Uterine Artery Embolization (UAE)

 

If you suffer from fibroids, your doctor may recommend uterine artery embolization (UAE). This relatively new treatment is an alternative to open surgery for fibroids. Embolization is a technique that blocks the blood flow to the fibroid or fibroids, causing them to shrink and die. This also often decreases menstrual bleeding and symptoms of pain, pressure, urinary frequency or constipation.

 
 
 
Preparation
After midnight the night before your UAE procedure, you should not eat or drink anything. Aspirin or ibuprofen should not be taken five days before the procedure. These medications can thin you blood. However, the morning of the UAE procedure, you may take other medications that you usually take with a small sip of water. Though if you take Coumadin, Plavix, Glucophage or Heparin, please talk to your doctor about when to stop taking these medications.
 
Procedure

UAE takes approximately two hours and is performed in a radiology suite rather than an operating room by an interventional radiologist. The first part of the procedure is called an arteriogram, also known as an angiogram. This involves taking a series of X-ray pictures of the arteries that are supplying the uterine fibroid after "contrast" material (X-ray dye) is injected into the artery, making them visible.

 
First, an intravenous (IV) line is placed in your arm so that you are able to receive fluids and medications during the procedure. Your groin area will be shaved and cleaned with a sterile solution to help prevent infection. You will then be covered by sterile gowns. A local anesthetic will be injected at the skin site. You will also be sedated, which will keep you awake but sleepy during the procedure.
 
A small catheter -- a thin flexible tube -- is then placed into the artery and dye is injected. X-rays are taken of the arteries that supply the uterine fibroid or fibroids. The catheter is then used to deliver particles to these arteries to block the flow of blood. These particles are called polyvinyl alcohol and are the size of a grain of sand. They are mixed with a dye and injected slowly while your doctors make sure they only go to the fibroid. It takes several minutes to block arterial flow. After the left and right uterine arteries are blocked, another arteriogram is performed. The catheter is removed and pressure is held over this area for approximately 15 minutes.
 
Recovery
After the procedure, you must be on bed rest for six hours lying flat with the leg in which the catheter was placed straight. The amount of pain patients experience varies. The most significant pain usually occurs immediately following the procedure and over the next six hours. Patients report that this pain is similar to menstrual cramps. Some patients experience no pain.
 

Patients usually stay overnight in the hospital, so that the arterial access site and your pain are monitored. You will be discharged in the next 1-2 days.

 
Once you return home, you must adhere to the following instructions to ensure a smooth recovery:

  ?  Drink eight glasses of liquid such as water or juice once you return home. You may begin your usual diet when you leave the hospital.
  ?  Avoid strenuous activity such as housework and heavy yard work for 48 hours. Most patients can return to their normal activities in a week.
  ?  Do not drive a car for 24 hours.
  ?  Do not take a hot bath for five days. You may shower.
Notify the Samitivej Hospital if any of the following occur:
  ?  Bleeding at the entry site.
  ?  Any unusual pain in the entry site or the leg in which the catheter was placed.
  ?  Any change in color or temperature of the leg. A small bruise may develop and is normal.

 
Possible complications
Serious complication is(are) rare and occurred less than 4%.The following side effects or complications are minor and frequently noted during the first few days.
 
Pain: 

  ?  Can be significant, especially during the first 6-8 hours.
  ?  Anti-inflammatory is used during and 5 days post procedure.
  ?  Narcotics (Morphine or synthetic narcotics) will be given during and immediately after the procedure intravenously. A patient-demand infusion pump is used until the morning after the procedure. At this point a prescription for oral medications will be given for home use. These medications are for pain not responding to the non-steroidal anti-inflamatory drugs (NSAIDS). The dose of these medications should be reduced over the first few days after the procedure and are rarely needed beyond one week. These medications cause nausea and constipation. You cannot drive a car or make important decisions while taking these drugs. You should take a daily laxative while taking these medications, drink plenty of fluids and eat lots of fruits and vegetables to avoid problems with constipation.
  ?  Tylenol is to be taken as directed on the bottle for the first week after treatment. This is mainly for fever, but also helps with pain control.

 
Fever: 

  ?  It is common to run a fever below 37.5 celcius after the procedure for a week or so.
  ?  Infection uncommonly occurs after UFE but can be a very serious problem if not properly addressed. If you have a temperature over 101º or fever with shaking chills, we ask that you seek medical attention immediately. If you are unable to contact us, please go to the emergency room ASAP.

 
Nausea: 

  ?  Usually due to narcotics.
  ?  Treated with intravenous medications at the hospital.

 
Uterine Cramping: 
  ?  Normal after the procedure. Treated with NSAIDs; narcotics if severe. 
  ?  Should decrease over the days following treatment. 
  ?  May be associated with passage of small clots or tissue from the dying fibroids. 
  ?  Notify us if cramping is becoming more severe or lasting more than a week after the procedure. 
 
Symptoms Associated with Uterine Fibroids: 
  ?  As symptoms vary in individuals, so does the length of time it takes for them to respond to the embolization. 
  ?  Bleeding usually decreases during the first period after treatment and continues to decrease thereafter. Inter-menstrual spotting is not uncommon and is related to the fibroids breaking down. 
  ?  The fibroids will feel softer and will cause less pressure after the procedure, but will not actually begin shrinking until several months after the procedure. Maximal shrinkage occurs at about one year. 
  ?  Cramping during periods should be less, but this may take several cycles before you see a substantial change. 
  ?  Early Ovarian failure (Menopause) is an extremely uncommon complication following UFE in patients under the age of 45. As patient age increases, the risk of early ovarian failure increases. 
  ?  Women can and have become pregnant after UAE. The effect of UAE on the health of the fetus is not known at this time, although there are a number of reports of uncomplicated pregnancies following this procedure
 
Komgrit Tanisaro