Uterine artery embolization is a minimally invasive procedure for uterine fibroids, noncancerous growths in the uterus.
In uterine artery embolization — also called uterine fibroid embolization — a doctor uses a slender, flexible tube (catheter) to inject small particles (embolic agents) into the uterine arteries, that supply blood to your fibroids and uterus. The main goal of it is to block the fibroid blood vessels, starving the fibroids and causing them to shrink and die.
It is done because:
Uterine fibroids can cause severe symptoms in some women, including heavy menstrual bleeding, pelvic pain, and swelling of the abdomen. Uterine artery embolization destroys fibroid tissue and eases these symptoms. And it provides an alternative to surgery to remove fibroids (myomectomy).
How to prepare
Uterine artery embolization usually is performed by an interventional radiologist or a specialist in obstetrics and gynecology who has training in uterine artery embolization.
Food and medications before the procedure
On the evening before the procedure, don’t eat or drink after midnight or after whatever time your doctor advised. If you’re taking medications, ask your doctor if you should stop taking them before or after the procedure.
What is it possible to expect
To see your uterus and blood vessels, the radiologist uses a fluoroscope. This device is a pulsed X-ray beam that produces moving images of internal structures and displays them on a computer monitor.
Before the procedure
In the radiology procedure room, you’ll have an intravenous (IV) line placed in one of your veins to give you fluids, anesthetics, antibiotics and pain medications.
During the procedure
The procedure includes:
- Anesthesia. Typically you’ll receive a type of anesthesia that reduces pain and helps you relax, but leaves you awake (conscious sedation).
- Blood vessel access. The doctor makes a small incision in the skin over your femoral artery, a large blood vessel that passes lengthwise through your groin. Then your doctor inserts a catheter into the artery and guides the catheter to one of the two uterine arteries. Generally, the doctor can access both uterine arteries through one incision.
- Blood vessel mapping and injection. 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 fibroids “light up” more brightly than other uterine tissue.The radiologist identifies the right area of the uterine artery and then injects the blood vessel with tiny particles made of plastic or gelatin. The particles are carried by the blood flow to block the fibroid vessels.After injecting more contrast into the uterine artery, the doctor 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.
After the procedure
In the recovery room, your care team monitors your condition and gives you medication to control any nausea and pain. When the effects of the anesthesia fade, they take you to your hospital room for overnight observation.
- Position. You must lie flat for several hours to prevent pooling of the blood (hematoma) at the femoral artery site.
- Pain. The primary side effect of uterine artery embolization is pain, which may be a reaction to stopping blood flow to the fibroids and a temporary drop in blood flow to normal uterine tissue. Pain usually peaks during the first 24 hours. To manage the pain, you receive pain medication.
- Observation. Post-embolization syndrome — characterized by low-grade fever, pain, fatigue, nausea and vomiting — is frequent after uterine artery embolization.Post-embolization syndrome symptoms peak about 48 hours after the procedure and usually resolve on their own within a week. Ongoing symptoms that don’t gradually improve should be evaluated for more-serious conditions, such as an infection.By the next day, 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:
- Vaginal discharge. You might have a watery or mucus-like vaginal discharge for a few weeks to a month after uterine artery embolization. The discharge should stop without treatment. In a few women, remnants of fibroids are passed through the vagina.
- Infection. Return to your obstetrician-gynecologist or primary care doctor for a follow-up exam within four weeks of the procedure to make sure there’s no infection. Signs and symptoms of infection include fever, chills and pain. Delayed infections and vaginal discharge are rarely reported weeks to months after the procedure.
