by Dr. Reddi Prasad Yadavali
Fibroids are benign tumours of the uterus, mostly seen in women during their reproductive
age. More than 50% of the patients with uterine fibroid remain asymptomatic, hence needing
no treatment at all. However, in many women, these may cause heavy menstrual bleeding,
prolonged periods, anaemia, dysmenorrhea (painful periods), intermenstrual bleeding and
infertility requiring medical attention. Large fibroids can also cause bloating, pelvic pressure,
increased urine frequency and bowel disturbance. Treatment options include hormonal
therapy, surgical options such as myomectomy (fibroid removal) or hysterectomy (uterus
removal) and minimally invasive procedures such as Uterine Artery Embolisation (UAE) and
MR guided Focused Ultrasound (MRgFUS). Extensive research and development in the last
30 years have established UAE to be a safe and effective procedure in the management of
symptomatic fibroids. This treatment option must be routinely offered to the patients during
the first consultation.
Advantages of UAE
The most important patient advantages of UAE over surgery include early recovery, no
scarring, no blood loss, low risk of infection and quicker resumption to work.
As for the clinician’s point of view, there is Level I evidence supporting UAE. Multiple pieces
of evidence in the form of Cochrane review, systematic reviews and meta-analysis,
Randomised Trials favouring its use are extensively available. The procedure has become
increasingly popular because the uterus is preserved and associated with very low rates of
complication. Pregnancy and live-births have also been documented in the literature
following UAE.
Procedure
Embolization is the process of blocking blood flow through a blood vessel and as the name
suggests. UAE essentially means blocking the blood flow in the uterine arteries to stop the
blood supply to the fibroids. This results in shrinkage of the fibroids without affecting the rest
of the uterus, relieving the patient of their symptoms. Most patients report symptom
improvement within one to two months.
The procedure is carried out in a Cath Lab by an interventional radiologist. The patient is
administered a sedative and pain blocker through IV line by the anaesthetist. The entire
procedure is done under image guidance. During the procedure, a thin flexible tube
(catheter) is placed through the right femoral artery in the groin area, which is navigated into
the uterine arteries. Polyvinyl alcohol (PVA) particles 500-700 microns size mixed with
iodinate contrast and normal saline is the most commonly used embolic agent. These are
injected until blood flow is stopped completely. After completion of the procedure, the
catheters and sheath are removed. Manual compression is applied at the access site.
Post-procedure management and follow-up
Abdominal pain, mild fever and nausea are not uncommon post-procedure, require
management with routine medications and usually subsides within a week or two. All patients
are routinely prescribed prophylactic antibiotics and analgesics. Patients are advised to
follow up regularly and a repeat MRI scan is recommended at 6 months post-procedure.
Conclusion
UAE is a well established, safe and effective procedure in the management of Uterine
Fibroids. The Uterus is preserved which has an important role in the physical, emotional and
sexual health as well as their overall well being. There are several advantages of this
procedure and should be offered to the patients routinely, seeking treatment for symptomatic
fibroids. Patients are best managed by both Gynaecology and Interventional Radiology team.
