Uterine artery embolization for fibroids, adenomyosis

Uterine artery embolization (UAE) is a minimally invasive procedure used to treat symptomatic uterine fibroids and adenomyosis. It involves blocking the blood flow to the fibroids or adenomyosis-affected areas by injecting embolic agents into the uterine arteries, leading to shrinkage of the fibroids and reduction of symptoms associated with adenomyosis.

Indications

Uterine artery embolization is indicated for patients with:

1. 1. Uterine Fibroids: Benign tumors in the uterus causing symptoms such as heavy menstrual bleeding, pelvic pain, and pressure symptoms (Click here to read more on Uterine Fibroids)
   2. Adenomyosis: A condition where the tissue lining the uterus grows into the muscular wall of the uterus, leading to heavy periods, pelvic pain, and enlargement of the uterus (Click here to read more on Uterine Adenomyosis)
   3. Symptomatic Relief: Patients experiencing significant symptoms that do not respond well to conservative treatments like medications.

Procedure

1. Pre-procedure Assessment:
   • Imaging Studies: MRI or ultrasound is performed to evaluate the size, location, and characteristics of fibroids or adenomyosis.
   • Medical History and Physical Examination: Assessment of symptoms, overall health, and suitability for the procedure.
2. Preparation:
   • Informed Consent: Explanation of the procedure, its risks, benefits, and alternatives, followed by obtaining informed consent from the patient.
   • Pre-procedure Medications: Pain medication, antibiotics, and anti-inflammatory drugs may be administered.
3. Anesthesia:
   • Local anesthesia is typically used to numb the groin area where the catheter is inserted.
4. Catheter Insertion:
   • A small incision is made in the groin area, and a catheter is inserted into the femoral artery.
   • Under fluoroscopic guidance, the catheter is navigated to the uterine arteries that supply blood to the fibroids or adenomyosis-affected areas.
5. Embolization:
   • Embolic agents, such as tiny particles or gelatin sponge particles, are injected through the catheter into the uterine arteries.
   • These embolic agents block the blood flow to the fibroids or adenomyosis, causing them to shrink over time.
6. Post-embolization Care:
   • The catheter is removed, and pressure is applied to the insertion site to prevent bleeding.
   • Patients are monitored for a few hours post-procedure for any immediate complications.
   • Post-procedure instructions are provided, including pain management, activity restrictions, and follow-up appointments.

Benefits

• Non-Surgical Approach: Minimally invasive procedure without the need for surgery or general anesthesia.
• Symptomatic Relief: Reduction in symptoms such as heavy menstrual bleeding, pelvic pain, and pressure symptoms.
• Preservation of Uterus: Allows for the preservation of the uterus, important for women who wish to retain fertility or avoid hysterectomy.
• Shorter Recovery: Faster recovery compared to surgical interventions, with most patients able to resume normal activities within a few days to a week.

Risks and Considerations

• Post-Embolization Syndrome: Temporary symptoms such as pain, nausea, and low-grade fever may occur but usually resolve within a few days.
• Infection: Risk of infection at the catheter insertion site, though uncommon.
• Uterine Ischemia: Rarely, there may be a risk of uterine ischemia or damage to nearby structures due to embolization 
• Recurrence: Fibroids or adenomyosis symptoms may recur over time in some patients, necessitating further treatment or monitoring.

Conclusion

Uterine artery embolization is an effective and minimally invasive treatment option for symptomatic uterine fibroids and adenomyosis. By blocking the blood flow to the affected areas, this procedure leads to symptom relief and reduction in the size of fibroids or adenomyosis-affected tissues. Close monitoring and follow-up are essential to assess treatment outcomes and address any potential complications. It is particularly beneficial for women seeking alternatives to surgery or wishing to preserve their uterus for future fertility.