To see your uterus and blood vessels, the radiologist uses a fluoroscope. This device is a pulsed X-ray beam that produces moving images of internal structures and displays them on a computer monitor.
During the procedure
The procedure includes:
- Anesthesia. Typically you'll receive a type of anesthesia that reduces pain and helps you relax, but leaves you awake (conscious sedation).
- Blood vessel access. The doctor makes a small incision in the skin over your femoral artery, a large blood vessel that passes lengthwise through your groin. Then your doctor inserts a catheter into the artery and guides the catheter to one of the two uterine arteries. Generally, the doctor can access both uterine arteries through one incision.
- Blood vessel mapping and injection. An injected contrast fluid, usually containing iodine, flows into the uterine artery and its branches and makes them visible on the fluoroscope's monitor. The fibroids "light up" more brightly than other uterine tissue. The radiologist identifies the right area of the uterine artery and then injects the blood vessel with tiny particles made of plastic or gelatin. The particles are carried by the blood flow to block the fibroid vessels. After injecting more contrast into the uterine artery, the doctor checks additional images to make sure that blood is no longer reaching the fibroids. The same steps are then repeated in the second uterine artery.
After the procedure
In the recovery room, the care team monitors your condition and gives you medication to control any nausea and pain. When the effects of the anesthesia fade, they take you to your hospital room for overnight observation.
- Position. You must lie flat for several hours to prevent pooling and clotting of the blood (hematoma) at the femoral artery site.
- Pain. The primary side effect of uterine artery embolization is pain, which may be a reaction to stopping blood flow to the fibroids and a temporary drop in blood flow to normal uterine tissue. Pain usually peaks during the first 24 hours. To manage the pain, you receive pain medication.
- Observation. Post-embolization syndrome — characterized by low-grade fever, pain, fatigue, nausea and vomiting — is frequent after uterine artery embolization. Doctors believe that chemicals released by degenerating fibroids stimulate inflammation, causing these symptoms. Post-embolization syndrome symptoms peak about 48 hours after the procedure and usually resolve on their own within a week. Ongoing symptoms that don't gradually improve should be evaluated for more-serious conditions, such as an infection.
By the next day, your urinary catheter is removed, and you're encouraged to walk around. Recovery is generally rapid, and complications are rare.
Most women return home the day after the procedure with a prescription for oral pain medication. Pain usually ends within a day or two, but in some women it may last up to a few weeks.
Monitor your recovery for:
- Vaginal discharge. You might have a watery or mucus-like vaginal discharge for a few weeks to a month after uterine artery embolization. The discharge should stop without treatment. In a few women, remnants of fibroids are passed through the vagina.
- Infection. Return to your obstetrician-gynecologist or primary care doctor for a follow-up exam within four weeks of the procedure to make sure there's no infection. Signs and symptoms of infection include fever, chills and pain. Delayed infections and vaginal discharge are rarely reported weeks to months after the procedure.
You'll likely undergo a magnetic resonance imaging (MRI) exam over the next year to monitor shrinkage or other changes in the fibroids or your uterus. Doctors usually schedule the first exam three months after the procedure.
June 04, 2013
- Frequently asked questions. Gynecologic problems FAQ074. Uterine fibroids. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq074.pdf?dmc=1&ts=20130423T1546469165. Accessed April 23, 2013.
- Bouwsma EVA, et al. Comparing focused ultrasound and uterine artery embolization for uterine fibroids — Rational and design of the fibroid interventions: Reducing symptoms today and tomorrow (FIRSTT) trial. Fertility and Sterility. 2011;96:704.
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Gynecology. ACOG Practice Bulletin No. 96. Alternatives to hysterectomy in the management of leiomyomas. American College of Obstetricians and Gynecologists. http://guideline.gov/content.aspx?id=13318. Accessed April 23, 2013.
- Laughlin SK, et al. Uterine leiomyomas: Individualizing the approach to a heterogeneous condition. Obstetrics and Gynecology. 2011;117:396.
- Van der Kooij, et al. Review of nonsurgical/minimally invasive treatments for uterine fibroids. Current Opinion in Obstetrics and Gynecology. 2012;24:1.
- Coddington CC, et al. Fertility and uterine artery embolization. Obstetrics and Gynecology. 2010;116:439.
- Martin J, et al. Complications and reinterventions in uterine artery embolization for symptomatic uterine fibroids: A literature review and meta analysis. Cardiovascular and Interventional Radiology. 2013;36:395.
- Scheurig-Muenkler C, et al. Clinical long-term outcome after uterine embolization: Sustained symptom control and improvement of quality of live. Journal of Vascular and Interventional Radiology. In press. April 4, 2013.
- Kaump GR, et al. The impact of uterine artery embolization on ovarian function. Journal of Vascular and Interventional Radiology. 2013;24:459.
- Choi, et al. Is uterine artery embolization for patients with large myomas safe and effective? A retrospective comparison study in 323 patients. Journal of Vascular and Interventional Radiology. In press. Accessed April 4, 2013.
- Kim D, et al. Uterine leiomyoma (fibroid) embolization. http://www.uptodate.com/home. Accessed May 6, 2013.
- Kim D, et al. Interventional radiology in management of gynecological disorders. http://www.uptodate.com/home. Accessed May 6, 2013.
- Parker WH. Techniques to reduce blood loss during abdominal or laparoscopic myomectomy. http://www.uptodate.com/home. Accessed April 23, 2013.
- Uterine fibroid symptoms, diagnosis and treatment. Society of Interventional Radiology. http://www.sirweb.org/patients/uterine-fibroids/. Accessed April 7, 2013.
- Gallenberg MM (expert opinion). Mayo Clinic, Rochester, Minn. May 8, 2013.
- Stewart EA (expert opinion). Mayo Clinic, Rochester, Minn. May 17, 2013.
- Vander Kooij SM, et al. Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: A systematic review and metaanalysis. American Journal of Obstetrics and Gynecology. 2011;206:e1.