Uterine Artery Emboliztion for Fibroids

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Uterine Artery Emboliztion for Fibroids

• Andrew Cragg M.D.
• Co-Director, Fairview Southdale Heart and
  Vascular Center

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Uterine Fibroid Embolization (UFE)

• Overview
• Procedure development
• Clinical outcomes
• Patient selection
• UFE technique
• Recovery
• Complications
• Collaborative care

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Gynecologic Pelvic Embolotherapy

• Historical indications
• Post-partum hemorrhage
• Post-surgical hemorrhage
• Pelvic malignancy
• Pelvic Trauma

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Uterine Fibroid Embolization
UFE Procedure Success
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Uterine Myomata

• Most common benign tumor in women
• 30-50 of women over 35
• Cause of over 300,000 hysterectomies/year in USA
• Does not include myomectomies and other
  procedures
• Possibly as many as 500,000 surgical procedures
  annually

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Uterine Fibroids

• Symptoms

• Heavy, prolonged menstrual periods
• Unusual monthly bleeding
• Possible anemia
• Increased menstrual cramping
• Pain, pressure or discomfort in the pelvis
• Pain in the back, sides or legs
• Pain during sexual intercourse
• Urinary frequency due to pressure on the bladder
• Blockage of urine flow from the kidney to the
  bladder
• Constipation and/or bloating due to pressure on
  the bowel
• Abnormally enlarged abdomen

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Standard Treatment

• Global Therapies

• Hysterectomy gold standard major surgery

• GNRHs not durable, side effects

Local/Limited Therapies

• Myomectomy major surgery, high failure rate

• Myolysis (RF, Cryo) general anesthesia,
  questionable durability

• Myomectomy major surgery, high failure rate

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Patient Selection

• UFE Candidates

• Patients with
• Symptomatic fibroids

• Single or multiple fibroids

• Submucosal, subserosal or intramural fibroids

• Patient Preferences

• UFE

• Uterous sparring

• Rapid recovery

• Aversion to Surgery

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Uterine Artery Embolization for Fibroids

• Pre-UAE work-up
• Clinical evaluation
• Is the patient a candidate?
• Indications and contraindications
• What is best for this patient?
• Review of imaging studies
• MRI
• Laboratory

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What is a Fibroid?

• Sagital MR

• 2 large myomas

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Uterine Artery Embolization for Fibroids

• Procedure
• Prophylactic antibiotics
• Conscious sedation
• Selective catheterization of both uterine
  arteries
• Embolization with 300-500u particles
• Post-procedure pain control

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UFE

• Procedure
• Small incision in skin

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40 yo female procedure 1-26-05
Bilateral Pre
Bilateral Post
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40 yo female procedure 1-26-05
Left Pre
Left Post
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40 yo female procedure 1-26-05
Right Pre
Right Post
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Uterine Fibroid Embolization

• Post-UFE Outcomes

Baseline
3 months
1 year
3 years
Indicates largest fibroid Images courtesy of
James Spies, M.D., Georgetown University Hospital
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30 yo emergency UAE procedure 5-18-05
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Uterine Artery Embolization for Fibroids

• Post-procedure pain
• Starts at or shortly after 2nd UA is occluded
• Worsens for about 2 hours, then plateaus for 6-8
  hours
• Rapid improvement over next 3-5 hours
• Lower level plateau by 15 hours
• Improves over next several days
• Delayed by 24-48 hours in some patients

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Uterine Artery Embolization for Fibroids

• Discharge and follow-up
• Discharge POD 1
• Oral meds
• Rapid recovery and return to ADL
• MR and visit at 3 and 12 months

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Uterine Artery Embolization for Fibroids

• Results
• Technical success gt98
• Rapid recovery
• Control of Menorrhagia in 80-90
• Control of bulk-related symptoms in 80-90
• Reduction in uterine volume
• Average 48 at 3 months
• Between 1/3 and 2/3 for most women
• Results are durable

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Uterine Artery Embolization for Fibroids

• Post-embolization syndrome
• Occurs in about 40 of patients
• Fever, malaise, WBC
• Resolves in 3-5 days
• Rest, fluids, and acetaminophen for some patients
• NOT a sign of infection
• Patients not toxic

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Uterine Artery Embolization for Fibroids

• Complications
• Minor 5
• Groin Hematoma
• Major rare
• Infection
• Misembolization
• Uterine infarction
• Menopause
• Failure of therapy

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Uterine Artery Embolization for Fibroids

• Fertility
• Numbers are small to date
• Pregnancy outcomes similar to general
• Population
• No IUGR, placental insufficiency
• No birth defects

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Uterine Artery Embolization for Fibroids

• Unusual Outcomes
• Sloughed fibroids
• Short-term buttock pain
• Amenorrhea

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Uterine Artery Embolization for Fibroids

• Summary
• Treats all fibroid simultaneously
• Permanent infarction without regrowth
• Effective in controlling bleeding from most
  fibroids
• Minimally-invasive
• Conscious sedation
• Procedure time under 1 hour
• Preserves options for other therapies
• Fertility preserved

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Minnesota Vascular Clinic
6405 France Avenue South, Suite W440Edina, MN
55435(952) 345-4178Office Hours 730 am -
430 pm M-F
Conveniently located in the Minnesota Heart
Vascular Center building.
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Our Interventional Radiologists

• Our interventional radiologists have over 20
  years of experience in minimally-invasive
  procedures.

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Our Nurse Clinicians

• Our highly-skilled and compassionate nurse
  clinicians and interventional coordinator guide
  you through the process to ensure the treatment
  goal was met.

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Our UFE Practice

• Services
• Evaluation for patient selection
• MRI/US
• Patient Care
• Preprocedure education
• Postprocedure care
• Follow-up
• On Call Availability for post procedural patient
  management
• 24 hour call by Interventional Radiologist