Uterine Fibroid Embolization

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Uterine Fibroid Embolization

• Renan Uflacker, M.D.
• Interventional Radiology
• Medical University of South Carolina
• Charleston, SC

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Uterine Fibroids

• At least 25 of women will develop fibroids in
  the uterus
• 40 of all women over 35 have fibroids
• Most fibroids do not require treatment
• Most common symptoms are
• Excessive menstrual bleeding (heavy bleeding
  anemia)
• Pain (Pelvic discomfort)
• Heaviness
• Infertility (difficulty getting or staying
  pregnant)
• Compressive symptoms (rectum, bladder)
• Painful or difficult bowel movements
• Frequent urination

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Uterine Fibroids

• Cause unknown
• Usually occur just before menopause
• May be related to estrogen levels
• Most common benign tumor in women
• Black women more vulnerable
• Most common cause of hysterectomy

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Uterine Fibroids

• Differential diagnosis
• Adenomyosis
• Ovarian Cysts
• Uterine Carcinoma

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Uterine Fibroids

• Available treatments
• Myomectomy
• Myolysis
• Hormonal treatment
• If above treatments fail or are not feasible
• Hysterectomy
• New less invasive treatment
• Uterine artery embolization

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• Potential problems with hysterectomy
• Post hysterectomy depression (?)
• Lack of interest in sex (7) (not significant)
• Lack of enjoyment of sex (1)

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Uterine Fibroids

• UAE is a fundamentally different treatment for
  fibroids
• Minimally invasive
• Low complication rates
• Effective
• Repeatable if necessary
• Uses proved technique of embolization, available
  for more than 30 years

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Uterine Artery Embolization

• Uterine artery embolization (UAE) as a primary
  form of therapy was reported by Ravina in 1995
• 16 patients were treated
• Polyvinyl alcohol particles used as embolic agent
• Mean FU 20 months
• Symptoms resolved in 11 of 16 patients
• 3 partially improved
• 2 failures (1 hysterectomy _at_ 6 weeks, 1
  myomectomy _at_ 6 months

Ravina et al. Lancet 1995
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PVA 300-500 microns
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• Fibroids die (caseous necrosis)
• Then scar down (hyaline sclerosis) and shrink

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Uterine Artery Embolization

• SCVIR (SIR) survey in October 2000
• 2741 Institutions were surveyed, 330 Institutions
  responded
• Aggregate caseload of the institutions was 542
  procedures per month
• 10,501 - UAE performed world-wide
• 8,644 - UAE performed in USA
• 40 (0.03) complications resulting in additional
  surgery within 30 days of the procedure
• 1 (0.009) death

CIRREF Fibroid Registry 2000
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Uterine Artery Embolization

• The procedure got a boost from a large
  multicenter prospective study involving 555
  patients in Canada
• Median uterine fibroid size was reduced by 35
• Dominant fibroid size was reduced by 42
• 83 reduction in menorrhagia
• 77 reduction in dysmenorrhea
• 86 reduction in urinary frequency

Pron et al Fertility Sterility, 2003
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Uterine Artery Embolization

• Severe bleeding was controlled, even in women
  with large uteri and minimal initial volume
  reductions
• UAE reduced the average menstrual duration from
  7.6 to 5.4 days
• 17 pregnancies were observed
• Major complications occurred in 1 of the cases

Pron et al Fertility Sterility, 2003
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Uterine Artery Embolization
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Uterine Fibroid Embolization