Embolisation - Procedure and Cure

The Fibroid Embolisation Procedure

Fibroid embolisation is carried out by a skilled experienced Interventional Radiologist and is technically demanding, requiring significant experience in the technique. Under local anaesthesia and intravenous sedation a tiny catheter is inserted under local anaesthetic into an artery in the right groin. Under X-ray control a micro catheter is introduced selectively into each of the two arteries that supply the uterus. The micro catheter is passed approximately half way down the artery and then fine particles of a solid substance called PVA (Poly Vinyl Alcohol) are injected through the catheter into the uterine artery. The particles are carried to the leash of vessels supplying the fibroids. These vessels become silted up thereby depriving the fibroid of blood which dies and shrinks. PVA is an inert harmless material which has been used to occlude vessels in other parts of the body for decades.


You can view an animated graphic of the procedure at 5:51 of Dr. Walker's top video here: Videos



Following the procedure the patient usually experiences pain over the next 12 to 24 hours. The pain varies from mild to severe and is controlled by intravenous and oral analgesics. Occasionally over the next 1-2 weeks the patient may experience cramps and some bleeding, often runnning a mild intermittent temperature in the first week. Patients spend 2 days in hospital and are usually advised to take 2 weeks off work. In our series the average time to patients feeling completely 'normal' was 2.2 weeks. During the procedure intravenous sedation is administered as required. The complete process of fibroid shrinkage or in a small percentage of cases expulsion takes about 6 to 9 months, however most patients notice a considerable improvement in their symptoms within 3 months (expulsion usually occurs early in the first 6-8 weeks).

Uterine fibroid embolisation for fibroids is no longer a new procedure. It was first carried out in France in a small number of cases in the early 1990s. Since then there have been numerous publications on the technique. The procedure which is non surgical involves the occlusion of blood vessels supplying uterine fibroids and many hundreds of thousands of fibroid embolisations have been carried out worldwide.

Complications

Mortality The mortality from UFE is almost negligible and is certainly less than 1 in 30-40,000 compared to a mortality for hysterectomy for fibroids of 1 in 1,000-1,500. Non fatal complications In the Guildford/London Clinic series of over 2,400 patients, 5 infective complications have occurred leading to hysterectomy. These were all in our first 500 cases, none were emergencies and none required ICU admission. Although the complication rate of fibroid embolization is very low and significantly less than any surgical procedure, complications can occur - these are:

  • Infection leading to hysterectomy: This is very rare in our series there have been none in the last 1,700 patients and only 5 in the whole series of over 3,000 patients. There have been no emergency hysterectomies or intensive care unit admissions.

  • Ovarian failure: Under 45 this is rare with an incidence of less than ½%. Ovarian failure leads to a premature menopause and a patient over 45 would normally then take HRT which these days is very effective. It should be remembered that around 2-3% of women will go into the menopause under 45 normally.

  • Vaginal discharge: This is usually transient and self limiting. Occasionally discharge may be persistent and require a hysteroscopy to resolve it. A hysteroscopy is a minor procedure like, in old fashioned terms, a D&C. Reference: Walker et al, American Journal of Obstetrics and Gynecology, 190(5):1230-1233 May 2004.