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WHAT IS THE ANSWER TO MY UTERINE FIBROID QUESTION?”  A PATIENT ASKS HER INTERVENTIONAL RADIOLOGIST AND GYNECOLOGIST  

What do fibroids look like?  Do you have any pictures of uterine fibroids?

Yes.  The picture was taken (uterine fibroid patient) during a cesarean section.  (Special thanks to a Wife and Husband for giving us permission to show this picture.)
 
 
Caution:   It is a large photo and is graphic in nature. 

What do Ovarian Cysts & Uterine Fibroids look like?  Clinical photos of Ovarian Cysts & Uterine Fibroids during surgery.  

Caution:  The photos are graphic in nature.

Did you know that Fibroids can grow to be the size of full term pregnancies? 

Caution:  The photos are graphic in nature.

 

Do you have an illustration of how the Uterine Artery Embolization procedure is performed?

Uterine Artery Embolization (UAE) Procedure: 

The UAE procedure takes an average of 20 minutes.  The procedure itself is painless.  There is a single tiny incision over the hip, which is less than an inch long.  After inserting a small plastic catheter (about the thickness of a piece of spaghetti) into the artery, the Interventional Radiologist watches on an X-ray monitor while he guides the catheter into the main arteries supplying the uterus (Figure A). 

After inserting a small plastic catheter (about the thickness of a piece of spaghetti) into the artery, the Interventional Radiologist watches on an X-ray monitor while he guides the catheter into the main arteries supplying the uterus (Figure A).

“Illustration (Figure A) by Mr. John Byrnes, Used with permission of Image Guided Surgery Associates, PC” 

Once the catheter is in position, he injects particles of a special plastic that block the blood vessels supplying the uterine fibroids (Figure B).

Once the catheter is in position, he injects particles of a special plastic that block the blood vessels supplying the uterine fibroids (Figure B).

“Illustration (Figure B) by Mr. John Byrnes, Used with permission of Image Guided Surgery Associates, PC” 

The particles are round and are about the same size as grains of salt.  Once the embolization is completed, the fibroids cannot receive any more blood or oxygen.  Starved for nutrition, the fibroids shrink dramatically. 

The result?  Women experience relief from the bleeding, pain, and other symptoms caused by the unwanted uterine fibroids.  Most patients spend only one night in the hospital.  Recovery after this procedure is rapid. - Robert Worthington-Kirsch, M.D.

Do you have a video of the Uterine Artery Embolization procedure?

The Case Video was taken during one of my UAE procedures.  The Example case shows the blood vessels during the UAE procedure as the particles and x-ray dye are administered.  - Robert Worthington-Kirsch, M.D.

 UAE Case Video - (Dr. Worthington-Kirsch web site:  www.fibroidcorner.com) Video of a Uterine Artery Embolization case.  The entire case is shown.  There is no descriptive narration.

An example case - (Dr. Worthington-Kirsch web site:  www.fibroidcorner.com) - A typical case describing the basic procedure and results (in lay terms for physicians).

Do you have any documentation on the embolic material that is used for the UAE procedure?

Embolic Materials - There are three (3) materials commonly used for UAE. 

1.
 
Poly-Vinyl Alcohol (PVA) Most UAEs (at least in the USA) are performed using PVA particles.  PVA has been used as an embolic material since the 1970s (at least), and has an excellent safety profile.  It is extremely biocompatible – there are no reports of allergic reaction or other similar complications of its use.
 

2.  
Embospheres
- One of the concepts, which are attractive for a new embolic material would be a spherical particle, which can (in theory) block flow with a single particle for each vessel.  Embospheres have recently been released for general use in the USA.  They have been used in Europe for some time, and have been used as an embolic material there (both for UAE an other embolizations) in hundreds of people.  (Embospheres come in two different preparations. The 'standard' spheres are colorless/white.  The 'Embosphere Gold' are colored magenta by the addition of a small amount of gold.  Some of the IRs like the Embosphere Gold because they are easy to see in the syringe.)

3. 
Gelatin Sponge
Is a material that has been used for many years in surgery to help stop bleeding.  It has been used as an embolic material for at least as long, if not longer, than PVA.  It is a temporary agent.  The body digests gelatin sponge in 1-2 weeks.   

What is the amount of radiation used during UAE, and what materials will be used during a hysterectomy?

The radiation exposure is minimal, no more than one would get while having a barium enema or 2 CT scans.  The embolic materials have long histories as implanted biomaterials without any problems.  If the patient has a hysterectomy, she's going to have steel blood vessel clips and a variety of different suture materials implanted. - Robert Worthington-Kirsch, M.D.

What happens to the plastic particles that are used in the procedure? - Carlisle, PA

The materials used for the embolization are degraded by the body, but very slowly.  For all intent and purposes, they will remain in a patient for the rest of their life.  However, we have been using these materials for years and there are no reports of allergic reaction or any short or long-term adverse consequences of these materials in the body. - Robert Worthington-Kirsch, M.D.

Have any of your patients had a rejection or any sensitivity to the plastic particles?  If so, how did you handle this situation? - Millersburg, PA

This has, to my knowledge, never been reported. - Robert Worthington-Kirsch, M.D.

How does the UAE procedure differ for patients with very large uteri to small uteri (amount of plastic particles used)? 

The amount of material used varies from patient to patient, depending largely on how many vessels supply the fibroids and how large they are. The size of the uterus or fibroids alone does not predict how much material will be used. In general, I use between 6 and 10 cc of particles for each case. Sometimes I use less, sometimes more. - Robert Worthington-Kirsch, M.D.

Are coils used for the UAE procedure?  Do the coils dissolve?

