any heavy lifting for about a month after the procedure

How long does it normally take to fully recover, from the Procedure?

• It takes about 1-2 weeks to fully recover from the Uterine Fibroid Embolization procedure
• Patients may resume their normal activities after about two weeks

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Uterine Fibroid Embolization procedure does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Uterine Fibroid Embolization radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Uterine Fibroid Embolization procedure is performed.