Uterine artery embolization (UAE) is a procedure where an interventional radiologist uses a catheter to deliver small particles that block the blood supply to the uterine body. If the procedure is done for the treatment of uterine fibroids it is also called uterine fibroid embolization (UFE).
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Under local anesthesia a catheter is introduced into the femoral artery at the groin and advanced under radiographic control into the uterine artery. There microparticules (spheres or beads) are released which will block the vessel. Due to collateral circulation the uterus will not necrose even if both arteries are occluded. The procedure is not a surgical intervention and allows the uterus to be kept in place.
This intervention can be used to relieve the main symptoms related to uterine fibromata (including excessive vaginal bleeding, pelvic pain and compression). This intervention can be proposed as an alternative to surgery in case of symptoms related to uterine fibroids. It is performed by interventional radiologists. UAE can also be used to control heavy uterine bleeding for other reasons than fibroids, i.e. in cases of postpartum obstetrical hemorrhage.[1]
Significant adverse effects resulting from uterine artery embolization have been reported, serious adverse effects are approximately four times less frequent than for hysterectomy.[2]
Adverse effects that have been reported include death from embolism, or septicemia (the presence of pus-forming or other pathogenic organisms, or their toxins, in the blood or tissues) resulting in multiple organ failure.[3] Infection from tissue death of fibroids, leading to endometritis (infection of the uterus) resulting in lengthy hospitalization for administration of intravenous antibiotics.[4] Misembolization from microspheres or polyvinyl alcohol (PVA) particles flowing or drifting into organs or tissues where they were not intended to be, causing damage to other organs or other parts of the body.[5] Ovarian damage resulting from embolic material migrating to the ovaries. Loss of ovarian function, infertility[6], and loss of orgasm. Failure of embolization surgery- continued fibroid growth, regrowth within four months. Menopause - iatrogenic, abnormal, cessation of menstruation and follicle stimulating hormones elevated to menopausal levels.[7] Post-Embolization Syndrome (PES) - characterized by acute and/or chronic pain, temperatures of up to 102 degrees, malaise, nausea, vomiting and severe night sweats. Foul vaginal odor coming from infected, necrotic tissue which remains inside the uterus. Hysterectomy due to infection, pain or failure of embolization.[8] Severe, persistent pain, resulting in the need for morphine or synthetic narcotics.[9] Hematoma, blood clot at the incision site. Vaginal discharge containing pus and blood, bleeding from incision site, bleeding from vagina, fibroid expulsion (fibroids pushing out through the vagina), unsuccessful fibroid expulsion (fibroids trapped in the cervix causing infection and requiring surgical removal), life threatening allergic reaction to the contrast material, and uterine adhesions.
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