There are a few doctors who use coils for one of three different purposes.  Coils never dissolve, and probably prevent future access into the vessel in which they are placed.   For this reason I do not use them unless absolutely necessary.

Reasons -

1 - Place them in the Uterine Artery after particulate embolization (with PVA or spheres) to 'cap' the vessel.  Some advocate doing this to prevent reflux of particles into a nontarget vessel by Venturi effect.  This was the original protocol for UAE (vessel capped with either Gelfoam or a coil).   Nobody has observed this Venturi effect non-target embolization, so this use of coils of Gelfoam has been abandoned by those with lots of UAE experience.

2 - Place a microcoil at the utero-ovarian collateral to block it during the particulate embolization.  This has been described in the literature.  It is technically very difficult and time consuming, so it adds to the complexity, expense, risk of complication, and radiation exposure.  It also does not guarantee that there will be no reflux across the utero-ovarian collateral, which may have more than one channel and the coil usually does not completely occlude the vessel.  There are other ways of preventing reflux across the U-O collateral (mostly using proper embolization technique).  In my opinion this isn't worth doing.

3 - If the UA tears or leaks during embolization (a VERY RARE event) a coil may need to be placed to seal the defect.  This is the only time that I currently use a coil during UAE - and I've done so less than 5 times out of more than 2,000 embolizations. - Robert Worthington-Kirsch, M.D.

Is it ok to have your menses during the UAE procedure?  What is Hypogastric Nerve Block?

1 - Where you are in your cycle when UAE is done makes no difference.  The meds that are given for post-UAE cramping are effective for dysmenorrhea.

2 - Using a Hypogastric Nerve Block was investigated by the folks at HUP several years ago. It is difficult to do, has a higher complication risk than spinal or conscious sedation, and doesn't give any advantage over Spinal (which is easier and safer).  HUP has abandoned using this approach.  I don't know why anyone would continue to do this.  In my opinion, use of a hypogastric nerve block is outside the standard of care.
- Robert Worthington-Kirsch, M.D. 

I understand that you are involved in clinical research studies? 

Yes, to seek improvements for both the patients’ experience of UAE and the results of the procedure I do participate in specific clinical studies.  Some of the studies I have conducted and others are studies that I have been requested to participate in. 

Previous Study Areas:  An Investigation of Steroid Use for Management of Pain Associated with Post Uterine Artery Embolization for Treatment of Symptomatic Leiomyomata Uteri (Fibroids), UAE for the Management of Myomata in Patients without Complaints of Menorrhagia, Time Course of Pain After UAE for Fibroid Disease, Comparison of Conscious Sedation and Limited Spinal Anesthesia in Management of Pain After UAE for Fibroid Disease.  Treatment of Uterine Leiomyomata with Bilateral UAE Using EmbosphereTM Micro spheres (FDA Phase I study), Treatment of Uterine Leiomyomata with Bilateral UAE Using EmbosphereTM Micro spheres (Phase II study) October 2000.

Current Study Areas:  Multicenter clinical study evaluating uterine artery embolization as an alternative to abdominal and laparoscopic myomectomy procedures for uterine fibroids (started in 2003).  - Robert Worthington-Kirsch, M.D.  (Refer to Bibliography.)

Are there a lot of complications with the Uterine Fibroid Embolization (i.e. UAE) procedure?

No procedure is risk-free. The risk of significant complications of UAE is 1-2%. This should be compared with the risk of significant complications of a major abdominal surgery such as hysterectomy, which is 5-8%. For every complication encountered to date after UAE, the risk of that same or similar complication is higher if a patient has surgery.    - Robert Worthington-Kirsch, M.D.

If a woman has a myomectomy procedure and later the uterine fibroids grow back, can UAE still be performed on her with satisfactory results?

Yes. About 20% of my patients have had a myomectomy - Robert Worthington-Kirsch, M.D.

I (Hope), as an UAE patient, am now involved in the Duke University study.  Can you explain what this study is?

I have been instrumental in the design of the CIRREF (Cardiovascular and Interventional Radiologist Research and Education Foundation) FIBROID (Uterine Artery Embolization  Fibroid Registry for Outcomes Data) Registry, which is obtaining data on many women having the procedure.  The registry brings together the scientific, technical, medical, academic research organization, and U.S. Food and Drug Administration (FDA) industry and consumers.  

Purpose of the registry is to assess procedure’s durability, impact on fertility and quality-of-life, and to obtain data which will allow researchers to compare UAE to other fibroid treatments.  Questionnaires are given to the patients, who volunteer, at specific times throughout their recovery process and beyond.  Refer to website www.fibroidregistry.org.  - Robert Worthington-Kirsch, M.D.
 


JUST THE FAQs - Section #2:
Uterine Fibroid treatment research questions  (Page 1)

Pages:  1 | 2 | | 4 | 5 | 6 
 

Robert Worthington-Kirsch, MD - Interventional Radiologist in Philadelphia, PA.
Robert Worthington-Kirsch, M.D.

FAQs List 1 | 2 | 3
Topics of Interest
Fibroid Photos
Ovarian Cyst and Fibroid Photos
Size of full term Fibroid pictures
UAE Illustration
Embolic Material
Coils - UAE
Menses and Hypogastric Nerve Block
Clinical Research
Fibroid Registry
Medical Terms

 

 

 

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Legal Note:  The material presented on Hope For Fibroids, Inc. web site is for informational purposes only.  It is not meant to be a substitute for physician care.  If you need medical advice on uterine fibroid disease or other medical conditions you should discuss them with a physician.  Hope For Fibroids, Inc.
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