Doctors often direct women with symptomatic uterine fibroids toward hysterectomy, or full removal of the uterus. But for roughly 25 years, interventional radiologists nationwide have offered a faster, simpler, and less invasive option. Below, Professional Radiology, Inc.’s James Traiforos, who is also head of interventional radiology at Jewish Hospital – Mercy Health, discusses the lesser-known procedure and its time-tested benefits.
There are a lot of women running around with fibroids. Sometimes they are symptomatic, so women seek treatment. To target individual fibroids, there’s myomectomy and focused MRI. But in terms of treatment of all fibroids at one time, it’s either hysterectomy or uterine artery embolization (UAE).
Both hysterectomy and UAE are very effective at treating symptoms from symptomatic fibroids. [And surveys of] women who had embolization and hysterectomy [showed] they had similar rates of satisfaction with their pain relief. [Hysterectomy] is a big surgery with a longer recovery and a higher complication rate but pretty much a guaranteed cure—you have no uterus, you have no fibroids. Fibroid embolization is a much quicker, easier procedure. Faster recovery, lower complication rates; the vast majority of women get great relief. This procedure really shines in comparison to hysterectomy.
Uterine fibroids receive their blood supply only through the uterine arteries, which are dual–one right, one left. Uterine artery embolization takes advantage of that unique blood supply. The technical definition of the word embolization means “to inject some particle to either partially or completely block off a blood vessel,” so that’s what we’re doing—we’re embolizing the uterine arteries.
The day of the procedure, patients receive moderate sedation. A catheter is inserted at the groin and advanced to the uterine arteries, where tiny particles are injected to completely block blood flow to the fibroids. Manual pressure is applied to the small hole in the artery to allow it to seal. I [also] prefer an overnight stay [in the hospital] for pain control, as there is some discomfort in the first 24 hours because you’re starving the fibroids of blood. [After that,] the recovery time with UAE is pretty quick—about a week on average until you’re back doing anything you want to do.
UAE has been around for about 25 years. It’s a relatively straightforward procedure and it’s had a track record of very reproducible results. It’s pretty widely available [in] any small or mid-sized city.
The ideal patient is 40 to 50—a woman who is past childbearing years but before menopause—and having either heavy pain or heavy bleeding, mostly with periods, but also between periods. Getting pregnant is a sticky issue after fibroid embolization, just like it’s a sticky issue after any treatment for fibroids. It is not contraindicated— meaning it’s not prohibited, [but] it’s a discussion that needs to be had.
In my personal experience, [patient] satisfaction with the UAE procedure has been very high, and I think it’s very effective.
Diagnostic Radiologist, Professional Radiology
Head of Interventional Radiology, Jewish Hospital – Mercy Health