UTERINE ARTERY EMBOLISATION (UAE)

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•   History of Embolisation
•   Pre-procedural diagnosis & assessment
•   Contraindications for Uterine Artery Embolisation
•   The Uterine Artery Embolisation procedure
•   Post-procedural recovery

History of Uterine Artery Embolisation (UAE)

Uterine Artery Embolisation (UAE), sometimes also name Uterine Fibroid Embolisation (UFE), was first performed by a group under the direction of French gynaecologist, Prof. Jacques Ravina in the late 1980s to stem post-surgical haemorrhage. Radiologists started to embolise patients with fibroids pre-operatively to reduce bleeding.  Patients started to cancel their surgery as their symptoms improved and a reduction in the size of their fibroids and uteri were noticed. ^{[51],[52],[53]}

To date approximately 50,000 embolisations have been performed worldwide with very high patient satisfaction.  There have been at least 50 pregnancies.  This procedure can also be used to treat adenomyosis (see  patient experiences), although the evidence is less clear.

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Pre-procedural Diagnosis and Assessment

It is important that a full assessment and diagnosis is carried out by a gynaecologist This should exclude other possible pathologies.  FSH (follicle stimulating hormone) levels may be useful for patients <45 years old. ^[29],[59]

MR (magnet resonance) imaging or ultrasound is required to determine the size, position and number of leiomyomata.  

Digital Subtraction Angiogram demonstrating the arterial supply to a uterus containing a 6cm. diameter solitary fibroid.
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MR is a superior modality for mapping leiomyomata accurately and can differentiate between leiomyomata and adenomyosis. ^{[29],[45],[46],[47],[48],[49],[50]}

More recently MRA (magnetic resonance angiography) using intravenous gadolinium based contrast medium has shown to be a useful pre-assessment for embolisation, as the arterial anatomy of the uterine and ovarian arteries is visualised and collaterals from the ovarian arteries and this can reduce screening and procedure time.  ^[57]

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Contraindications for Uterine Artery Embolisation

At this time the presence of a pedunculated subserosal leiomyoma is a contraindication for embolisation.  Also asymptomatic fibroids would not normally be treated.

Large leiomyomata used to be contraindicated, but it has been found that those over 21cm can also be successfully treated.

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The Uterine Artery Embolisation Procedure

The procedure is carried out by an interventional radiologists in an angiography suite The patients normally receive intravenous sedo-analgesia.  No general anaesthetic is required.  The procedure normally takes 60-90 minutes and requires a 1-night hospital stay, with return to work in 2-5 weeks.

The Embolisation Procedure
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Diagram showing how particles are positioned within blood vessels
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Polyvinyl alcohol (PVA) particles (355-500m) are most commonly used as embolic material, although gelatin particles are also used. 

Platinum coils were used in addition to particles, but have been found to be unnecessary, as well as increasing the procedural time.

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Post-procedural Recovery

Post procedural pain can vary enormously from no pain at all to severe cramping pain requiring considerable analgesia.  However, any pain tends to ease after 24 hours.

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Last updated: 24 Apr 2004