Uterine Artery Embolization

Overview

What is uterine artery embolization (UAE)?

Uterine artery embolization (UAE) is a minimally invasive treatment used to stop serious pelvic bleeding. The cause of such bleeding could be uterine fibroids (noncancerous tumors inside the uterus), trauma, malignant (cancerous) gynecological tumors, or hemorrhage following childbirth, among other conditions.

The terms uterine artery embolization and uterine fibroid embolization (UFE) are often mistakenly used to mean the same thing. To be exact, UFE is a particular kind of uterine artery embolization. As noted above, UAE can treat a number of conditions other than fibroids that cause pelvic bleeding.

How does uterine artery embolization (UAE) work?

In UAE, blocking agents are introduced into particular blood vessels. These agents are guided to the uterine arteries through a tube (catheter) with the use of fluoroscopy, a form of X-ray that captures moving images. When blood vessels are blocked, bleeding can be brought under control, and tumors or fibroids can be made to shrink by cutting their blood supply. Surrounding healthy tissue is not affected because it continues to be fed by other unblocked vessels.

Who needs to have uterine artery embolization (UAE)?

Women who experience heavy pelvic bleeding as a result of fibroids or other conditions may benefit from UAE.

Uterine fibroid embolization (UFE) should not be performed:

  • When the patient has uterine fibroids but no symptoms
  • If the woman is pregnant
  • If cancer may be present
  • In cases of pelvic infection
  • In cases of allergic reaction to contrast dyes

How common are uterine artery embolizations (UAE)?

About 25,000 UAE procedures are performed around the world each year.

Procedure Details

What happens before a uterine artery embolization (UAE)?

  • A general overview of the patient’s health, allergies (such as to anesthetics or injected dyes), medications, menstrual history, current pregnancy and desire for future pregnancy will be determined.
  • Magnetic resonance imaging (MRI), laparoscopy or ultrasound will provide images of the interior structure of the uterus, helping to determine the source of symptoms.
  • A biopsy (tissue sampling) of the inner lining of the uterus may be taken to determine if cancer is present.
  • Use of aspirin, non-steroidal anti-inflammatory drugs, or blood thinners is discontinued some time before UAE.
  • No eating or drinking is permitted before the procedure. The doctor will communicate the length of this fasting period.

How is a uterine artery embolization (UAE) done?

  • A UAE is done in a catheterization lab or operating room by an interventional radiologist.
  • The patient lies on an examining table, and is hooked up to machines that will monitor vital signs such as heart rate, blood pressure, and breathing.
  • An IV (intravenous) line will administer an anesthetic (pain blocker) and sedative.
  • A small incision is made in the groin. An X-ray camera (fluoroscope) and contrast dyes are used to guide the insertion and positioning of a catheter.
  • The catheter delivers particles called embolic agents (such as polyvinyl alcohol) that will halt the flow of blood in specific uterine arteries.
  • When finished, the catheter is removed. Any bleeding from the incision is controlled, and a bandage is applied. Stitches are not needed.
  • The entire procedure usually takes about 90 minutes.
  • Pain medications may be given as the patient rests in the hospital overnight for observation.

What happens after a uterine artery embolization (UAE)?

  • Most patients return home the day after the procedure.
  • Prescriptions for pain and other medications are given for use at home. Normal activities may resume within one to two weeks after the procedure.
  • Menstrual bleeding may not resume for a cycle or two. When it does resume, the amount of blood may be less than normal but will gradually increase in the next cycles to a level that shows improvement from pre-procedure levels.
  • In the case of treatment for fibroids, symptoms should begin to disappear in about two to three weeks. By six months the level of improvement reaches its maximum and then stabilizes.

Risks / Benefits

What are the advantages of uterine artery embolization (UAE)?

  • Can be performed under local anesthesia.
  • Short period of recovery.
  • Little blood loss or bleeding afterwards.
  • Avoids the side effects of hormone therapies that are sometimes used to treat fibroids.
  • Needs only a tiny incision, making it less invasive than other treatments such as myomectomy (surgical removal of uterine fibroids) or hysterectomy (removal of the entire uterus).
  • Nearly 90 percent of women treated with UAE for fibroids experience partial or full relief of symptoms.

