Uterine Artery Embolization, its procedure, Advantages, and Limitations

Uterine Artery Embolization

Uterine Artery Embolization:

Uterine artery embolization (UAE) is a minimally invasive treatment for benign uterine tumors.

Fibroids, also known as fibroids, are benign tumors that grow from the muscular wall of the uterus. For fibroids, degeneration into a malignant course is extremely rare. Most often, they lead to violations, incl. to heavy menstrual bleeding, pelvic pain, and pressure on the bladder and/or bowel.

During UAE surgery, doctors use X-rays to control the introduction of special small spherical particles (emboli) that block blood flow in the uterine arteries. Emboli are introduced through a thin, flexible, and long tube (catheter). Emboli after the introduction block the lumen of the uterine arteries, which provide blood flow to the uterus, as a result of which the uterus contracts. Almost 90% of women with uterine fibroids after the UAE procedure experience relief of all unpleasant symptoms and menstrual irregularities.

Typically, UAE is offered to women who want to avoid surgery to remove their uterus (hysterectomy).

In which cases UAE performed:

• UAE has been used for many decades and is often used as an aid to stop serious pelvic bleeding caused by:
• Trauma
• Malignant gynecological tumors
• Hemorrhage after childbirth

Preparations of UAE Procedures:

• Before the procedure, the uterus is imaged using magnetic resonance imaging (MRI) or ultrasound to confirm the presence of a fibrous tumor (fibroids) that is causing symptoms and to evaluate the size, number, and location in the uterine wall.
• Uterine fibroids can also be detected during laparoscopy.
• If a woman is bleeding heavily between periods, a biopsy of the endometrium (inner lining of the uterus) may be recommended to rule out cancer.
• Before starting the UAE procedure, you must tell your doctor:
• All medications you take, including herbal and nutritional supplements;
• About the presence of allergies, especially to drugs used for local and general anesthesia or to a contrast agent (containing iodine);
• About recent illnesses or other important medical facts related to health;
• Pregnancy.
• If UAE is necessary while pregnant, we will take every precaution to minimize radiation exposure to the baby.
•  On the eve of the study, it is necessary to shave the groin area. It is recommended not to eat or drink at night.

Equipment Used in this procedure:

• When performing EMA, our clinic uses the Philips Allura CV20 angiographic complex (manufactured in Germany, manufactured in 2014), disposable catheters and guide wires (made in the USA), as well as emboli of the patient’s choice made in Russia, the USA or Japan.
• The angiographic complex consists of a transparent X-ray table and a C-shaped X-ray tube that generates ultra-low doses of radiation and provides maximum visualization of the blood arteries, including the capillary order. The high resolution of the angiographic complex eliminates the possibility of medical error and minimizes possible theoretical complications. The entire course of the operation and diagnostics is recorded in a computer and can be recorded on an individual magnetic medium (CD or flash card) of the patient.
• All instruments and consumables used during the EMA procedure have Registration Certified by Government.

How procedure performed?

• UAE refers to a minimally invasive procedure, which is performed through a small skin puncture in the groin area (groin fold) approximately 1.5-2.0 mm in diameter.
• For the duration of the procedure, it is necessary to remove jewelry, glasses a,nd any metal objects that may be visible on the image and make it difficult to visualize the area of ​​intervention. A single dose of light sedatives and ant allergic drugs is prescribed. On the operating table, the puncture site in the inguinal region (usually on the right) will be treated with an antiseptic. Anesthesia is performed with a local anesthetic, during which there is a slight numbness of the skin in the groin area. Then the femoral artery is punctured, and the catheter under the control of the x-ray image will be passed to the mouth of the uterine arteries without pain. Further, through the lumen of the catheter, emboli will be introduced into the lumen of the uterine arteries until the effect of complete blockade of the lumen of the artery and the cessation of blood flow is obtained.
• The entire UAE procedure is usually completed within 90-120 minutes. After UAE, bed rest must be observed.

Thoughts during and after Procedure:

• Electrodes will be attached to the body to monitor cardiac activity and record each heartbeat on a computer. A prick is felt when the needle is inserted into the femoral artery for intravenous infusion.
• After light sedation, relaxation, and a sleepy state come, you can stay awake or sleep, depending on your desire.
• During the insertion of the catheter, alight pressure is felt, but no pain. When the contrast is injected, there is a feeling of heat in the groin and sometimes a metallic taste in the mouth.
• After the UAE procedure within 24-48 hours, pain syndrome may appear in the lower abdomen, sometimes a feeling of cramps in the pelvic area. The most intense pain and cramps are noted on the first day after UAE and quickly decrease over the next few days. While in the clinic, adequate anesthesia is prescribed.
• Return to your normal activities occurs within 7-10 days after UAE.
• After UAE, it is possible to skip one or two menstrual cycles, or in very rare cases and with extensive fibroids, a complete cessation of menstruation is possible. Complete disappearance of symptoms, as a rule, takes two to three weeks, and within a month, the fibroids will shrink and soften. After six months, the process ends, and the clinical picture and well-being stabilize.

Advantages and Risk Factors:

Advantages:

• UAE, performed under local anesthesia, is significantly less invasive than open or laparoscopic surgery, which involves the removal of individual uterine fibroids (myomectomy) or the entire uterus (hysterectomy);
• No surgical incision, maximum cosmetic effect;
• Returning to your usual rhythm of life occurs much faster than after a major surgical operation;
• Compared to surgery, anesthesia is not required and the recovery time is much shorter, with virtually no blood loss.

Risk Factors:

• Numerous studies have proven that almost 90% of women who underwent UAE had complete resolution of symptoms associated with uterine fibroids. Including those women who had heavy bleeding, frequent urination, pelvic pain, or a feeling of pressure. On average, fibroids shrink to half of their original volume after UAE. Moreover, the fibroid softens after embolization and no longer puts pressure on the adjacent pelvic organs.
• Only in some rare cases, re-germination of myomatous nodules after embolization is possible. This occurs because some fibroids in the uterus look like nodules at an early stage, which may be too small to be seen on examination.

Limitations:

• UAE should not be performed in women who do not have any symptoms of fibroids, when cancer is suspected, or when there is evidence of pelvic inflammation and/or infection. UAE is not recommended for pregnant women.
• Patients with a history of allergic reactions to contrast injections should have specific premedication prior to UAE or should be given the opportunity to consider another treatment option.