Capital Region Health Park
711 Troy-Schenectady Rd, Suite 113
Latham, New York 12110

(518) 262-5149

Gary Siskin, MD
Meridith Englander, MD
Kenneth Mandato, MD
Allen Herr, MD
Gail Sansivero, ANP
Nancy Mitchell, FNP
Christopher Doti, FNP
Sharon Ryan, LPN

UTERINE FIBROID EMBOLIZATION (UFE) – Complications

WHAT ARE THE POTENTIAL COMPLICATIONS OF UFE?

UFE is a nonsurgical procedure but is still an invasive procedure, and as an invasive procedure, there are potential complications that all patients need to be aware of when considering this treatment option.  Serious complications have been reported in 2-3% of patients undergoing this procedure worldwide.

• Angiographic Complications:  As a diagnostic test, angiography is performed routinely throughout the world.  The potential complications of angiography are well established and include bleeding (around the groin where the catheter enters the artery), clot formation inside the artery which can potentially block the flow to the leg, and reactions to the X-ray contrast material used to take the pictures of the arteries.  The X-ray contrast that is used is iodine-based and a variety of reactions to contrast are possible, including hives, coughing, and breathing difficulties.
  
  
• Uterine Infection:  This is one of the earliest reported complications of UFE.  Since then, other infections have been reported with some patients successfully treated with antibiotics and others requiring a hysterectomy.  In very rare cases, a severe infection can lead to uterine rupture or death.  Given the potential severity of an infection, antibiotics are given to all of our patients in association with UFE.  In addition, all patients with a prolonged fever (>7 days) are evaluated for a possible uterine infection with a pelvic examination, pelvic imaging, and blood work.
  
  
• Uterine Injury (Ischemia):  The goal of embolization is to reduce the flow of blood to the fibroids while allowing flow to continue to the normal parts of the uterus.  If normal flow is not maintained to the uterus, there is a chance that this muscle can be injured due to a lack of oxygen (uterine ischemia).  These patients can present with pelvic pain that persists for several weeks beyond the expected post-embolization syndrome.  A hysterectomy may be required for pain relief due to this complication.
  
  
• Early Onset of Menopause:  2-14% of patients report significant alterations in their menstrual cycles after UFE that ranges from temporary to permanent loss of normal menstrual cycles.  The existence of the blood vessels connecting the circulation of the ovaries and uterus (collateral pathways) makes it possible for the embolic materials injected into a uterine artery during this procedure to enter the ovarian arterial circulation. This may potentially result in ovarian failure, the risk of which has been shown to increase in patients older than 45 years of age.
  
  
• Transcervical Fibroid Passage:  It is known that submucosal fibroids are at increased risk for being passed out of the uterus and vagina after UFE.  This has been reported in 1-2% of patients and may not require any additional treatment or problems.  Some patients may require further treatment to remove parts of the fibroid that are retained within the uterus in order to minimize the possibility of infection.  Therefore, imaging is recommended in this situation in order to determine if any fibroid tissue has been retained within the uterine cavity.  Importantly, good imaging is recommended prior to UFE because it may enable our physicians to assess the risk of this potential complication for each patient undergoing this procedure.
  
  
• Deep Venous Thrombosis and/or Pulmonary Embolus:  Blood clots in the veins of the leg and the lung have been rarely reported after UFE.  It is felt that this complication is not unique to UFE but is rather a risk of any invasive procedure requiring some bed rest during the recovery period.  As a result, we encourage our patients to walk within several hours of the procedure and to avoid prolonged bed rest.  Additional preventative measures can be taken in patients felt to be at increased risk for blood clot formation.