UFE Procedure
Literature Review
References

Uterine Fibroid Embolization (UFE), performed in the U.S. since 1995, is a minimally invasive therapeutic alternative to hysterectomy or myomectomy.

The FDA approved embolics for UFE in 2002.

The position of the American College of Obstetrics and Gynecology is that UFE is a safe and effective alternative to hysterectomy.

In the August 2008 Practice Bulletin of the American College of Obstetrics and Gynecology, the ACOG changed its position to recommending UFE as an alternative for women who wish to avoid hysterectomy. The following is a quote from pages 8 and 9 of that document:

"The following recommendations and conclusions are based on good and consistent scientific evidence (Level A)

Based on long- and short-term outcomes, uterine artery embolization is a safe and effective option for appropriately selected women who wish to retain their uteri."

UFE is NOT experimental.

If you have a patient with dysfunctional uterine bleeding, pelvic pain or pressure attributable to leiomyomata, she may be a candidate for UFE.

Call my clinic (210) 616-7780 for more information. If you wish to speak to our clinical nurse, ask for Ms. Shelly Beckett. Or you can email me or email Shelly

I would be happy to set up a time to come to your office for a brief chat, or to give a complete presentation for you and your partners and office staff. We will bring breakfast or lunch, if appropriate.

The Procedure

Who is a good candidate?

Our typical patient is a woman in her late 30's to early 50's with documented fibroids and menorrhagia or pelvic pain/pressure, urinary frequency, or painful sex. She does not want to have a hysterectomy because she wants to keep her body whole, she wants to avoid major surgery, she wants to preserve her ability to reproduce, or she wants to avoid the convalescence of hysterectomy.

I have heard that UFE causes a lot of pain. Is that true?

The procedure itself is virtually painless, limited to a little sting at the groin as I infuse local anesthetic. During the procedure, most of my patients enjoy chatting with me and watching the procedure progress on our video monitors. I am happy to explain what is happening and am always interested to hear about what she is feeling.  Most women will experience pain after embolization. The pain starts at the end of the procedure and may worsen over the next 4 hours. It then plateaus for about 12 hours before it tapers off the morning after UFE. The severity of her pain does not correlate with the size or number of her fibroids.

Some of our patients have told me that the pain was no worse than the cramps they get with their period. Others have described the pain as the same as labor but without the breather in between contractions. Most fall between these two extremes.

We strive to keep our patients as comfortable as possible. She will have a PCA the first day and night to give her control, and we coach her on the actions of narcotics and what kind of relief they provide. The morning after UFE we switch her over to oral pain medications. I caution my patients to expect a waxing and waning of crampy pain for the next several days. Usually this symptom persists for less than a week; often only a couple of days. Rarely it goes on for 10 to 14 days.

It is hard for me to believe that the pain from UFE is any worse than the pain of hysterectomy. For most women it is certainly less severe and of much shorter duration.

I am a Family Practitioner. Do I need to refer my patient to a Gynecologist for this procedure?

No. As long as you are comfortable in treating general gynecological disorders and can perform gynecological surgery (D&C, hysterectomy) and are willing to follow her long-term. If you do not treat general gynecological disorders and your patient does not have a gynecologist, we can provide her with the names of some who are interested in following UFE patients, at her request or at your request.

Scheduling

You, your staff, or your patient can call us at our clinic, the Interventional Radiology Clinic (IRC) of South Texas Radiology Group in San Antonio's Medical Center. (210) 616-7780. Or if you wish to fax a referral form our fax is (210) 616.7789

We will take care of the rest:

We will schedule a formal consult and her pre-procedure MRI. During our encounter at the IRC we will gather her history, ensure she has no contraindication to the procedure, and review her MRI images and perform a physical exam to make sure she is a UFE candidate.

If we decide she is a candidate for UFE and she wishes to proceed we will help her verify her benefits, schedule the procedure, perform the procedure, admit her, discharge her, manage her post-discharge symptoms, and answer her post-procedure questions. We ask our patients to return to the IRC for a follow-up visit 3 months post-UFE. We also stress to them the importance of continuing to be followed by you for continuous long-term gynecological health.

Expected results

Symptoms resolve in 85-95% of patients. Menorrhagia and dysmenorrhea often resolve by the first menses post-procedure. Once infarcted, the fibroids undergo fibrinoid necrosis that results in dramatic volume decrease over time. The fibroids do not immediately shrink, but women feel relief from bulk symptoms faster than a measurable drop in volume; often just a few weeks after her UFE. The fibroids and uterus decrease in volume by approximately 30% at three months. The fibroids will continue to shrink, often by 60-70% by the end of the first year.  Symptoms due to mass effect continue to improve over this time.

Out of town patients?

No problem, we have treated patients from La Grange to Laredo to El Paso. We have also treated patients from out of state and international patients.

Pre-procedure imaging

We request that the patient have an MRI of the pelvis (T1 axial, T2 axial coronal and sagital, and a gadolinium enhanced set of images) to document fibroid number, position, size, and viability. The MRI will also help exclude coexisting pathology, such as adnexal disease or adenomyosis. 

We do not accept a pelvic ultrasound as a substitute as it is woefully inferior to MRI. 

We will arrange for her imaging, but also gladly accept outside imaging.

What about her cancer risk?

True, by keeping the uterus and ovaries a woman remains at risk for developing neoplasia of those organs. When taken together, the lifetime risk of ovarian cancer, endometrial cancer, cervical cancer, and uterine leiomyosarcoma is less than 5%. If that risk is unacceptable to your patient, she may wish to proceed to TAH&BSO. To keep things in perspective, the lifetime risk of developing breast cancer is 12.7%, and few women elect to have prophylactic bilateral mastectomy.

The incidence of leiomyosarcoma in women undergoing hysterectomy for abnormal uterine bleeding from presumed leiomyoma is between 0.23%-0.49%. We expect the same incidence in UFE patients. If the patient's symptoms do not respond appropriately to UFE we would recommend repeat MRI. The follow-up imaging studies should be able to pick up any tumor that is growing, a flag that would suggest the possibility of a sarcoma.

For more information, please contact me by e-mail or by phone 210.616.7780. 

Or visit the Society of Interventional Radiology's www site and follow the links about UFE.

This site was created and is hosted at my personal expense.

This page was last updated on Monday, March 01, 2010

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