Uterine fibroids is a tumor of a benign nature, which is formed from the muscular layer of the organ and mainly consists of connective tissue elements. This education is subject to treatment. Modern medicine has the latest methods to eliminate pathology with minimal losses to women’s health.
Uterine artery embolization (UAE)
One of the modern methods of treating fibroids is uterine artery embolization. This is a minimally invasive technique that allows a non-surgical method to remove the tumor.
What is uterine artery embolization?
Embolization of the uterine arteries is one of the modern methods of treating fibroids without surgical intervention. The therapeutic effect is achieved due to the fact that the nodes of the fibroids cease to receive nutrients delivered with the blood. This is due to the blockage of the blood supply to the tumor.
It should be noted that this method is considered cardinally new in Russia, while in most countries of the world it has been successfully used since the beginning of the 70s of the last century. Although at first embolization was used to stop bleeding during an operation, and then it was transformed into an independent method of treatment. Permission for embolization, as an endovascular procedure, was obtained in the Russian Federation in 1998. Naturally, against the background of a previously used surgical operation aimed at removing the uterus along with fibroids, this method is considered innovative.
The very word embolization already implies the selective occlusion or blockage of vessels through the introduction of emboli (unbound intravascular substrate). For the treatment of fibroids, small balls are used, which come with the injected drug. As a result, the fibroid dies within a few hours, as its arteries are blocked. The doctor who performs this technique is called a radiologist (interventional radiologist, endovascular surgeon). For its implementation, it is necessary that the clinic be equipped with special angiographic equipment and an X-ray operating room.
This technique makes it possible to refuse the removal of the uterus when fibroids are detected and the need to make incisions in the abdominal cavity. That is, a woman does not lose her reproductive function, and after the completion of the rehabilitation process, she will be able to return to a full life and conceive a child.
Indications for embolization
In order for uterine artery embolization to be prescribed, a woman needs to be examined by a gynecologist.
Indications for carrying out are:
Fibroids that do not exceed 20 weeks of gestation in size. If the formation is larger, embolization is not possible.
The absence of pathological processes in the cervix, in the endometrial layer and in the ovaries.
A woman’s desire to have children in the future.
The effect of fibroids on infertility in establishing this relationship.
When myoma affects the inability to bear a child, when the tumor becomes the cause of miscarriages.
The impossibility of performing a myomectomy that is safe for a woman’s health.
Preparing for an upcoming myomectomy or surgery to remove the uterus along with fibroids.
Large nodules of multiple fibroids.
Amyloidosis of the uterine vessels.
A woman’s desire to maintain reproductive function has a significant impact on the procedure.
Contraindications for uterine artery embolization
Like any other type of minimally invasive intervention, embolization has not only indications, but also contraindications to its implementation.
Among them:
The size of the uterus with fibroids exceeds 20 weeks of pregnancy.
Oncological diseases.
Pregnancy.
Any active inflammatory and infectious processes in the vagina or ovaries.
Obstruction of the iliac arteries and their branches.
Renal failure.
Blood clotting disorders.
Submucosal myoma on the leg, but at the same time it should be single. In the presence of multiple submucosal fibroids, one of which will be pedunculated, embolization can be performed.
Allergic reaction to the contrast agents that will be used for embolization.
In addition, subserous nodes larger than 10 cm in size, the blood flow inside which is weakened, can become a relative contraindication.
Mechanism of action
Before the procedure is performed, a woman needs to go through a small preparatory stage. It boils down to the fact that on the day of hospitalization, you should refuse to eat. The groin and thigh should be hairless, for which you should use a razor. Both legs can be covered with elastic bandages immediately before the procedure.
The patient is brought into the office and placed on the angiography table. The abdomen and thigh are treated with antiseptic solutions. Through a puncture (its size does not exceed 1,5 mm), which is performed in the region of the inguinal fold, a catheter tube (its diameter is not more than 1,2 mm) is inserted into the femoral artery. Local anesthesia is used for anesthesia, as the procedure is not too painful. Most often, either novocaine or lidocaine is used for this. Under X-ray control, the doctor guides the catheter into the uterine artery, to the point where it begins to branch and feed the myoma nodes.
An arteriogram is taken to make sure the catheter is in the correct position and to confirm fibroids. That is, a special contrast agent is introduced into the catheter, which can be seen using an x-ray. After making sure that everything is done correctly, the surgeon begins the introduction of emboli into the artery. In their role are either the smallest particles of a gelatin sponge, or plastic balls made of polyvinyl alcohol or polyurethane foam.
After the emboli reach narrow vessels, they stop there, blocking them. Therefore, blood can no longer flow to the tumor tissues and its nutrition is disrupted.
To completely deprive the myoma of nutrition, a similar procedure is performed on the second femoral artery. Then the surgeon once again performs an arteriogram, the purpose of which is to exclude the slightest possibility of feeding the tumor.
