A non-surgical treatment for uterine fibroids called uterine artery embolization (UAE) blocks blood flow to the fibroids—killing the tissue, shrinking the tumors and relieving symptoms. It can be an alternative to hysterectomy.

Fibroid tumors are noncancerous (benign) growths that develop in the muscular wall of the uterus. While fibroids do not always cause symptoms, their size and location can lead to problems for some women, including pain and heavy bleeding. Fibroids range in size from very tiny to the size of a cantaloupe or larger. In some cases, they can cause the uterus to grow to the size of a five-month pregnancy or more. Fibroids may be located in various parts of the uterus.

Uterine fibroid embolization, also called uterine artery embolization (UAE), is done without surgery. It requires only a tiny nick in the skin about the size of a pencil tip. It is performed while the patient is conscious, but sedated—drowsy and feeling no pain. Fibroid embolization is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally invasive procedures.

The interventional radiologist makes a small nick in the skin in the groin, through which a tiny tube called a catheter is inserted into an artery. The catheter is guided through the artery to the uterus while the radiologist watches the progress of the procedure using a moving x-ray called fluoroscopy. When the catheter is in place, the interventional radiologist injects tiny plastic or gelatin sponge particles the size of grains of sand into the artery that supplies blood to the fibroid tumor. The particles cut off the blood flow to the fibroid and cause it to shrink.

Uterine Fibroid Embolization Guidelines

When Your Procedure Is Scheduled

• Our scheduler will give you a date and time for your procedure at Overlake Hospital Medical Center. You will need to arrive at the hospital two hours before the procedure to allow the admitting and nursing staffs to get you ready.
  
• Please let the scheduler know if you take Coumadin, Plavix, Insulin or Metformin. You will need to receive specialized instructions.
  
• Please notify us if you’ve had a previous reaction to contrast dye.
  
• If you have any questions regarding your procedure, you may call us at 425-688-5507.
  
• The admitting department will attempt to call you the night before your procedure to confirm your arrival time.
  
• Please plan to leave any jewelry or valuables at home.
  
• Make sure to arrange for someone to drive you home after the procedure.

Preparation

• Do not eat or drink for four hours before your exam.
  
• Please take your normal heart and blood pressure medications with a sip of water.
  
• You need to be at the hospital’s admitting area two hours before you procedure’s scheduled start time. This is located at the large desk at the hospital’s main entrance (across from Stanza’s Café).
  
• You will be taken down to your room where you will meet your nurse. You will be asked to change into a patient gown. An IV will be started and blood drawn for lab tests. The nurse will ask you for your medical history.
  
• If possible, bring a list of all the medications you take and when you take them.
  
• The nurse will also ask you about allergies. If you are allergic to radiology/contrast dye please let them know.
  
• If there is a possibility that you’re pregnant, please let the nurse know. You will be asked to sign a form if you are a female of childbearing age (12-57).
  
• The nurse or tech will clean and shave, as necessary, an area around the catheter’s point of entry. Since part of your procedure will include an angiogram, both sides of your groin will be shaved for access to the femoral artery.
  
• Before the procedure, the interventional nurse will meet with you and your family to review the procedure and answer any questions you might have.

What to Expect During the Procedure

• The procedure takes from 1-3 hours. You will meet the interventional radiologist who will go over the consent form and answer any questions you might still have.
  
• You will receive sedation medication during the procedure to help you relax.
  
• During the procedure you might feel warmth, tingling or flushing when you are given the contrast dye. This usually lasts about 10 seconds.
  
• During the procedure the nurse will be monitoring your heart, blood pressure and the oxygen level in your blood.
  
• Your OIA interventional radiologist will numb the skin and make a small cut (normally smaller than 1/4 of an inch) at the crease at the top of the leg to access the femoral artery.
  
• A small, hollow tube (catheter) is then inserted into the artery. Local anesthesia is used so the needle puncture is not painful. You may feel a small amount of pressure as the catheter is inserted.
  
• Using x-ray imaging (fluoroscopy) to guide the catheter's progress, the interventional radiologist steers the catheter through the artery to the uterus. The catheter is moved into the uterine artery at a point where it divides into the multiple vessels supplying blood to the fibroids.
  
• An arteriogram (a series of images taken while radiographic dye is injected) is then performed to provide a road map of the blood supply to the uterus and fibroids.
  
• The interventional radiologist slowly injects tiny plastic (polyvinyl alcohol or PVA) or gelatin sponge particles the size of grains of sand into the vessels. The particles flow to the fibroids first, wedge in the vessels and cannot travel to other parts of the body. Over several minutes, the arteries are slowly blocked. The embolization is continued until there is nearly complete blockage of the blood flow in the vessel. As a result of the restricted blood flow, the tumor or tumors begin to shrink.
  
• The procedure may then be repeated on the other side so the blood supply is blocked in both the right and left uterine arteries. (Some physicians block both uterine arteries from a single puncture site, while others puncture the femoral artery at the top of both legs.)
  
• After the embolization, another arteriogram will be performed to confirm the results.
  
• Once the procedure is over, the skin puncture where the catheter was inserted is cleaned and covered with a bandage. Then, you will be transferred back to your room.

What to Expect After the Procedure

• Fibroid embolization usually requires a hospital stay of one night, although some women do go home the same day. (Six to eight hours of bed rest is typical after the procedure.) Your blood pressure, pulse and puncture site will be monitored very frequently by the nurse.
  
• You will be encouraged to drink a lot of fluids to help wash the contrast out of your system.
  
• You will need to continue to drink fluids for the first 24 hours after your procedure, unless your physician has limited your fluid intake.
  
• Total recovery generally takes one to two weeks, but can take longer.
  
• Vaginal spotting and discharge may occur for several weeks after completion of the procedure.
  
• Pain-killing medications and drugs that control swelling typically will be prescribed following the procedure to combat cramping, which is a common side effect. Fever is also an occasional side effect and is usually treated with acetaminophen.
  
• You will be given written instructions and a phone number to call if you have any questions or concerns.
  
• One of the interventional nurses will do a follow-up call the next day after your discharge. Write down any questions you might have for them.
  
• To speak to an interventional nurse, please call 425-688-5005. It is best to call between 8AM and 4PM Monday thru Friday. You can leave a message on the voicemail, and a nurse will return your call as soon as possible.
  
• If you are on Coumadin and have been told not to take it before your procedure, you need to check with your physician, and/or the Anti-Coagulation Clinic for instructions.
  
• If you are on Metformin/Glucophage, withhold taking it for 48 hours post procedure. Check with the physician who ordered the medication on when to restart it. Additional blood work may be required.
  
• If you an insulin-dependent diabetic, restart your regular dosing when you get home. Check your sugar regularly and if you have a concern, contact your diabetic doctor.
  
• You may resume taking all of your normal medications once you are home.