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“WHAT IS THE ANSWER TO MY UTERINE FIBROID QUESTION?” A PATIENT ASKS HER INTERVENTIONAL RADIOLOGIST AND GYNECOLOGIST
What
do fibroids look like?
Do you have any pictures of uterine fibroids? Caution: The photos are graphic in nature.
Did you know that Fibroids can grow to be the size of full term
pregnancies?
Do you have an illustration of how the Uterine Artery Embolization procedure is performed? Uterine Artery Embolization
(UAE) Procedure: The UAE procedure takes an average of 20 minutes. The procedure itself is painless. There is a single tiny incision
over the hip, which is less than an inch long. After inserting a small plastic
catheter (about the thickness of a piece of spaghetti) into the artery,
the Interventional Radiologist watches on an X-ray monitor while he guides
the catheter into the main arteries supplying the uterus (Figure A).
“Illustration (Figure A) by Mr.
John Byrnes, Used with permission of Image Guided Surgery Associates, PC” Once the catheter is in position, he injects particles of a special plastic that block the blood vessels supplying the uterine fibroids (Figure B).
“Illustration (Figure B) by Mr.
John Byrnes, Used with permission of Image Guided Surgery Associates, PC” The particles are round and are about the same
size as grains of salt. Once
the embolization is completed, the fibroids cannot receive any more blood
or oxygen. Starved for
nutrition, the fibroids shrink dramatically. The result?
Women experience relief from the bleeding, pain, and other symptoms
caused by the unwanted uterine fibroids.
Most patients spend only one night in the hospital. Recovery after this procedure is
rapid.
Do you have a video of the Uterine Artery Embolization procedure?
The Case Video was taken during one
of my UAE procedures. The
Example case shows the blood vessels during the UAE procedure as the
particles and x-ray dye are administered.
UAE Case Video
- (Dr. Worthington-Kirsch web site: www.fibroidcorner.com)–
Video of a Uterine Artery
Embolization case. The entire
case is shown. There is no
descriptive narration. An example case - (Dr. Worthington-Kirsch web site: www.fibroidcorner.com) - A typical case describing the basic procedure and results (in lay terms for physicians). Do you have any documentation on the embolic material that is used for the UAE procedure?Embolic Materials - There are three (3) materials
commonly used for UAE.
The
radiation exposure is minimal, no more than one would get while having a
barium enema or 2 CT scans. The embolic materials have long
histories as implanted biomaterials without any problems. If the
patient has a hysterectomy, she's going to have steel blood vessel clips
and a variety of different suture materials implanted.
What happens to the plastic
particles that are used in the procedure?
The materials used for the embolization are
degraded by the body, but very slowly. For
all intent and purposes, they will remain in a patient for the rest of
their life.
However, we have been using these materials for years and there are
no reports of allergic reaction or any short or long-term adverse
consequences of these materials in the body.
Have any of your patients had a rejection or any sensitivity to the plastic particles? If so, how did you handle this situation? - Millersburg, PA
This has, to my knowledge, never been reported.
How does the UAE procedure differ for patients with very large uteri to
small uteri (amount of plastic particles used)?
The amount of material used
varies from patient to patient, depending largely on how many vessels
supply the fibroids and how large they are. The size of the uterus or
fibroids alone does not predict how much material will be used. In
general, I use between 6 and 10 cc of particles for each case. Sometimes I
use less, sometimes more.
Are coils used for the UAE procedure? Do the coils dissolve? There are a few doctors who use coils for one of three different purposes. Coils never dissolve, and probably prevent future access into the vessel in which they are placed. For this reason I do not use them unless absolutely necessary. Reasons - 1 - Place them in the Uterine Artery after particulate embolization (with PVA or spheres) to 'cap' the vessel. Some advocate doing this to prevent reflux of particles into a nontarget vessel by Venturi effect. This was the original protocol for UAE (vessel capped with either Gelfoam or a coil). Nobody has observed this Venturi effect non-target embolization, so this use of coils of Gelfoam has been abandoned by those with lots of UAE experience. 2 - Place a microcoil at the utero-ovarian collateral to block it during the particulate embolization. This has been described in the literature. It is technically very difficult and time consuming, so it adds to the complexity, expense, risk of complication, and radiation exposure. It also does not guarantee that there will be no reflux across the utero-ovarian collateral, which may have more than one channel and the coil usually does not completely occlude the vessel. There are other ways of preventing reflux across the U-O collateral (mostly using proper embolization technique). In my opinion this isn't worth doing. 3 - If the UA tears or leaks during embolization (a VERY RARE event)
a coil may need to be placed to seal the defect. This is the only
time that I currently use a coil during UAE - and I've done so less than 5
times out of more than 2,000 embolizations.
Is it ok to have your menses during the UAE procedure? What is Hypogastric Nerve Block? 1 - Where you are
in your cycle when UAE is done makes no difference. The meds that
are given for post-UAE cramping are effective for dysmenorrhea.
I understand that you are involved in clinical research studies? Yes, to seek improvements for both the patients’
experience of UAE and the results of the procedure I do participate in
specific clinical studies.
Some of the studies I have conducted and others are studies that I have
been requested to participate in. Previous Study Areas: An Investigation of Steroid Use for Management of Pain Associated with Post Uterine Artery Embolization for Treatment of Symptomatic Leiomyomata Uteri (Fibroids), UAE for the Management of Myomata in Patients without Complaints of Menorrhagia, Time Course of Pain After UAE for Fibroid Disease, Comparison of Conscious Sedation and Limited Spinal Anesthesia in Management of Pain After UAE for Fibroid Disease. Treatment of Uterine Leiomyomata with Bilateral UAE Using EmbosphereTM Micro spheres (FDA Phase I study), Treatment of Uterine Leiomyomata with Bilateral UAE Using EmbosphereTM Micro spheres (Phase II study) October 2000.
Are there a lot of complications with the Uterine Fibroid Embolization (i.e. UAE) procedure?
No procedure is risk-free. The risk of significant complications of UAE
is 1-2%. This should be compared with the risk of significant
complications of a major abdominal surgery such as hysterectomy, which is
5-8%. For every complication encountered to date after UAE, the risk of
that same or similar complication is higher if a patient has surgery.
Yes. About 20% of my patients
have had a myomectomy. I have been instrumental in the design of the
CIRREF (Cardiovascular and Interventional Radiologist Research and
Education Foundation) FIBROID (Uterine Artery Embolization Fibroid Registry for Outcomes
Data) Registry, which is obtaining data on many women having the
procedure. The registry
brings together the scientific, technical, medical, academic research
organization, and U.S. Food and Drug Administration (FDA) industry and
consumers. Purpose of the registry is to assess procedure’s durability, impact on fertility and quality-of-life, and to obtain data which will allow researchers to compare UAE to other fibroid treatments. Questionnaires are given to the patients, who volunteer, at specific times throughout their recovery process and beyond. Refer to website www.fibroidregistry.org. |
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