What should a patient expect when getting the Uterine Artery Embolization (UAE - i.e. UFE) procedure?       

I see all patients for a consultation before scheduling any procedure.  Before seeing me, patients should have an MRI  examination of the pelvis and a blood count.  Patients should also have  had a Pap smear within the last year.  After seeing me some patients may need to see their gynecologist for an office procedure called an endometrial biopsy, which is similar to a Pap smear.  (Refer to Biopsy.)

On the day of the procedure women are admitted to the Short Procedure Unit, have some blood drawn, an IV started, and a catheter placed in the bladder.  Antibiotics are administered and choices of conscious sedation or spinal analgesia are offered. 

Short Procedure Unit:  The patient will take off all her clothes and put on a hospital gown.  Some women like to wear cotton socks to keep their feet warm.  The patient may have a Transdermal Scopolamine patch put behind her ear for nausea, which is kept in place for 4 more days after the UAE procedure. - Hope

Next patients go to the Radiology Department for ultrasound pictures of the pelvis, to measure the uterus and size of the fibroids.  The information is used to decide on any changes that need to be made from the routine procedure, and as a baseline for further follow-up studies. 

The Angiography Suite is where the procedure is performed.  The radiologist sterilizes the skin lying on top of a large artery located in the groin area with an iodine solution and numbs it with a local anesthetic.  The injection for the anesthetic may sting and burn for a few seconds.  A needle is inserted into the artery and exchanged for a plastic catheter about the thickness of a strand of spaghetti. 

Watching under X-ray the Interventional Radiologist then maneuvers the catheter into  the main arteries supplying the uterus and injects small plastic particles to plug up the blood vessels supplying the fibroids.  X-ray dye is injected through the catheter to show the vessels during this process, and the patient may feel sensations of warmth from these injections. 

When the procedure is over, the catheter is removed from the artery and pressure is applied at the small puncture site to stop the bleeding.  The patient is wheeled to her room and must stay in bed for several hours to avoid any bleeding at the puncture site (the patient can sit up, eat, read,  or watch television). The patient is allowed to get out of bed after this period, which is typically about six hours. 

Loss of blood supply to the fibroids may cause cramping to occur shortly after the procedure, which may cause some patients to have to stay over night at the hospital.  The trained nursing staff know the proper techniques to handle my patients after having the UAE procedure done and the patient gets round the clock attention as needed.   The next day the patient is released to go home with detailed instructions on what to do and phone numbers to contact me if needed.  If any prescriptions are required the patient is given them at this time.  The next day I call to see how the patient is doing and answer questions. During the entire recovery process I answer every e-mail and phone call.

February 2006 update:  Depending on how the patient is feeling she may not have to stay over night at the hospital.  Medications are the same.  About 90% of the patients go home the same day. The only other change is that I keep all patients on fluids only (whether in the hospital or at home) until the morning after the UAE.  No other changes in how they are cared for.  Patients are typically discharged 6-7 hours after I finish the procedure.  If any prescriptions are required the patient is given them at this time.  The next day I call to see how the patient is doing and answer questions. During the entire recovery process I answer every e-mail and phone call.   

Note:  After the procedure the patient may receive anti-inflammatory drugs (example Motrin or one of its relatives).  A narcotics (usually Morphine) is available through a PCA (Patient Controlled Analgesia) pump, which is self-administered by the patient by pushing the demand button. 

Prescriptions vary because of each patient's medical situation (examples of medication:  Motrin, Percocet, and Surfak for constipation).  Always ask your doctor if you have questions about medication.

In about three months another ultrasound or MRI of the pelvis is taken to  measure the reduction of the uterus and fibroids.  At this time, the  average woman’s uterus has decreased by 50% in volume, and volume reduction continues for as much as a year (if not longer).  Individual fibroids decrease by about 65%, if not more, at 3 months.  After three months a follow up with your gynecologist will need to be done.  - Robert Worthington-Kirsch, M.D.