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Uterine fibroid embolization (UFE), also referred to as uterine artery embolization, is gaining increased attention as an alternative to hysterectomy for symptomatic uterine fibroids. Authoritative medical reports indicate it is safe, effective and increasingly covered by insurance.

One of the most important reports evaluating the treatment is The American College of Obstetricians and Gynecologists August 2008 Practice Bulletin (“Alternatives to Hysterectomy in the Management of Leiomyomas”). The bulletin concludes that “based on long- and short-term outcomes, uterine artery embolization is a safe and effective option for appropriately selected women who wish to retain their uteri.”

Interventional radiologists with Virginia Interventional and Vascular Associates (VIVA) have been performing UFEs locally for the past decade with a high (97 percent) technical success rate, said R. Donald Doherty Jr., MD. During the minimally invasive procedure, physicians thread a catheter through the patient’s femoral artery to embolize targeted arteries, resulting in fibroid devascularization and involution.
“UFE is a safe, proven treatment for uterine fibroids with excellent short- and long-term outcomes based on consistent Level A scientific research,” noted Dr. Doherty. “Most women with symptomatic fibroids are candidates, regardless of fibroid size.”

VIVA is the interventional radiology group of Radiologic Associates of Fredericksburg (RAF). Its interventional radiologists are board certified and fellowship trained in percutaneous interventions using guided imaging. In addition to Dr. Doherty, VIVA physicians include Michael P. McDermott, MD, who heads the group; John J. McLaughlin, MD; John D. Statler, MD; and Victor J. D’Addio, MD.

Indications and Contraindications

Dr. Doherty noted most women with symptomatic fibroids are potential candidates for UFE. Typical symptoms include all or some of the following: heavy menstrual bleeding, bleeding between periods, pelvic pressure, pelvic pain, urinary frequency, nocturia , leg and back pain, constipation, and painful intercourse.

The procedure has relatively few contraindications. Active pregnancy and a severe, life-threatening allergic reaction to the x-ray contrast medium are absolute contraindications,
according to Dr. Doherty.

Procedure Overview

VIVA provides longitudinal services for uterine fibroid patients, including UFE evaluation, treatment, interventional radiology (IR) service admission, and clinical follow-up. The group works closely with referring physicians on individual cases.

During a UFE, an interventional radiologist makes a small incision in the patient’s groin, inserting a catheter into the femoral artery. Using a high-definition x-ray camera for guidance, the physician threads the catheter through the patient’s femoral artery and then releases an embolic agent (polyvinyl particles) into the uterine arteries that supply blood to the fibroid tumor. This blocks blood flow to the fibroids and results in the eventual shrinkage and death of fibroid tissue.
VIVA operates an outpatient office where patients are seen for initial consults and clinical follow-up. The procedure itself is performed in the IR suite at Mary Washington Hospital. A local anesthetic is applied to the small incision site while the patient is conscious, but sedated. UFEs do not require general anesthesia.

UFE usually requires a hospital stay of one night. Medications are prescribed following the procedure to treat cramping and pain. Many women resume light activities in a few days, and return to normal activities within seven to ten days, according to the Society of Interventional Radiology (SIR).
Safety, Efficacy and Reimbursement
SIR’s website provides the following data on the safety, efficacy and insurance reimbursement of UFEs.

  • On average, 85 – 90 percent of women who undergo UFEs experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms.
  • Recurrence of treated fibroids is Short and mid-term data show UFE to be highly effective with a low rate of recurrence. Long-term (10-year) data are not yet available, but in one study in which patients were followed for six years, no growth returned after embolization.
  • Numerous pregnancies have been reported after the UFE procedure; however, prospective studies are needed to determine the effects of UFE on a woman’s ability to have children.
  • Less than 2 percent of patients have entered menopause as a result of This is more likely to occur if the woman is in her mid-forties or older and is already nearing menopause.
  • UFE is a safe method and, like other minimally invasive procedures, has significant advantages over open surgery. However, as with any surgery, UFE comes with some associated risks. A relatively small number of patients have experienced infection, which usually can be controlled by There also is a less than 1 percent chance of injury to the uterus.
  • Most major insurers cover UFEs for symptomatic fibroids.

Future Treatments

Magnetic resonance–guided focused ultrasound is another procedure that is also being evaluated by VIVA for treatment of uterine fibroids. The procedure is FDA approved for treating uterine fibroids, but is relatively new and not cost-effective at present, Dr. Doherty noted. Most insurers do not cover the procedure.

For more information contact R. Donald Doherty Jr., MD at richard.doherty@medicorp.org or Michael P. McDermott, MD at michael.mcdermott@medicorp.org or call (540) 361-1000 and leave a message.

 

Pictured above is VIVA’s R. Donald Doherty Jr., MD, performs a UFE.