Uterine Artery Embolisation

Fibroid embolisation is a much safer procedure than surgery

Uterine Artery Embolisation is a procedure in which a small catheter is inserted into the femoral artery in the groin and under X-ray TV control, the catheter is manipulated into the arteries which supply blood to the uterine fibroids. This is usually the uterine arteries, one on either side of the pelvis. Small particles of an inert substance called PVA are then injected through the catheter into the arteries that supply the fibroids, the fibroids are thus deprived of their blood supply and die off, eventually being converted into balls of scar tissue. The material used is entirely harmless and has been used for many decades for embolisations in fibroids and in many other areas of the body for other conditions.

The fibroid embolisation procedure was first carried out in France in the early 1990s and since then well over 100,000 fibroid embolisations have been carried out in the world. Fibroid embolisation is a much safer procedure than surgery: there are really two complications, one of which is infection leading to hysterectomy. This is rare and in our series of 2,400 patients we have had no such cases in over 1700 patients. Ovarian failure and premature menopause is another complication: again this is rare, around 0.5% under the age of 45 and of course it needs to be remembered that hysterectomy with preservation of the ovaries also may result in ovarian failure. The other small downside of the procedure is that after the procedure (which is painless, taking about an hour) is carried out, the patients experiences pain in the pelvis for some 12 hours which is described as a heavy period pain, and requires treatment with heavy painkillers (including morphine). However, the pain is controlled. The patient is then discharge and we usually advise 2 weeks convalescence and during that time, the patient may get some attacks of pain, some bleeding or discharge.

Rarely, if a fibroid is submucous, either projecting into the cavity of the uterus, the fibroid may come out but this is unusual. Sometimes, if the fibroid becomes impacted, a Gynaecologist needs to remove the fibroid using a hysteroscope which is a little camera inserted up through the cervix when the fibroid can then be sucked out. In the majority of these cases the patient will end up with a virtually normal uterus.

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Dr. Walker is a Consultant Diagnostic and Interventional Radiologist who pioneered UFE in the UK as Lead Clinician at the Royal Surrey County Hospital, Guildford

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