The area that has been punctured is closed with a sterile patch. In addition, a pressure bandage is applied to the thigh. After 12 hours, it is removed and embolization is considered complete. Then the woman has to go through a recovery period.
During the technique, a woman may experience a feeling of warmth in the legs and in the lower abdomen. The average time to complete embolization is 15 minutes. Although the duration depends on the depth of the nodes, on their number and can reach half an hour.
Results of uterine artery embolization
The result of the embolization is the resorption of fibroids. It continues to actively decrease in size during the first six months. Although in the future there is a tendency to decrease it. According to statistics, after 12 months, after the embolization, the size of the tumor becomes 4 times smaller. At the same time, the uterus itself acquires normal volumes.
Sometimes the result of embolization may be the release of tumor nodes through natural routes. This is especially often observed when they are close to the uterine cavity. Such expulsion of fibroids is considered the most favorable outcome of the procedure, since all damaged structures are restored as soon as possible.
The woman’s pain disappears, the menstrual cycle normalizes, the volume of secretions decreases. Moreover, these are early qualitative characteristics of the procedure performed.
The myoma itself is replaced by connective tissues.
Benefits of Uterine Artery Embolization
This procedure for getting rid of the tumor has undoubted advantages over other methods of treatment.
They boil down to:
There is no risk of disease recurrence. This is due to the fact that during embolization, the arteries of all nodes are clogged, regardless of their size. That is, even the smallest fibroid formations will stop receiving food and die. Statistics indicate that 98% of patients who have undergone embolization do not require further treatment at all. With any surgical intervention, it is impossible to achieve such indicators.
After the procedure, no visible scars or scars will remain on the woman’s body.
The procedure does not require the introduction of general anesthesia. The procedure is practically painless. This means that the body will not be subjected to additional stress and will not require recovery from global anesthesia.
After embolization, the patient does not need to stay in the hospital for a long time. Doctors recommend staying under supervision for another two days. However, many women leave the clinic several hours later on the same day.
The technique is applicable to those women who have contraindications for surgical intervention.
A woman does not lose the opportunity to have children in the future.
That is why the procedure is becoming more and more popular every year and more and more clinics in the country offer it.
Post-embolization period
When the procedure is completed, the woman will need to return to the room. The puncture site is cooled with ice. Sometimes a drip may be required. After a couple of hours, the woman will begin to experience unpleasant pulling sensations, sometimes quite painful. The place of their localization is the lower abdomen. They are due to the fact that the myoma begins to experience attacks of ischemia. Such sensations last for several hours and, if necessary, will be stopped by painkillers.
At the puncture site where the catheter was inserted, one can observe a hematoma, which disappears with time. During the first 12 hours, a woman will not be able to bend her right limb, if a pressure bandage has been applied, then it will be removed after two hours.
In addition, during the psoembolization period, an increase in body temperature is possible. As a rule, the thermometer does not show values above 37,5 degrees. Sometimes concomitant symptoms become dizziness, weakness, nausea. You should not be afraid of this, since such companions of the early rehabilitation period pass quickly and do not threaten the patient’s health.
After a couple of days, the woman goes home, but she will need to refrain from physical activity for a week.
The following recommendations will help the patient to pass the later period of rehabilitation without complications:
The amount of fluid you drink should be increased, which is the prevention of blockage of blood vessels.
Sometimes it is possible to take acetylsalicylic acid, as a means that can thin the blood.
In some cases, doctors recommend wearing elastic bandages on your legs for a week.
It is impossible to visit a bath, sauna, steam room, bath or pool in the first week after the operation.
Sexual rest should be observed during the first 10 days after the procedure.
In the next three months, it is forbidden to use tampons during menstruation. For hygienic purposes, only pads can be used.
Thus, the post-embolization period passes and it takes no more than 10 days.
Side effects and complications
Although the procedure is considered quite safe, there is still a risk of side effects. However, they are much lower than after surgery and develop in isolated cases.
Among the most common complications are the following:
The appearance of a hematoma in the puncture area. As a rule, it resolves itself after a week.
Menstrual disorders, which occurs in 3% of cases. Sometimes amenorrhea can develop. But these phenomena are temporary and after 3 months, and sometimes even earlier, they disappear.
Infection is possible only in 1% of cases. If inflammation develops, it is eliminated by taking antibacterial drugs. Cases of performing a hysterectomy to eliminate the infectious process are extremely rare.
Even less often, particles used for embolization enter the vascular pool. This complication is a threat to the life of a woman and requires surgical intervention.
If submucosal fibroids have been treated, there is a risk of new nodes. As a rule, their birth is possible in 20% of cases.
Perforation of the uterine arteries is a rare but possible complication of the procedure.
