Uterine Artery Embolization
Uterine Artery Embolization (UAE) or Uterine Fibroid Embolization(UFE), is an option offered by interventional radiologists. An incision is made in the groin area and a catheter is inserted into the iliac artery, the large artery that supplies blood to the pelvis and leg. It is guided along the artery until it reaches the arteries supplying blood to the fibroids.Tiny bead-like particles are then injected into the arteries to block the blood supply to the fibroids.
Embolization will avoid surgery in those patients with smaller fibroids, and is very effective in controlling menstrual bleeding. In the correct patient, the results are quite good and the recovery better than with open procedures. CGS supports the use of embolization, but only in those patients who have been counseled thoroughly on minimally invasive surgical procedures using ARLS and Dualport techniques, and refuse to undergo minimally invasive surgery. Embolization was developed as an alternative to open abdominal surgeries for hysterectomy and myomectomy. The recovery with ARLS and Dualport GYN procedures is actually much better than embolization, with better long term results. The following describes some of the limitations of embolization when compared to Advanced Retroperitoneal Laparoscopic Procedures as performed by the Center for GYN Surgery.
Fertility
Embolization cannot be used for patients wanting pregnancy. Embolization may affect embryo implantation and development, and is not recommended for the treatment of fibroids in patients wanting to become pregnant.
Pain
Embolization can cause severe and significant pain in some patients undergoing the procedure. This is because the blood supply to the fibroids is immediately stopped, resulting in rapid degeneration of the fibroids, and release of compounds that make the uterus contract causing severe pain. In some patients, the pain is limited in severity and duration. In others, the pain can be severe and long term. Note that almost all patients undergoing embolization are admitted to the hospital overnight with a morphine pump for pain control. With ARLS procedures - either myomectomy or hysterectomy - almost all patients are discharged home the same day with pain pills only for pain control. Many patients do not require narcotics for pain management, with ibuprofen or Tylenol adequate for pain control.
Recovery
ARLS procedures in general will provide a faster recovery with less pain than embolization procedures. This is because the smallest incisions possible are used and are located at sites creating the least amount of pain and the best cosmetic result. Dualport GYN patients are able to ambulate the day of surgery, with recovery stressing movement to achieve normal function immediately. Most patients are back to work in seven days on average.
Fibroid Bulk
Many patients have symptoms from fibroids due to the “bulk” of the uterus and fibroids displacing normal structures in the pelvis. An example is frequency of urination, which is caused by the fibroids pushing on the bladder and decreasing the capacity of the bladder. The result is more frequent urination. Pelvic pressure, back pain, and abdominal distension are common symptoms resulting from fibroid bulk. Embolization will not remove fibroid bulk quickly. It will take time for the fibroid to decrease in size, and in many cases the fibroids will not decrease significantly to relieve symptoms. Fibroids will often calcify after embolization, becoming very hard and and sometimes causing symptoms. Myomectomy or hysterectomy performed with ARLS procedures results in complete removal of the fibroids, stopping bleeding immediately and removing the bulk of the uterus completely to relieve symptoms. Considering that in some cases of embolization fibroids take more than a year to decrease in size to resolve symptoms, ARLS procedures provide a much better alternative with faster recovery than embolization.
Fibroids Not Treated with Embolization
Not all patients with fibroids can undergo embolization procedures. Those patients with fibroids in the cavity of the uterus, those with very large fibroids or many smaller fibroids, and those with fibroids on stalks are not candidates. In general, patients with fibroids greater than 7 cm will not be well treated with embolization.
Recurrence
Thirty percent or more of those patients treated with embolization will have recurrence of their fibroids within 3 to 5 years of undergoing the procedure. The uterus is a reproductive organ with an excellent blood supply. There are many sources of “collateral” flow, or flow from other sites, that will continue to provide blood supply to the fibroids for growth after embolization has been completed. Hysterectomy is the only definitive long term solution to fibroid recurrence. DualportGYN hysterectomy is an excellent option to embolization, allowing patients to achieve a much better recovery and better long term control than embolization.
The doctors at CGS are confident that embolization does not provide an advantage over ARLS and DualportGYN procedures for the management of fibroids. In fact, the recovery with these procedures as performed by CGS surgeons are better than embolization, with less pain, faster recovery, minimal narcotic use, and immediate relief of bulk symptoms. Embolization is limited to only certain types of fibroids being treated. All patients with fibroids can be treated with ARLS procedures. Further, Dualport hysterectomy provides superior long term control for fibroid recurrence over embolization at 100%. Patients should consider all their options before undergoing embolization procedures. ARLS and DualportGYN procedures are better options than embolization for most patients with fibroids requiring treatment.