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A doctor performs uterine artery embolization under sterile conditions.
This procedure usually requires sedation, a type of anesthesia that reduces pain, yet allows you to breathe on your own, respond to questions and report any discomfort. It also blocks your memory of the procedure.
Alternatively, you might undergo regional anesthesia. In this approach, the doctor injects medication around the spinal nerves that supply your pelvis. Regional anesthesia blocks pain, yet leaves you conscious and able to communicate.
During the procedure
To see your uterus and blood vessels, the radiologist uses a fluoroscope. The device is a pulsed X-ray beam that produces moving images of internal structures and displays them on a computer monitor. The radiologist makes an incision less than 1/4-inch wide (6 millimeters) in the skin over your femoral artery, which passes lengthwise through your groin, then inserts a catheter into the artery and guides the catheter to one of the two uterine arteries. An injected contrast fluid, usually containing iodine, flows into the uterine artery and its branches and makes them visible on the fluoroscope's monitor.
The contrast material makes the fibroids "light up" more brightly than other uterine tissue because of increased fibroid blood flow. The radiologist identifies and maps the vessels leading to the fibroids, then injects the branches with tiny particles made of plastic or gelatin. After injecting more contrast into the uterine artery, the radiologist checks additional images to make sure that blood is no longer reaching the fibroids. The same steps are then repeated in the second uterine artery. Generally, the radiologist can access both uterine arteries through one incision.
After the procedure
In the recovery room, staff members monitor your condition and give you medication to control nausea and pain. When the effects of the anesthesia fade, staff members bring you to your hospital room for continued observation.
You must lie flat for several hours to prevent pooling and clotting of the blood (hematoma) at the femoral artery site. Pain is the primary side effect of uterine artery embolization. Doctors believe it's a reaction to stopping blood flow to the fibroids. Some pain may also result from a temporary drop in blood flow to normal uterine tissue.
Pain usually peaks during the first 24 hours. To manage the pain, you receive medication through the catheter in your vein. Usually, the medication will be an opioid, such as morphine, although nonsteroidal anti-inflammatory drugs (NSAIDs) may be added or used instead. Many hospitals offer patient-controlled analgesia (PCA), a system that delivers a dose of pain medication to your bloodstream through a vein when you press a button.
Post-embolization syndrome — fever, extreme fatigue, nausea and vomiting — is common after uterine artery embolization. Doctors believe that chemicals released by degenerating fibroids stimulate inflammation, causing these symptoms. Although post-embolization syndrome usually resolves spontaneously, it's important to rule out endometritis, a serious complication marked by delayed pain, a rise in the white blood cell count and a pus-like vaginal discharge. Doctors treat endometritis with intravenous (IV) antibiotics.
By the next day, oral pain medications usually can replace IV medications. Your urinary catheter is removed, and you're encouraged to walk around. Recovery is generally rapid, and complications are rare.
Recovery
Most women return home the day after the procedure with a prescription for oral pain medication. Pain usually ends within a day or two, but in some women it may last up to a few weeks.
Monitor your recovery for potential complications:
- Vaginal discharge. You might have a mucus-like vaginal discharge after uterine artery embolization. The discharge should stop without treatment. In a few women, remnants of fibroids are passed through the vagina. The discharge isn't dangerous and usually stops on its own.
- Infection. Return to your obstetrician-gynecologist or primary care doctor for a follow-up examination within four weeks of the procedure to make sure there's no infection. Signs and symptoms of infection include fever, chills and pain.
You'll likely undergo a series of ultrasound or magnetic resonance imaging (MRI) examinations over the next year to monitor shrinkage or other changes in the fibroids or your uterus. Doctors usually schedule the first ultrasound examination three months after the procedure. Delayed infections and vaginal discharge are sometimes reported up to a year after the procedure.
- The American College of Obstetrics and Gynecologists. Alternatives to hysterectomy in the management of leiomyomas. Obstetrics & Gynecology. 2008;112:387.
- Haney AF. Leiomyomata. In: Gibb RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:916.
- Kim D, et al. Uterine fibroid embolization. http://www.uptodate.com/home/index.html. Accessed Feb. 6, 2009.
- Kim MD, et al. Long-term results of symptomatic fibroids treated with uterine artery embolization: In conjunction with MR evaluation. European Journal of Radiology. In press. Accessed Feb. 9, 2009.
- Marshburn PB, et al. Uterine artery embolization as a treatment option for uterine myomas. Obstetrics and Gynecology Clinics of North America. 2006;33:125.
- Walker WJ, et al. Long-term follow up of uterine artery embolization — an effective alternative in the treatment of fibroids. BJOG. 2006;113:464.
- Lohle PNM, et al. Long-term outcome of uterine artery embolization for symptomatic uterine leiomyomas. Journal of Vascular and Interventional Radiology. 2008;19:319.
- The Practice Committee of the American Society for Reproductive Medicine. Myomas and reproductive function. Fertility and Sterility. 2008;90(suppl):S125.
