At Desert Vein & Vascular Institute, we pride ourselves in our experience and ability to diagnose and treat symptomatic uterine fibroids by a procedure called Uterine Fibroid Embolization (UFE).
Being an endovascular specialist who specializes in this specific procedure for over 15 years, Dr Rami is a leader in treating fibroids in women. He first started doing UFE in 2001 during residency training at the Medical College of Ohio and subsequently specializing in the procedure, amongst many other, during his fellowship at the University of Michigan in 2003. Over the years, Dr Rami has gone on to master the procedure and refine it according to his high standards to be safely performed in the outpatient ambulatory setting at our brand new, state of the art ambulatory surgical center, Desert Endovascular Surgical Center.
Our goal at DVVI is to become the leader in Women’s Health in Arizona and the Southwest, specializing in the evaluation and treatment of uterine fibroids and chronic pelvic pain such as pelvic congestion syndrome (PCS).
The Truth About Uterine Fibroid Embolization
What is Uterine Fibroid Embolization (UFE)?
Uterine fibroid embolization (UFE) is a minimally invasive treatment for fibroid tumors of the uterus.
Fibroid tumors are benign tumors that arise from the muscular wall of the uterus. Also known as myomas, it is extremely rare for them to turn cancerous. More commonly, they cause heavy menstrual bleeding, pain in the pelvic region, pressure on the bladder or bowel, and even chronic anemia and fatigue.
In a UFE procedure, Dr Rami uses x-ray guidance (fluoroscopy) to guide a thin flexible tube called a catheter to the uterine arteries and subsequently deliver tiny particles to the uterus and fibroids. The particles block the blood flow preferentially to the fibroids, causing them to shrink and sparing the uterus and allowing it to heal. Nearly 90 percent of women with fibroids experience relief of their symptoms.
What to expect on your initial consultation?
We are proud to evaluate our patients in our new vascular clinic. Please have any relevant records or imaging sent prior to your consultation or bring with you at your initial visit.
A detailed history and physical exam will be performed. If imaging has not been obtained, a pelvic ultrasound or MRI will be ordered to fully assess the size, number and location of the fibroids. On the subsequent visit, the imaging findings will be reviewed with each patient and the UFE procedure discussed in detail, planned and scheduled to be performed at our endovascular surgical center. Blood work be may also be ordered.
How does the procedure work?
The procedure involves inserting a catheter through the groin, maneuvering it through the uterine artery, and injecting the embolic agent into the arteries that supply blood to the uterus and fibroids. As the fibroids die and begin to shrink, the uterus fully recovers and patients begin to see a significant reduction or even resolution of symptoms.
How is the procedure performed?
UFE is an image-guided, minimally invasive procedure that uses a high-definition x-ray camera to guide an endovascular specialist like Dr Rami, to introduce a catheter into the uterine arteries to deliver the embolic particles. The procedure is performed in our state of the art endovascular surgical center.
Prior to the procedure, a nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously. Moderate or deep sedation may be used by our board certified anesthesiologists.
You will be positioned on the examining table. Devices to monitor your heart rate and blood pressure will be attached to your body.
The area of your body where the catheter is to be inserted will be sterilized and covered with a surgical drape. The area will be numbed with a local anesthetic. A very small skin nick is made at the site.
Using x-ray guidance, a catheter is inserted into your femoral artery, which is located in the groin area. Contrast material provides a roadmap for the catheter as it is maneuvered into your uterine arteries. The embolic agent is released into both the right and left uterine arteries. Depending on individual anatomy, one or both femoral arteries may be accessed to treat the uterine artery on each side..
At the end of the procedure, the catheter will be removed and the artery puncture(s) sealed with a closure device. In the case a closure device cannot be utilized, manual pressure will be applied to stop any bleeding. The opening in the skin is then covered with a dressing. No sutures are needed. This procedure is usually completed within 90 minutes.
You will recover in the post-operative area for 4-6 hours, receiving IV pain and anti-inflammatory medications. Your intravenous line will be removed prior to discharge home.
What will I experience during and after the procedure?
With moderate or deep sedation, most patients are relaxed, sleepy and comfortable for the procedure, often times not even feeling the anesthetic to the groin.
Injection of contrast material may cause a warm feeling in the body or legs which quickly subsides.
Patients are expected to have moderate pelvic cramps for several days after the UFE procedure, and low-grade fever and nausea could occur. The cramps are most severe during the first 24 hours after the procedure and improve rapidly over the next several days. With Dr Rami’s refined outpatient protocol, all women will be prescribed an intense analgesic and anti-inflammatory oral regimen prior to and, in particular, after the procedure. The real expectations of the procedure will be discussed in detail with every patient by Dr Rami prior to scheduling of the UFE procedure.
