CWC Article - Exercise In Pregnancy

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Uterine Artery Embolization

By: Bradley G. Goldberg, M.D.

Uterine artery embolization is a relatively new treatment for uterine fibroids. The treatment involves the destruction of uterine fibroids under fluoroscopy (moving X-rays) by injecting microscopic particles to destroy the fibroid. It is performed in a hospital’s radiology department, usually as an outpatient.

While using this X-ray guidance, the doctor inserts a catheter into the large femoral blood vessel in the leg. This catheter is then carefully threaded into the blood vessels that supply the uterus. Once the catheter is in the proper blood vessel, the doctor then injects the microscopic particles (usually polyvinyl alcohol) that will cause a clot to form.

This clot prevents further blood flow through these vessels. Since the fibroid tumors depend on a good blood supply, once destroyed the tumor will shrivel and die. All of this is accomplished with no major surgical incisions. Most patients are discharged within 24 hours, with recovery period of 1 - 2 weeks.

Drawbacks of this procedure include the fact that experience is so far limited. In the world, only 30,000 women have had this procedure. Compare this to the 600,000 hysterectomies performed in the U.S. each year. In addition, women who undergo this treatment are more likely to need further treatment in the next 5 years than women who have a myomectomy (described below). Finally, this procedure is not yet widely available, and is mostly limited to larger medical centers. While this treatment may be promising in the future, it should be pointed out that the standard of care in treating symptomatic fibroids remains surgical, either myomectomy or hysterectomy.

If a woman who wishes to maintain her ability to have children, uterine artery embolization is not recommended. In this case, a myomectomy can be performed. This is abdominal, or laparoscopic surgery that removes the fibroid tumor but leaves the uterus in place.

The problem with myomectomy is that the tumor could return in up to 25% of patients. Because of this high recurrence rate, women who are past the age of childbearing are usually offered hysterectomy.

Bear in mind though that most fibroids do not require surgical treatment. Surgery should be reserved only for those patients who have significant symptoms such as pain and bleeding which has not responded to medication, or for those tumors that seem to be growing rapidly.