For Physicians : Protocol
Purpose
- Treatment of symptomatic uterine leiomyomata with bilateral superselective uterine artery embolization.
Candidates
- Premenopausal women with symptomatic leiomyomata, without extensive adenomyosis (usually), endometriosis, or other causes for their symptoms,
who wish to avoid surgery.
- Women who have completed childbearing.
- For women who wish to preserve fertility, and are not candidates for myomectomy, or have recurrent fibroids
following myomectomy, UFE may be considered.
- Ideally, <24 weeks gestational size uterus. Larger uteri may be considered depending on symptoms.
- Since there is virtually no blood loss, or need
for transfusion, UFE may be an ideal treatment for women who wish to avoid transfusion for health or religious reasons.
Contraindications - Absolute
- Pregnancy
- Active pelvic or abdominal infection
- Malignancy
Contraindications - Relative
- Post-menopausal patients
- History of severe contrast reaction
- Renal insufficiency
- Uncorrectable coagulopathy
- Presence of IUD – should be removed if possible.
- Patients with systemic illnesses such as multiple sclerosis, lupus, etc. may experience a
flairup of symptoms following the stress of surgery or UFE.
Pre-Procedure Evaluation
- Thorough history and physical examination performed by gynecologist who determines that symptoms are very likely caused by presence of leiomyomata.
UFE will not be performed without a supportive gynecologist.
- Consultation with Interventional Radiologist.
- For patients with abnormal bleeding, periods lasting 10 days or longer or intermenstrual bleeding,
endometrial biopsy or other sampling procedure to exclude endometrial cancer or dysplasia.
- MRI of the pelvis to document the size, number, and
extent of fibroids and to exclude fibroid mimics such as adenomyosis or endometriosis. The ovaries will also be evaluated.
- Negative pap smear
within last year.
- Cervical cultures for patients with history of PID, or with discharge.
Procedural Considerations
- Ancef 1gm IV on call to angio suite.
- Foley catheter
- Conscious sedation with fentanyl and versed. Epidural,spinal, or general anesthesia is unnecessary.
- Single femoral artery access in most cases.
- Pre-embolization pelvic arteriogram.
- Toradol 60mg IM upon selective catheterization of first uterine artery.
- Embolize each uterine artery using Biosphere Embospheres, sized 500-700um
and 700-900um. We do not embolize to stasis or near-stasis in the uterine artery. Instead we strive for a "pruned tree" appearance of
the peri-fibroid plexus branches.
- PCA morphine pump connected prior to leaving angio suite.
- Overnight, 23 hour extended observation in most cases.
Post-Procedure Evaluation
- Office follow-up visit with Interventional Radiologist within two weeks of procedure.
- Initial follow-up questions or problems directed to Interventional
Radiologist who will enlist help of gynecologist as needed.
- Three month follow-up with Interventional Radiologist to assess early response to
procedure.
- MRI pelvis at 6 months if symptoms have improved. Sooner if no improvement or worsening of symptoms. Phone/office follow-up to review
results of MRI. No further imaging unless symptoms recur. Of the 10% of patients who don’t respond, repeat UFE can be offered to those with
persistent enhancement on follow-up MRI.
- Routine gynecological follow-up thereafter.
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