UTERINE FIBROID EMBOLIZATION (UFE) – Technique
Patients undergoing UFE procedures by our interventional radiologists of Interventional Care at Albany Medical Center, are typically scheduled to arrive at the hospital at 7:00 AM. Once they have checked in at the reception desk, patients are escorted to the Radiology Observation Area where they are prepared for the procedure. After speaking with one of our physicians and signing the forms needed for consent, an IV will be placed within a vein of the arm. The IV is needed to so that antibiotics can be administered before the procedure, sedation can be administered during the procedure, and medications to address pain and nausea can be administered after the procedure.
In addition to the IV, a Foley catheter is placed within your bladder. This is done for your comfort during and after the procedure and to eliminate the build-up of x-ray dye in the bladder during the procedure. Finally, anti-nausea medication is given to our patients in order to prevent some of the nausea experienced after the procedure. Once these steps have all been completed, you will be taken to one of the angiography suites within the Department of Radiology. In the procedure room, one of our technologists will clean and prep both the right and left groin areas prior to the start of the procedure.
The first part of the UFE procedure involves entering the arterial system of the body. This is done via the right common femoral artery, which is the artery responsible for the pulse that you can feel in the right groin. Local anesthesia (lidocaine) is used to numb the area surrounding this artery and once this has been administered, a very small incision is made in the groin and a skinny needle is place into the common femoral artery. Once the needle is inside the artery, a wire is advanced through the needle into the artery. This allows us to remove the needle and place a catheter, which is approximately the size of a piece of spaghetti, inside the artery. An angiogram is then performed by injecting X-ray dye into the catheter. This lets us see the arteries of the pelvis, including the right and left uterine arteries.
Once the uterine arteries have been identified, the catheter is repositioned under X-ray guidance and moved into the left uterine artery. X-ray dye is once again injected in order to confirm the position of the catheter. Once this is done, an embolic agent is injected into the catheter in order to stop the flow of blood within the left uterine artery. When flow has stopped in the left uterine artery, the catheter is moved into the right uterine artery and the procedure is repeated in order to embolize the right uterine artery. In our experience, most patients can be embolized with a single catheter entering the arterial system on the right side; a second catheter placed into the left common femoral artery is necessary in only the most difficult cases.
Once the right and left uterine arteries have been embolized, a final angiogram is performed in order to confirm the absence of flow in these vessels and to make sure that no other vessels are seen that may be supplying blood to the fibroids. If additional arteries are seen (including the ovarian arteries) then consideration may be given to embolizing these vessels as well. Once the blood supply to the fibroids has been eliminated, the catheter is removed and a physician will press down on the groin for approximately 10-15 minutes until there is no evidence of bleeding from the site. On average this procedure takes less than an hour to complete.
Many patients are interested in knowing as much as they can about the embolic agents that are injected into the uterine arteries during a UFE procedure. Our interventional radiologists utilize many of the agents available on the market that have been approved by the FDA for use during UFE procedures. These agents include Contour SE Microspheres (Boston Scientific Corporation) and Embosphere Microspheres (Biosphere Medical Inc.). Both agents are injected into the uterine arteries through a catheter as described above.
Once the agent has been injected, they cause inflammation, slow blood flow, and clot formation within the artery. The clot that forms within the uterine arteries stays within the uterine arteries because the vessel beyond the clot is to small for it to pass further into the system. In addition, the clot formed in response to embolization with this agent has been shown to dissolve over the course of several weeks but the agent itself permanently remains within the artery. While complications relating to the use of these agents have been reported, they appear to be related to the effects of the embolization procedure and not to the agents themselves.
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