Uterine Fibroid Embolization Renan Uflacker, M.D. Interventional Radiology Medical University of South Carolina Charleston, SC

Uterine Fibroids At least 25% of women will develop fibroids in the uterus 40% of all women over 35 have fibroids Most fibroids do not require treatment Most common symptoms are Excessive menstrual bleeding (heavy bleeding anemia) Pain (Pelvic discomfort) Heaviness Infertility (difficulty getting or staying pregnant) Compressive symptoms (rectum, bladder) Painful or difficult bowel movements Frequent urination

Uterine Fibroids Cause unknown Usually occur just before menopause May be related to estrogen levels Most common benign tumor in women Black women more vulnerable Most common cause of hysterectomy

Uterine Fibroids Differential diagnosis Adenomyosis Ovarian Cysts Uterine Carcinoma

Uterine Fibroids Available treatments Myomectomy Myolysis Hormonal treatment If above treatments fail or are not feasible Hysterectomy New less invasive treatment Uterine artery embolization

Potential problems with hysterectomy Post hysterectomy depression (?) Lack of interest in sex (7%) (not significant) Lack of enjoyment of sex (1%)

Uterine Fibroids UAE is a fundamentally different treatment for fibroids Minimally invasive Low complication rates Effective Repeatable if necessary Uses proved technique of embolization, available for more than 30 years

Uterine Artery Embolization Uterine artery embolization (UAE) as a primary form of therapy was reported by Ravina in 1995 16 patients were treated Polyvinyl alcohol particles used as embolic agent Mean FU 20 months Symptoms resolved in 11 of 16 patients 3 partially improved 2 failures (1 hysterectomy @ 6 weeks, 1 myomectomy @ 6 months Ravina et al. Lancet 1995

PVA 300-500 microns

Fibroids die (caseous necrosis) Then scar down (hyaline sclerosis) and shrink

Uterine Artery Embolization SCVIR (SIR) survey in October 2000: 2741 Institutions were surveyed, 330 Institutions responded Aggregate caseload of the institutions was 542 procedures per month 10,501 - UAE performed world-wide 8,644 - UAE performed in USA 40 (0.03%) complications resulting in additional surgery within 30 days of the procedure 1 (0.009%) death CIRREF Fibroid Registry 2000

Uterine Artery Embolization The procedure got a boost from a large multicenter prospective study involving 555 patients in Canada Median uterine fibroid size was reduced by 35% Dominant fibroid size was reduced by 42% 83% reduction in menorrhagia 77% reduction in dysmenorrhea 86% reduction in urinary frequency Pron et al Fertility & Sterility, 2003

Uterine Artery Embolization Severe bleeding was controlled, even in women with large uteri and minimal initial volume reductions UAE reduced the average menstrual duration from 7.6 to 5.4 days 17 pregnancies were observed Major complications occurred in 1% of the cases Pron et al Fertility & Sterility, 2003

Uterine Artery Embolization

Uterine Fibroid Embolization