What are the Risks?

Uterine artery embolization

Major complications

Major complications occur in about 1 percent to 5 percent of women undergoing uterine artery embolization. A degenerating fibroid can provide a site for bacterial growth and lead to endometritis. In extreme cases, infection may require a hysterectomy. Unintended embolization of another organ or tissue could lead to serious illness.
Recovery

Most women return home the day after the procedure with a prescription for oral pain medication. Pain usually ends within a day or two, but in some women it may last up to a few weeks.

Monitor your recovery for potential complications:

Vaginal discharge
You might have a mucus-like vaginal discharge after uterine artery embolization that clears without treatment. In a few women, remnants of fibroids are passed through the vagina. This is more likely if the fibroids are submucosal, but it can also occur with intramural fibroids. The discharge isn’t dangerous and usually stops on its own. Rarely, women need hysterectomies after uterine artery embolization treatment to make sure that no remnants remain. You can expect to resume your normal routine in about two weeks.

Infection
Return to your obstetrician-gynecologist or primary care doctor for a follow-up examination within four weeks of the procedure to make sure there’s no infection. Signs and symptoms of infection include fever, chills and pain.

You’ll likely undergo a series of ultrasound or magnetic resonance imaging (MRI) examinations over the next year to monitor shrinkage or other changes in the fibroids or your uterus. Doctors usually schedule the first ultrasound examination at three months to allow time for fibroids to shrink. Late infections and vaginal discharge have occasionally been reported up to a year after the procedure.

Menstruation and menopause
Your menstrual period will probably resume within a few months. A small number of women, however, enter menopause after the procedure. The risk appears highest among women age 45 and older. Some embolic agents may pass from branches of the uterine artery to branches of the ovarian artery at areas where the two arterial systems connect. The emboli presumably travel through branches of the ovarian artery to your ovaries. Women who are near menopause (perimenopause) are especially vulnerable to a drop in blood flow. Occasionally disruption of blood supply to the ovaries can lead to menopause. If so, you might be at increased risk of entering menopause after uterine artery embolization.

For women who desire future fertility, uterine artery embolization needs to be carefully considered. Although the risk of entering menopause following the procedure is low, subtle ovarian damage may make getting pregnant more difficult. There also may be an increased risk of pregnancy complications, especially involving abnormal placement of the placenta. Still, despite these concerns, many women have had successful pregnancies following uterine artery embolization.
Common concerns about uterine artery embolization

Radiation exposure
Uterine artery embolization exposes your ovaries to radiation for imaging, about the same amount as two barium enemas performed to examine your colon. Proper technique is critical to minimize radiation.

Infections and scar tissue
Some doctors who perform uterine artery embolization say that it isn’t the best treatment for large submucosal and subserosal fibroids or for fibroids that hang from a stalk (pedunculated). Others report satisfactory results with uterine artery embolization for women with these types of fibroids. Those who are concerned say that a pedunculated fibroid hanging from the uterine cavity could detach from your uterus after treatment, be too large to exit through your vagina and cause infection. Uterine artery embolization for subserosal fibroids may result in the formation of adhesions, bands of scar tissue between pelvic organs. But surgical treatment of fibroids, such as myomectomy, also carries this risk.
Reason to avoid this procedure

Don’t undergo uterine artery embolization if you have:

* A history of pelvic radiation
* A history of kidney failure
* When cancer is a possibility
* An active, recent or chronic pelvic infection
* Poorly controlled diabetes
* Inflammation of the blood vessels (vasculitis)
* A bleeding disorder
* A severe allergy to contrast material containing iodine (the Mayo Clinic offers a well rounded article, here.

Radiology Research

OAK BROOK, Ill. – A new multicenter trial found that uterine artery embolization (UAE) is a good alternative to hysterectomy in women with symptomatic fibroids. The findings of the Embolisation versus Hysterectomy (EMMY) Trial appear in the March issue of the journal Radiology.

“After two years, patients who had undergone UAE reported health-related quality of life equal to that of women who had undergone hysterectomy,” said study co-author Jim A. Reekers, M.D., Ph.D., an interventional radiologist at Academic Medical Centre in Amsterdam, Netherlands.

Uterine fibroids are benign growths of the muscle inside the uterus. According to the National Institutes of Health, at least 25 percent of women in the U.S. age 25 to 50 suffer from symptomatic uterine fibroids. Fibroid symptoms can include excessive menstrual bleeding, enlarged uterine size, frequent urination, pelvic pressure or pain and infertility.

According to the National Women’s Health Information Center, fibroids are the primary reason for surgical removal of the uterus, accounting for approximately one-third of the 600,000 hysterectomies performed annually in the U.S.

UAE is a minimally invasive fibroid treatment in which catheters are placed in each of the two uterine arteries, and small particles are injected to block the arterial branches that supply blood to the fibroids. The fibroid tissue dies, the masses shrink and, in most cases, symptoms are relieved. UAE requires only a local anesthetic and has a shorter recovery period than hysterectomy.

“UAE has a number of benefits compared to hysterectomy,” said co-author Wouter J.K. Hehenkamp, M.D., gynecology resident at Academic Medical Centre. “With UAE, there is a faster recovery time, a shorter hospital stay and, most importantly, the uterus is not removed.”

For the EMMY trial, 177 women with uterine fibroids and heavy menstrual bleeding scheduled to undergo hysterectomy were randomly assigned to undergo UAE (88 women) or hysterectomy (89 women). During a 24-month follow-up period, 20 percent of women who had undergone embolization in the trial subsequently underwent hysterectomy due to insufficient symptomatic relief. Over the same period, health-related quality of life (HRQOL) was measured six times for all women in the trial with a series of scientifically validated questionnaires, which assessed various physical, mental and functional components contributing to quality of life, as well as overall satisfaction with the treatment.

Results showed that HRQOL improved significantly in all patients six months after treatment, except in the defecation distress inventory, which improved significantly in the UAE patients at six-month follow-up, but not the hysterectomy patients. Six weeks after treatment, the UAE patients also scored significantly higher scores on the physical component summary, which measured factors related to physical function.

After 24 months, no HRQOL differences were observed between the two groups, but while more than 90 percent of patients in both groups were at least moderately satisfied with the treatment they received, the hysterectomy patients reported a higher level of overall satisfaction. This may be attributable to the fact that they no longer experienced menstrual cycles or worried that their symptoms would recur. However, previous studies lasting several years have shown that it is rare for treated fibroids to regrow or for new fibroids to develop after UAE.

“For those women seeking absolute certainty of being asymptomatic after treatment, I would recommend a hysterectomy,” Dr. Reekers said. “But for women who wish to retain their uterus and who desire a fast recovery, I would definitely recommend UAE.”

Radiology is a monthly scientific journal devoted to clinical radiology and allied sciences. The journal is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass. Radiology is owned and published by the Radiological Society of North America, Inc. (RSNA.org/radiologyjnl)

The Radiological Society of North America (RSNA) is an association of more than 41,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (RSNA.org)

“Symptomatic Uterine Fibroids: Treatment with Uterine Artery Embolization or Hysterectomy—Results from the Randomized Clinical Embolisation versus Hysterectomy (EMMY) Trial.” Collaborating with Drs. Hehenkamp and Reekers were Nicole A. Volkers, M.D., Erwin Birnie, Ph.D., and Willem M. Ankum, M.D., Ph.D.