Uterine artery embolization

Uterine artery embolization (UAE) is a procedure where an interventional radiologist uses a catheter to deliver small particles that block the blood supply to the uterine body. The procedure is done for the treatment of uterine fibroids and adenomyosis. Given that this minimally invasive procedure is commonly used in the treatment of uterine fibroids it is also called uterine fibroid embolization (UFE).

Uterine artery embolization is used to treat bothersome bulk-related symptoms or abnormal or heavy uterine bleeding due to uterine fibroids or for the treatment of adenomyosis. Fibroid size, number, and location are three potential predictors of successful UFE

Long term outcomes with respect to how happy people are with the procedure are similar to that of surgery. There is tentative evidence that traditional surgery may result in better fertility. UAE also appears to require more repeat procedures than if surgery was done initially.

It has shorter recovery times. UAE is thought to work because uterine fibroids have abnormal vasculature together with aberrant responses to hypoxia.

UAE can also be used to control heavy uterine bleeding for reasons other than fibroids, such as postpartum obstetrical hemorrhage. and adenomyosis.

The rate of serious adverse effects is comparable to that of myomectomy or hysterectomy. The advantage of substantially faster recovery time is offset by a higher rate of minor complications.

Adverse effects that have been reported include death from embolism, or septicemia (the presence of pus-forming or other pathogenic organisms, or their toxins, in the blood or tissues) resulting in multiple organ failure. Infection from tissue death of fibroids, leading to endometritis (infection of the uterus) resulting in lengthy hospitalization for administration of intravenous antibiotics. Misembolization from microspheres or polyvinyl alcohol (PVA) particles flowing or drifting into organs or tissues where they were not intended to be, causing damage to other organs or other parts of the body. Ovarian damage resulting from embolic material migrating to the ovaries. Loss of ovarian function, infertility, and loss of orgasm. Failure of embolization surgery- continued fibroid growth, regrowth within four months. Menopause - iatrogenic, abnormal, cessation of menstruation and follicle stimulating hormones elevated to menopausal levels. Post-Embolization Syndrome (PES) - characterized by acute and/or chronic pain, temperatures of up to 38.8 °C, malaise, nausea, vomiting and severe night sweats. Foul vaginal odor coming from infected, necrotic tissue which remains inside the uterus. Hysterectomy due to infection, pain or failure of embolization. Severe, persistent pain, resulting in the need for morphine or synthetic narcotics. Hematoma, blood clot at the incision site. Vaginal discharge containing pus and blood, bleeding from incision site, bleeding from vagina, fibroid expulsion (fibroids pushing out through the vagina), unsuccessful fibroid expulsion (fibroids trapped in the cervix causing infection and requiring surgical removal), life-threatening allergic reaction to the contrast material, and uterine adhesions.

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