Patients are able to resume normal activities in usually one week after UFE.
When can I expect see improvement of my symptoms?
After UFE it is common for menstrual bleeding to be much less during the first cycle and gradually resume to a new level that is vastly improved as compared to the heavy cycles before. Occasionally a women may miss a cycle or two or even rarely stop having periods altogether. As fibroids continue to shrink and soften over months, relief of bulk-related symptoms may be seen as early as two to three weeks after the procedure. Symptom improvement may be gradual over six months, at which time the process has usually finished and symptom improvement maximized.
What are the benefits vs. risks of UFE compared to surgery?
- At DESC, UFE is done with conscious or deep sedation, is much less invasive than open or laparoscopic surgery to remove individual uterine fibroids (myomectomy) or the whole uterus (hysterectomy).
- No surgical incision—only a small nick in the skin that does require a stitch.
- Patients ordinarily can resume their usual activities much earlier than if they had surgery to treat their fibroids (typically 1 week compared to several weeks to months for surgery)
- Compared to surgery, general anesthesia is not required, there is virtually no blood loss and the recovery time is remarkably much shorter.
- Women are discharged from the center same day
- Follow-up studies have shown that nearly 90 percent of women who have their fibroids treated by UFE experience either significant or complete resolution of their fibroid-related symptoms. This is true both for women who have heavy bleeding as well as those who have bulk-related symptoms including urinary frequency, pelvic or back pain or pressure or constipation.
- it is rare for treated fibroids to regrow or for new fibroids to develop after UFE. Embolization is a more permanent solution than the option of hormonal therapy, because when hormonal treatment is stopped the fibroid tumors usually grow back. Recurrence after myomectomy and regrowth also has been a problem with laser treatment of uterine fibroids.
- Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection. However precaution is taken to mitigate these risks.
- When performed by an experienced endovascular specialist like Dr Rami at Desert Endovascular Surgical Center (DESC), the chance of any of these events occurring during uterine fibroid embolization is less than one percent (1%).
- Any procedure where the skin is penetrated carries a risk of infection. DESC is an accredited ambulatory surgical center (ASC), held by the most stringent standards for infection control. As a result, chance of infection requiring antibiotic treatment is less than one in 1,000– 20 times less when compared to hospitals and other office based labs (OBLs).
- An occasional patient may have an allergic reaction to the x-ray contrast material used during uterine fibroid embolization. Women undergoing UFE are carefully monitored by two physician (Dr Rami and board-certified anesthesiologist) and a nurse during the procedure, so that any allergic reaction can be detected immediately and addressed.
- Approximately two to three percent of women will pass small pieces of fibroid tissue after uterine fibroid embolization. This occurs when fibroids located inside the uterine cavity detach after embolization. Women with this problem may require a procedure called D & C (dilatation and curettage) to be certain that all the material is removed to prevent bleeding or infection from developing.
- In the majority of women who undergo uterine fibroid embolization, normal menstrual cycles resume after the procedure. However, in approximately 1-4% of women, menopause occurs after uterine fibroid embolization. This appears to occur more commonly in women who are older than 45 years.
- The question of whether uterine fibroid embolization impacts fertility has not yet been answered, although a number of healthy pregnancies have been documented in women who have had the procedure. Because of this uncertainty, physicians may recommend that a woman who wishes to have more children consider surgical removal of the individual tumors rather than undergo uterine fibroid embolization. If this is not possible, then UFE may still be the best option.
- Because the effect of uterine fibroid embolization on fertility is not fully understood, UFE is typically offered to women who no longer wish to become pregnant or who want or need to avoid having a hysterectomy, which is the operation to remove the uterus. However, women have been known to become pregnant after the UFE procedure.
- It is not possible to predict whether the uterine wall is in any way weakened by UFE, which might pose a problem during delivery. Therefore, the current recommendation is to use contraception for six months after the procedure and to undergo a Cesarean section during delivery rather than to risk rupture of the wall of the uterus from the intense muscular contractions that occur during labor.
When should Uterine Fibroid Embolization (UFE) not be performed?
Uterine fibroid embolization should not be performed in women who are asymptomatic, when cancer is a possibility, or when there is inflammation or infection in the pelvis. Uterine fibroid embolization is not an option for women who are pregnant. Women with known history of severe allergic reaction to contrast materials that contain iodine require pretreatment before UFE or perhaps should consider a different treatment option.