A woman should know that over the next year she should not plan a pregnancy, as this threatens with a high risk of miscarriage.
A woman should be informed in advance about all possible complications and consequences of the procedure by the attending physician. This must also be done because surgery may be required before the completion of the embolization procedure.
FUS ablation of uterine fibroids
FUS ablation is a non-invasive procedure in which fibroids are treated using focused ultrasound. All actions of the doctor are carried out under the control of a magnetic resonance tomograph.
Ultrasonic waves act precisely on the tumor. The woman is inside the tomograph. Before proceeding with the procedure, the doctor scans the uterus and accurately determines the place that will need to be processed. After that, the fibroid area is heated under the influence of a beam of ultrasonic waves and its tissues are destroyed.
In the Russian Federation, this method has been approved for use in the treatment of fibroids since 2004 and is a relatively young procedure. However, this does not affect its effectiveness in any way.
Preparation for FUS ablation of uterine fibroids
As for the preparation for the procedure, it is important to clarify the absence of contraindications and exclude pregnancy. There is no food or water restriction. However, you should refrain from consuming those foods that lead to increased gas formation. It is advisable to wear compression stockings on your legs, this should be done immediately before the procedure.
FUS ablation of uterine fibroids
The operation can last up to several hours, the time of each exposure is equal to 20 seconds. Most often, a woman in the doctor’s office spends up to 4 hours. However, she is conscious. She lies on her stomach, under it is a special helium pad. The doctor is in the next room and watches what is happening through the glass and on the monitor. To provide a sedative and analgesic effect, special medicines are given to a woman through a catheter. In addition to the sensation of warmth in the lower abdomen, during the procedure, the patient does not experience anything else.
The waves pass through the tissues of the body and thermally affect the tissues of the tumor, heating it up to 85 °C. The exposure will continue until the entire tumor has been treated.
The completion of the procedure will be a control scan using MRI.
In order to prevent unforeseen situations, a woman always has a special button in her hand, by pressing which she can stop the procedure. But, as a rule, it is not necessary to use it. In addition to a slight burning sensation and a slight soreness in the lower back, a woman cannot feel anything. If suddenly the patient complains of pain, then the procedure is immediately stopped, the energy and duration of exposure are changed. Thus, the session becomes comfortable again.
To be under the supervision of doctors, the patient will have only a few hours. If there are no complications, she goes home. The destruction of the myomatous node itself occurs gradually, but this process is inevitable.
Advantages and contraindications of FUS ablation
Despite the fact that this procedure is quite new, it has already gained popularity.
This is due to the following benefits:
Fuzz ablation can be used when the size of the fibroids is quite impressive, as well as with multiple nodular formations.
On the body of a woman there are no injuries, no scars, scars.
This is a completely bloodless procedure. The size of the nodes either decreases several times, or they completely dissolve.
There is no risk of uterine necrosis and inflammation after the procedure.
The uterus remains in the body of a woman, which means that she has the opportunity to reproduce.
The possibility of recurrence of the disease is minimized.
The recovery period does not take long.
No anesthesia is required during the procedure.
However, in some cases, FUS ablation cannot be performed. This is due to the following factors:
The woman has metal implants or a pacemaker in her body.
There are pronounced disorders in the liver, kidneys and cardiovascular system.
The presence of an intrauterine device in the body of a woman until it is removed.
Contraindications for MRI.
There are massive scars and scars on the abdominal wall.
Inflammatory diseases of the pelvic organs in the acute period.
Body weight exceeding 110 kg and waist circumference greater than the same figure.
Embolization of the uterine arteries, which was previously performed.
Severe extragenital pathologies.
Therefore, it is so important that a woman undergo a thorough examination before the procedure. It should be aimed at clarifying the number of nodes, their size and location. It is important that the node is at least 4 cm from the sacrum so that the sciatic nerves are not damaged. The maximum volume of the neoplasm should not exceed 500 cubic centimeters. The nodes themselves should not be more than five pieces. In addition, it will not be possible to perform the procedure if the neoplasm is of the type of submucosal or subserous nodes that have a leg. A contraindication is the location of the nodes under multiple bowel loops. In all other cases, the procedure is not contraindicated and is an excellent alternative to surgical interventions.
Complications of FUS ablation of uterine fibroids
Although the procedure is quite safe, the following complications may nevertheless occur:
Minor thermal burns on the skin may occur (they occur in less than 5% of cases);
The development of neuralgia of the sciatic nerve, however, this phenomenon is temporary and, after a short period of time, it disappears;
Due to unqualified actions of the doctor, some myomatous tissues may remain untreated, which increases the risk of recurrence;
Possible damage to the rectum (less than 1% of cases).
In some cases, FUS-ablation is the only procedure that allows you to save the opportunity for further reproduction.