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Uterine Artery Embolisation (UAE)

 

History of Uterine Artery Embolisation (UAE)

Uterine Artery Embolisation (UAE), side effects sometimes also name Uterine Fibroid Embolisation (UFE), was first performed by a group under the direction of French gynaecologist, Prof. Jacques Ravina in the late 1980s to stem post-surgical haemorrhage. Radiologists started to embolise patients with fibroids pre-operatively to reduce bleeding. Patients started to cancel their surgery as their symptoms improved and a reduction in the size of their fibroids and uteri were noticed. [51],[52],[53]

To date over 100,000 embolisations have been performed worldwide with over 20,000 in the UK, with very high patient satisfaction. Here in the UK there has been 60 successful pregnanciesafter UAE by one interventional radiologist, the total number is not known.  This procedure can also be used to treat adenomyosis (see patient experiences), although the evidence is less clear.

 

Pre-procedural Diagnosis and Assessment

Types of fibroidsIt is important that a full assessment and diagnosis is carried out by a gynaecologist This should exclude other possible pathologies. FSH (follicle stimulating hormone) levels may be useful for patients <45 years old. [29],[59]

MR (magnet resonance) imaging or ultrasound is required to determine the size, position and number of leiomyomata.

Click on the image for a larger view of a Digital Subtraction Angiogram demonstrating the arterial supply to a uterus containing a 6cm. diameter solitary fibroid.

MR is a superior modality for mapping leiomyomata accurately and can differentiate between leiomyomata and adenomyosis. [29],[45],[46],[47],[48],[49],[50]

More recently MRA (magnetic resonance angiography) using intravenous gadolinium based contrast medium has shown to be a useful pre-assessment for embolisation, as the arterial anatomy of the uterine and ovarian arteries is visualised and collaterals from the ovarian arteries and this can reduce screening and procedure time. [57]

 

Contraindications for Uterine Artery Embolisation

There are few contraindications to UAE. Large leiomyomata used to be contraindicated, but it has been found that those over 21cm can also be successfully treated. Multiple fibroids can be treated very successfully by UAE.

Asymptomatic fibroids would not normally be treated and if there is a history of allergies to contrast media, that would be a consideration.

Pedunculated subserosal fibroids used to be a contraindication, but these are now treated in many centres by UAE followed immediately by myomectomy to remove that fibroid.

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Embolisation procedureThe Uterine Artery Embolisation Procedure

The procedure is carried out by an interventional radiologists in an angiography suite The patients normally receive intravenous sedo-analgesia. No general anaesthetic is required. The procedure normally takes 60-90 minutes and requires a 1-night hospital stay, with return to work in 1-5 weeks.

Click on the diagram to the right for a larger view
showing the embolisation procedure.

Uterus with spheres

 

Normally both branches of the uterine artery can be embolised from a unilateral 1mm incision of the femoral artery using a 4Fr internal mammary catheter. Use of this catheter also negates the need for Waltman loop and reduces procedure and screening time and thus radiation dose.  Some centres use a bilateral approach with incisions in both femoral arteries to reduce radiation dose. [29],[58],[59]

 

UFE procedure

 

 

Click on the diagram to run an animation of how particles are positioned within blood vessels.

Polyvinyl alcohol (PVA) particles (355-500m) are most commonly used as embolic material, although gelatin particles are also used.

Platinum coils were used in addition to particles, but have been found to be unnecessary, as well as increasing the procedural time.

CLICK HERE to run an animation showing how the Uterine Embolisation procedure blocks the artery, thus starving fibroids of the blood supply and causing them to shrink over time ...

 

Post-procedural Recovery

Post procedural pain can vary enormously from no pain at all to severe cramping pain requiring considerable analgesia. However, any pain tends to ease after 24 hours.

Patients will normally return home with non-steroidal anti-inflammatory drugs (NSAIDs) to control pain.

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