What are the risks of a uterine artery embolization (UAE)?

  • Insertion of the catheter could damage other blood vessels in the area, or cause an infection. The risk of this occurring is less than 1 percent when UAE is performed by an experienced practitioner.
  • The embolic agent could be deposited in an unintended blood vessel, choking off blood supply to healthy tissue.
  • An allergic reaction to X-ray contrast dyes could occur.
  • In about 1 percent to 5 percent of women, menstrual cycles will shut down permanently following uterine fibroid embolization (UFE). This usually occurs in women over the age of 45.
  • The younger a woman is at the time of UFE, the greater the chances that symptoms could return and a hysterectomy might eventually be needed.

Is a uterine artery embolization (UAE) safe?

  • There is still some question on whether uterine fibroid embolization (UFE) reduces future chances of pregnancy. Some doctors prefer to have fibroids surgically removed if the woman wishes to have more children.
  • Pregnancies after UAE can have higher rates of miscarriage and are more likely to have a cesarean section and postpartum hemorrhage.

Recovery and Outlook

What is the long-term outlook for patients?

  • Studies on patients who had uterine artery embolization (UAE) show control of bleeding symptoms in 90 percent to 92 percent of patients after 12 months.
  • For treatment of fibroids, patients who received uterine fibroid embolization (UFE) showed similar levels of satisfaction at both the one- and five-year marks as patients who had a surgical treatment.

How long is the healing process?

Ninety percent of patients resume normal activity within 10 days. In comparison, recovery from a hysterectomy can take up to six weeks.

How often should I have a uterine artery embolization (UAE)?

Studies have shown patients receiving uterine fibroid embolization (UFE) had a 13 percent rate of repeat procedure after 12 months, and a 32 percent rate at five years. Over the long term, any procedure that leaves the uterus in place is subject to a return of fibroids. A second round of UFE can be administered, with results on par with those of the first.

When to Call the Doctor

When should I call my healthcare provider?

Pelvic cramps are a possible side effect for several days following uterine artery embolization (UAE), most particularly in the first 24 hours. Fatigue, mild nausea and a low-grade fever are also possible. Up to 10 percent of patients are readmitted to the hospital because of such symptoms. Serious or long-lasting discomfort following UAE should be communicated to your doctor.

Last reviewed by a Cleveland Clinic medical professional on 11/15/2018.

References

  • RadiologyInfo.org. . Accessed 11/16/2018.Uterine Fibroid Embolization (UFE) (https://www.radiologyinfo.org/en/info.cfm?pg=ufe)
  • Worthington-Kirsch RL. . Semin Intervent Radiol 2004 Mar; 21(1): 37-42. Accessed 11/16/2018.Uterine Artery Embolization: State of the Art (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036203/)
  • Memtsa M and Homer H. . Obstretrics and Gynecology International Vol. 2012, Article ID 290542, 5 pages. Accessed 11/16/2018.Complications Associated with Uterine Artery Embolisation for Fibroids (https://www.hindawi.com/journals/ogi/2012/290542/)
  • Bulman JC, Ascher SM, Spies JB. . RadioGraphics Vol. 32 No. 6. Accessed 11/16/2018.Current Concepts in Uterine Fibroid Embolization (https://pubs.rsna.org/doi/10.1148/rg.326125514)
  • Dariushnia SR, Nikolic B, Stokes LS, Spies JB. . Journal of Vascular and Interventional Radiology November 2014 Vol. 25, Issue 11, Pages 1737-1747. Accessed 11/16/2018.Quality Improvement Guidelines for Uterine Artery Embolization for Symptomatic Leiomyomata (https://www.jvir.org/article/S1051-0443(14%2900847-1/fulltext)
  • Smith SJ. . Am Fam Physician 2000 Jun 15;61(12): 3601-3607. Accessed 11/16/2018.Uterine Fibroid Embolization (https://www.aafp.org/afp/2000/0615/p3601.html)

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