What is it?

Uterine fibroid embolisation is a method to close off the blood supply to fibroids by introducing a catheter (small tube) along the groin and by using small plastic beads.

Advantages

  • it is a minimally-invasive method (skin incision of +/- 2 mm in the (right) groin
  • performed using local (epidural) anaesthesia
  • small chance of complications, lower than with surgery (operation)
  • performed during a short hospitalisation, especially focused on pain control
  • faster recovery than with surgery (operation)

Possible risks

A uterine fibroid embolisation is a very safe procedure, but, as with all treatments, there are certain associated risks:

  • every intervention where the skin is broken, for example, has a chance of infection.
  • there is a possibility of allergic reaction to the iodine in the contrast. If you have had a previous reaction to contrast, please do not forget to tell the physician or nursing staff.
  • bleeding from the puncure side in the groin. This is a temporary problem. The bleeding will stop on its own.
  • pain resulting from the embolisation
  • very rarely: damage to the artery that has been punctured with the catheter.
  • very rarely: there can be displaced embolisation material (beads) toward the unintended arteries ('non-target' arteries.
  • The effect on fertility is still uknown and is being researched. What is known is that it is possible to become pregnant after a uterine fibroid embolisation.

Procedure

Preparation for the procedure

There are a few steps you must first take before an embolisation is performed:

  • MRI scan of the uterus: a test where a very detailed image will be made of the uterine fibroids and of the blood vessels.
  • Consultation with the interventional radiologist with explanation of the treatment, focused on your specific situation.
  • Consultation wtih a gynaecologist for a general gynaecological opinion.
  • If you are pregnant or think you might be, you must inform the physician of this. In this case, the embolisation cannot be performed.
  • Medication that influences coagulation (Aspirin, Clopidogrel, Warfarin, DOACs) must be stopped prior to the treatment. If you take this medication, contact the Radiology Department at least one week before the treatment.
  • Medication for diabetes must be adjusted before the treatment. If you take this medication, contact the Radiology Department.
  • Are you allergic to certain materials (medications, latex, contrast agent)? Do not forget to check in for your admission.
  • You must be fasting for this treatment:
    Type of food:Example:Allowed until at the latest:
    Normal mealmidnight before the surgery or examination
    Light meale.g. a sandwich or toast with jam. Deep-fried/fatty foods or meat are not includedsix hours prior to the procedure or examination
    Dairy productsMilk, bottle-feeding for a child, yoghurt...six hours prior to the procedure or examination
    Breastfeedingfour hours prior to the procedure or examination
    DrinksAs wished: water, sugar water, sports drinks, clear fruit juices without pulp (apple juice, grape juice)

    Maximum
    a cup: clear tea and coffee without milk
    .
    Recommended: continue to drink clear beverages up to two hours before the procedure or examination
    Up to six hours before the procedure: fizzy drinks

    (Exceptions: gastrointestinal surgery. You should follow the instructions of your attending physician).

  • You may not smoke after midnight the night before the procedure.

Intervention

  • You will be given a surgical gown to wear during your admission. You will also be given special compression stockings to prevent thromboses in your legs.
  • The treatment is performed in a room especially designed for this purpose (an angiography room), and that utilises X-rays.
  • You will lie on your back for the procedure. The anaesthesiologist will place an epidural for the embolisation and
    a thin tube will be left in place. This catheter is then used to administer medication that cuts off pain conduction. The primary side effect is itching and loss of strength or tingling in the legs. These symptoms should disappear after the tube is removed.
  • Next, a bladder catheter will be placed:
    • Because of the anaesthesia, you will not be able to walk to the bathroom.
    • And because the bladder fills with contrast during the procedure, which makes the blood vessels around the uterus harder to see well.
  • Your groin will be shaved and disinfected, and your body will be covered with a blue, sterile sheet. The physician and the assisting nurse will also wear a sterile apron, mask and cap.
  • The inguinal vein will be punctured and a thin tube (catheter) will be introduced to where the blood vessel supplying the fibroids sits. Contrast is used to visualise the artery and in order to make a clinical diagnosis. After receiving the contrast injection, you may feel warm and some patients have the feeling that they need to urinate.
  • The artery will then be blocked with small plastic beads (e.g. round particles).
  • After blocking the blood vessel on the left side, the blood vessel will also be treated on the right side.
  • Afer closing the blood vessel, the catheter is removed from the groin and firm pressure is applied for ten minutes.

The total duration of the procedure is +/- one hour, depending on the anatomy and the size of the fibroids.

After the procedure

  • After the embolisation, the pain pump is installed by an anaesthesiologist so that you can dose your own pain medication.
  • After a brief stay in the recovery room, you will return to the department to which you were admitted. You will be on bedrest until the epidural anaesthesia has worn off.
  • The puncture site, your blood pressure and pulse will be monitored regularly.
  • Together with the anesthesiologist, pain medication will be given on time and as quickly as possible.
  • A pain nurse will come and visit you regularly in the department.
  • The worse pain is immediately during the 12 hours, with recurrent painful episodes during the first two weeks. This is no reason for panic and pain medication can be prescribed by the attending physician.
  • The bladder catheter will be removed as soon as you can spontaneously urinate and you can move sufficiently.

Guidelines for at home

  • Take it easy for the first week, but do make sure to move enough.
  • Resume normal activities after two weeks. Heavy physical exertion should be avoided for four weeks.
  • If you have a fever, contact the Radiology Department or your gynaecologist.
  • If you are worried or if you feel uncomfortable and think that a medical check is necessary, you may always contact the hospital's Radiology Department, your gynaecologist, GP or the A&E.
  • Blood loss during the first couple of weeks after the embolisation is normal.
  • Do not take a bath or use a swimming pool or sauna for six weeks. Showering is not a problem.
  • Use sanitary napkins during the first four weeks. Do not use tampons.
  • Intercourse is not allowed during the first four weeks.
  • Would you like to have children? If not, consider contraception. Note: you may not have an IUD placed during the first six months.

Do you have any of the following warning signs:

  • fever higher than 38.5°C
  • severe increase in pain
  • shortness of breath
  • general feeling of being ill

It is then best to contact the Radiology Department or your gynaecologist. If it is after regular clinical hours, then please contact the hospital’s A&E.

Results

Studies show that 85-90% of women stop having symptoms.

Centres and specialist areas

Radiology

Latest publication date: 05/02/2021
Supervising author: Dr Schoofs Christophe