"Everything you said would happen following the procedure, did.  I wasn't surprised at anything...Thank you again for being so thorough and honest. You rock." 

Alexandra

Information on this page is for women who have decided to proceed with UFE.

Insurance pre-certification:

To be certain that you will not have any problems with your insurance company after the procedure, it is best to get their OK up front. This go ahead is called pre-certification. We will help you obtain this pre-certification. It all starts with a call to the IRC at 210.616.7780.

Procedure day details:

Generally you will come to the hospital between 6:30 and 7:00 in the morning; you cannot eat anything for 6 hours before UFE so it is best to get it done after a night of fasting.

You come directly to the Radiology Department in sublevel 2 of Methodist Hospital. Do not go to the admissions desk on the first floor.

You will get registered at our Front Desk and meet our nurses in our Holding Area. You will change into a hospital gown; it is a good idea to leave your valuables at home. One of our nurses will start an IV in your arm. When your procedure is over you will need to stay at bedrest for at least 2 hours, sometimes 4 hours. If you have to urinate during that time you will have to use a bedpan. If you would rather not have to struggle with a bedpan we can place a tube into your bladder (Foley catheter), and this is a good time to get that done if you think you need it. I will go over things with you a final time and we will ask you to give your consent for the procedure and sign the hospital consent forms. We will give you some medications through your IV that get you ready for the procedure, including an antibiotic (usually cefazolin), a medicine the reduces nausea (Zofran), and another that stops pain and inflammation (Toradol). You are transferred from the Holding Area to the procedure room. If you bring friends or family with you this is when you say goodbye, you will see them again as soon as your procedure is over. 

This procedure room, an Angiography room, contains a special x-ray machine that allows me to use real-time x-ray (called fluoroscopy). Here you will meet our technologists. They are specially trained to assist me during the procedure. You will be asked to slide over from you stretcher onto the angio table. We then do the final preparation by cleansing the skin at your groins with an antimicrobial soap (Betadine). This soap is great for killing bugs on the skin but works best if there is no hair. So if needed we will clip away any hair at the site we are cleaning. A large drape, like a bed sheet, is placed over you to provide a barrier to infection. So the only part of you that is exposed below your chin are two small circles, one at each groin.

We have a sound system in the angiography suite. Music can help you take your mind off of all the technical things happening in the room, and we are happy to listen to whatever type of music you wish; either bring a CD or pick and artist or song and we will create a Pandora station for you. Or you can take your chances and listen to our music! You are going to be in this room for about 90 minutes.

Our nurse will give you some medicines through your IV that will help you be relaxed and stop pain (usually Versed and Fentanyl). I put some medicine into the skin, usually the right side, where the catheter will be passed into the artery. This is a local anesthetic (Xylocaine) that makes the area numb; the same medicine a dentist uses. I will make a tiny nick in the skin through which I puncture the artery and pass the catheter that I use for the embolization. I use ultrasound to guide this puncture so it is extremely accurate and done with a very tiny needle. Typically, you feel none of this manipulation. When I make the injections to see the arteries most women feel a warm sensation in the pelvis and at first it feels like you are urinating (you aren't, it just feels like it).  The uterus has two main arteries, one from the right and one from the left. I can usually get to both uterine arteries from one side, rarely I need to come from both groins to get both arteries. When the catheter is safely within the uterine artery I will block off the artery by injecting small particles. When the embolization is complete we remove the catheter from the artery and place a small device under the skin to help the artery not bleed. This device is called a Mynx and will be absorbed by your body after a week or so. We also hold pressure on the site for about 5 minutes.

Then we transfer you back to your stretcher and you go back to the holding area. Once your nurses have you situated they will allow your family/friends to see you. Since we have limited space we ask that patients have just one visitor at a time. The nurses will show you how to use a special IV that gives you small doses of pain medicine at your request...you just hit a button. This IV is called PCA (Patient Controlled Analgesia) and allows you to be in charge of your pain medicine. It is set to a safe limit so you cannot hurt yourself by hitting the button too often. Some people wind up using a fair amount of the pain medicine, others hardly use it at all. People have various amounts of pain after the UFE. Some women have told me the pain was no worse than their monthly cycle pain. On the other extreme, some women have told me it was like a labor cramp that would not stop.  Most women are in between these two extremes. Typically you begin to have some discomfort toward the end of the procedure. This escalates and gets as bad as it is going to get in about four hours. It levels off at that point, staying about the same for the next 8 hours. Then it begins to go away, and by the morning after the UFE it is about 80% gone.

Most of our patients go home after a few hours of observation in our holding area. If you stay overnight in the hospital you will switch from the IV medicine to pain medicine that you take by mouth as the sun rises the following morning.  Your nurse will remove the catheter from your bladder if you have one, and take out the IV once you stop using the PCA. Your IRC doctor will come by to evaluate you and get you ready for discharge by reviewing your discharge instructions.

The discomfort you have in your pelvis will wax and wane over the next several days, but each day you will feel a little better than before. The post-embolization syndrome will cause you to feel tired and have a low-grade fever for a few days. We will prescribe that you take ibuprofen (the same medicine in Advil, but a higher dose) for one week to help keep the post-embolization syndrome in check. We will also give you some prescriptions for pain medications that you can take if needed. We ask that you come back to see us in three months.

Also, you can e-mail me anytime. I tend to be more accessible by e-mail than by phone since I am often in a procedure during the day and cannot come to the phone.

Our nurses will be in contact with you to see how you are doing in a day or so after your UFE, and possibly later as part of our long term follow-up.

For more information, please contact me by e-mail or call the clinic at 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 Wednesday, June 22, 2011