Uterine fibroid Embolization - a non-surgical alternative to hysterectomy.

Introduction

Uterine fibroid is a common pathology of the female uterus. It is primarily a benign pathology that can interfere with the fertility of women and cause multiple other symptoms.Fibroids can cause variable symptoms. Fibroids can be non-symptomatic, or they can present with typical symptoms like pelvic heaviness, abnormal periods with increased bleeding or abnormal menstrual cycles.

Multiple treatments have evolved over some time. Surgical treatment of the fibroids includes complete removal of the uterus, called hysterectomy, or partial removal, called myomectomy. However, surgical treatments have multiple limitations.

New treatments have come into the picture in recent times. These include uterine artery embolisation. It is the least surgical technique for the treatment of symptomatic fibroids.

Embolisation is performed by specialists called interventional radiologists . It is performed by blocking the abnormal blood supply of the fibroids. This leads to the correction of abnormal bleeding associated with fibroids and the shrinkage of fibroids over time. This procedure is becoming more popular due to its efficacy and higher recovery time. It also helps save the uterus from future pregnancy.

Uterine Artery Embolization

UAE is a procedure that selectively cannulates the uterine arteries that supply blood to fibroids.

The procedure involves multiple steps

1. Patient Preparation
   The patient generally remains awake, or mild sedation is given Access is developed for the femoral artery using a sheath.
2. Catheter cannulation and Embolization
   Under fluoroscopic guidance, the catheter is moved into the uterine arteries. Tiny embolic particles are injected into the arteries supplying the fibroids. These particles block blood flow, causing fibroid shrinkage over time.
3. Completion and Recovery
   The catheter is removed after the procedure's completion, and the entry point is closed. There is minimal discomfort to the patient. Patients stay in the hospital for observation for a few hours or overnight, and recovery is faster than surgical methods.

Benefits of Uterine Artery Embolization

UAE is the preferred alternative to surgery due to several advantages:

• It is minimally Invasive, and no significant surgical cuts are required.
• It reduces the risk of complications and infection.
• Unlike hysterectomy, UAE allows women to retain their uterus, which helps to preserve the future pregnancy.
• It has a shorter recovery time, and patients can resume normal activities within a few days.
• It provides effective symptom relief in uterine bleeding, pain and pressure effects.
• The risks associated with general anaesthesia and major surgery are not present.

Risks and Potential Complications

While UAE is generally safe, there are potential risks, including:

1. Post-Embolization Syndrome:
   It includes symptoms like mild fever, pelvic pain, and nausea due to fibroid shrinkage and degeneration. It can be managed with painkillers and resolves within a few days.
2. Incomplete Fibroid Shrinkage:
   Some fibroids may not respond entirely and require additional treatment or repeat embolisation.

Rare Complications include infection, uterine necrosis (damage to uterine tissue), or non-target embolisation (where embolic material affects unintended areas).

Who should go for UAE?

UAE is suitable for women who:

• Have symptomatic fibroids causing heavy bleeding, pain, or pressure symptoms.
• Seek an alternative to surgery with a faster recovery.
• Want to preserve their uterus.
• Are not candidates for myomectomy due to multiple or large fibroids.

However, the UAE may not be suitable for patients with huge fibroids. Women with submucosal fibroids (which distort the uterine cavity and may be better treated with hysteroscopic myomectomy

UAE and Fertility Considerations

While UAE preserves the uterus and the hope for future pregnancy, it helps to improve pregnancy by reducing the size of the fibroids, which are associated with miscarriage or placental abnormalities. Careful evaluation is required.

Conclusion

Uterine artery embolisation is a new minimally invasive treatment for uterine fibroids. It helps in effective symptomatic relief with fewer complications and a shorter recovery time than traditional surgery.

UAE provides an essential option for women seeking an alternative to hysterectomy. However, UAE is emerging as a primary treatment for fibroid management in many patients.