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The Uterine Artery Embolization Procedure - A Follow-Up

Editor’s Note:  Since local patient Hope Waltman’s article on Uterine Artery Embolization (UAE) in the February issue, there has been considerable response from readers, asking for more in-depth  information on the procedure. Below, Dr. Worthington-Kirsch, a Subspecialty Board-Certified Interventional Radiologist answers some frequently asked questions.  Dr. Worthington-Kirsch has been in  practice in the Philadelphia area since 1990 and performs UAE (and other procedures) at Roxborough Memorial Hospital.  As of May 1, 2002, he has treated over 1,250 women with UAE - more than any other  physician in the world.) 

How long has Uterine Artery Embolization been performed in the United States? 

Fibroids are benign tumors of the uterus. They are not cancers, but can cause symptoms such as excessive bleeding during or between periods, pressure on the bladder or rectum, discomfort during sexual relations, or even interfere with fertility. These symptoms can be anywhere from mild to disabling. The most common symptom from fibroids is excessive bleeding. 

One of the most effective treatments for bleeding is to stop the blood supply to the area that is bleeding by blocking the vessels from the   inside, this is known as “embolization.”  Embolization of the arteries to  the uterus has been used as a treatment for severe uterine bleeding after surgery or childbirth since at least the late 1970s. Uterine Artery Embolization (UAE) was first used as a treatment for fibroids in France  in the late 80’s/early 90’s and the first report was published in Lancet in 1995.  Drs. Goodwin (IR) and McLucas (Gyn) started performing UAE for fibroids in Los Angeles in the 1st quarter of 1996.  Dr. Francis Hutchins, Jr., a Gyn, saw an article by Dr. McLucas and asked me to perform UAE in the second half of 1996. 

UAE has an extensive track record of safety and efficacy for other  causes of bleeding.  When I started to offer UAE, there was already more than 5 years experience in France with treatment of fibroids by UAE. 

Are there special training requirements that an Interventional Radiologist needs before performing the UAE procedure? 

Yes, physicians need to be specifically trained in this procedure.  I was part of a committee that drafted a standard for the training of UAE.  All physicians should complete the recommended training before performing the UAE procedure. 

Is there anyone who is not a candidate for UAE and if so why? 

Some women have other pelvic disorders in addition to fibroids, and  need to have those addressed first.  Some women with specific patterns of fibroid disease may well be better served by surgery.  Because of equipment limitations, I am unable to treat a patient who weighs 280 lbs. or more; however, there are no fibroid size limitations in my practice.  I have treated women with large fibroid uteri, in a few cases  as large as a term pregnancy.  These women have done just as well as women with smaller uteri, so long as they do not have unrealistic expectations for size reduction.  

After UAE how much do the fibroids decrease? 

Average overall uterine reduction is 50% at 3 months, with reduction continuing for as much as a year (if not longer).  Individual fibroids decrease by about 65%, if not more, at 3 months. 

What happens with part of the fibroids that don’t decrease? 

If a fibroid doesn’t decrease, it’s because it is either already infarcted before the embolization, as happens occasionally, or wasn’t sufficiently embolized.  In the rare instance of insufficient embolization, the fibroid may continue to grow. 

Are there a lot of complications with the 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. 

What is the success rate of UAE? 

The clinical success rate of UAE is approximately 90%. 

What percentage of UAEs require a subsequent hysterectomy or myomectomy? 

About 4-7% of patients do not get enough resolution in symptoms after UAE to be satisfied and go on for elective myomectomy or hysterectomy. About 1 patient in 200-300 UAEs develops a complication of UAE that leads to urgent or emergent hysterectomy. 

Are there any studies being conducted to obtain data on this particular fibroid treatment? 

Yes, I was instrumental in the design of the FIBROID (Uterine Artery Embolization (UAE) Fibroid Registry for Outcomes Data) Registry, which is obtaining data on many women having this procedure.  The Registry is sponsored by CIRREF (Cardiovascular and Interventional Radiologist Research and Education Foundation), the research arm of  the Society of Cardiovascular & Interventional Radiology. The Registry brings together scientific, technical, medical, academic research organizations, the U.S. Food and Drug Administration (FDA), industry, and consumers.  

The purpose of the Registry is to assess the procedure’s durability, impact on quality-of-life and fertility, and to obtain data that will allow researchers to compare UAE to other fibroid treatments.  More information about the Registry can be found at www.fibroidregistry.org  

For more information check out www.fibroidcorner.com or contact Robert L. Worthington-Kirsch, MD, FSCVIR, Image Guided Surgery Associates, PC, email kirsch@igsapc.com.

Copyright:  Today's Woman May 2002 Issue, Lancaster, Pennsylvania.