THE EMBOLISATION PROCESS

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•   History of Embolisation
•   What is it?
•   How many embolisation procedures have been performed?
•   What does the procedure involve?

History of Embolisation

In the late 1980s a group under the direction of Professor  Jacques Ravina, a French gynaecologist, embolised uterine arteries in patients who started bleeding post-operatively.  Radiologists  started to embolise the uterine arteries pre-operatively to reduce bleeding.  Patients started to cancel surgery as their symptoms improved.

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What is it?

Embolisation is the blocking of an artery, the blood vessels supplying an organ, to stop blood flow. As well as uterine fibroids embolisation can be used to treat:-

•   inoperable cancers

•   aneurysms (dangerous ballooning of a blood vessel) in the brain
    - avoiding major brain surgery 

•   arterio-venous shunts in the lung (blood vessels have direct links
    between the arterial and venous systems, thus bypassing the
    heart) - otherwise treated by a heart-lung transplant.  

In the case of uterine fibroids small particles are introduced into the arteries supplying the uterus and fibroids and block them.  The fibroids, thus starved of blood shrivel and die.  There is enough blood supply to the uterus from other arteries (usually the one supplying the ovaries) for the uterus to maintain normal function and fertility.

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How many have been performed? 

There have been at least 50,000 uterine artery embolisation procedures performed around the world to date.  Precise figures for the UK are unknown, but it is thought that at least 1500 have been performed as part of clinical trials or assessments.

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What does the procedure involve?

An MRI (magnetic resonance imaging) scan is normally performed to determine the number, size and position of the fibroids.

This is also important to ensure that none of the fibroids are pedunculated (on a stalk) and sitting outside the uterus in the abdominal cavity.  Embolisation is not performed on such fibroids at the moment.  Having large fibroids does not stop successful embolisation.  If fibroids are very large this will be discussed with you directly by your interventional radiologist.  One woman had a fibroid of 21cm, which was successfully treated by embolisation.

The procedure is performed in an angiography suite, not an operating theatre and by an interventional radiologist, not a surgeon.  It is carried out under light sedation and local anaesthetic.  A catheter is inserted into the bladder before the procedure.
   

The patient will lie on a table and the radiologist will view what is going on by fluoroscopy, a very low-level x-ray. A small catheter (hollow plastic tube) is inserted into the femoral artery, the blood vessel supplying the leg, in the groin, usually on the right side. The catheter is very small and the incision is only 1-2 mm wide. There is little if any  pain. 

From time to time he/she will introduce radio-opaque dye (contrast media) down the catheter into the blood vessel to visualise them. A warm sensation may be felt when the contrast media is injected.

The Embolisation Process
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Diagram showing how particles are positioned within blood vessels
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This procedure is done on both branches of the uterine artery. 

CLICK HERE  to run an animation showing how the Uterine Embolisation procedure blocks the artery, thus starving fibroids of the blood supply and causing them to shrink over time. 

After the second side is embolised - particles are injected, the woman may start to feel cramping pain.  Pain varies greatly.  Some feel none at all and others need considerable pain relief.  Pain is usually controlled with a strong painkiller such as diamorphine and anti-emetic drugs to help to stop sickness.

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Last updated: 24 Apr 2004