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

2. 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

4. 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

5. Uterine Fibroids Differential diagnosis Adenomyosis Ovarian Cysts
Uterine Carcinoma

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

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

9. 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

10. 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 6 weeks, 1 6 months
Ravina et al. Lancet 1995

11. PVA microns

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

15. 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

16. 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

17. 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

18. Uterine Artery Embolization

20. Uterine Fibroid Embolization