Uterine artery embolization (UAE) is an outpatient, nonsurgical procedure used to treat adenomyosis and is the most effective, uterus-sparing, minimally invasive treatment option. We will follow the UAE procedure step by step and understand how this state-of-the-art interventional radiology treatment option works.
How Does UAE Treat Adenomyosis?
In an earlier article, we talked about treatment options for adenomyosis. These commonly include first-line medical treatments aiming to relieve symptoms and maintain fertility, but their effects are only temporary and come with potential side effects. Invasive surgery (such as a hysterectomy) removes the possibility of future pregnancy and increases the risk for heart disease, stroke, and many other serious health issues. The only minimally invasive technique that has proven to be effective in the significant majority of adenomyosis patients is uterine artery embolization (UAE).
UAE is a safe, effective, non-invasive, uterus-preserving alternative to hysterectomy. The technique used during UAE treatment for adenomyosis is very similar to the one used in treating fibroids (UFE or uterine fibroid embolization). In a previous article entitled, “What to Expect During a UFE Procedure” we outlined how UFE is performed step by step to treat uterine fibroids.
What Is The Uterine Artery Embolization Success Rate For Adenomyosis?
Historically, the only definitive treatment known for women suffering from adenomyosis was to remove the uterus. Other techniques, such as uterine ablation, only work temporarily, and many experience a recurrence and may require a hysterectomy within three years. The medical management of adenomyosis is still under investigation, and there is not currently any medication specifically labeled for its treatment.
A recent study reported a uterine artery embolization success rate of approximately 82% in patients treated for adenomyosis. These patients experienced significant improvements in the severity of their symptoms; they reported an enhanced quality of life; and they avoided having to undergo a hysterectomy.
History Of Uterine Artery Embolization
In 1968 a doctor from Columbia University developed a procedure that created a deliberate blockage of a blood vessel to treat a certain brain condition. Today this procedure known as embolization is widely used to treat conditions related to many different organs. This can be performed to cut off the blood supply for benign (e.g. uterine fibroids) or cancerous tumors or to stop a bleeding vessel in a trauma situation (e.g. gunshot, stabbing, car accident, or postpartum hemorrhage).
Postpartum hemorrhage (PPH) affects between 1 and 5 out of every 100 women in the United States and can cause shock and death very quickly if not addressed. It is still the leading cause of maternal mortality in this country today. Embolization has been used for many years and is a very effective way to treat PPH.
The use of UAE for postpartum hemorrhage led to the development of the treatments used today for fibroids and adenomyosis.
Is There Any Difference Between UAE and UFE?
Embolization procedures vary in technique but the principle is the same. Uterine artery embolization (UAE) and uterine fibroid embolization (UFE) are used interchangeably.
When treating fibroids or fibroids and adenomyosis, the embolization procedure can either be called a UAE or UFE. However, if the patient only has adenomyosis, UAE is the correct term used (i.e. as there are no fibroids).
When using uterine artery embolization to treat adenomyosis, the thickened area containing adenomyosis is targeted and treated and when treating fibroids the blood supply running to the fibroids is targeted and treated.
Aside from the targeted treatment area, the only other difference between treating fibroids and adenomyosis is the size of the particles used to block the blood vessels. When using UAE for adenomyosis, the particle size of the embolic is smaller than those used during UFE to treat fibroids.
The clinical success of the UAE procedure for fibroids is somewhat higher than it is for adenomyosis. For fibroids, the success rate is 90%, while for adenomyosis it is 75-80%. The only other alternative for adenomyosis patients is an invasive hysterectomy so UAE should be the initial treatment for adenomyosis patients that want to avoid surgery.
How Long Does The UAE Procedure for Treating Adenomyosis Take?
An interventional radiologist like Dr. Lipman or Dr. Ermentrout of the Atlanta Fibroid Center performs uterine artery embolization for adenomyosis. UAE is done in an outpatient setting and patients return home the same day (about 3-4 hours after the procedure).
The length of the procedure can vary by patient and the degree of treatment needed for adenomyosis. With extensive experience in UAE for both adenomyosis and fibroids at the Atlanta Fibroid Center, the procedure takes approximately 30 to 40 minutes.
How Is UAE Performed for Treating Adenomyosis?
The Interventional Radiologist (IR) usually uses a catheter, guidewire, contrast material, and an embolic agent during the uterine artery embolization procedure.
The steps involved in treating adenomyosis with UAE include:
- The patient is sedated.
- The right femoral (or left radial) artery is accessed by the IR. The right femoral artery is preferred over the left radial artery because the left radial artery is much smaller and can lead to clot formation in the hand. It is also much farther away from the target (i.e. uterus) and the catheter’s path creates a small risk of causing a stroke.
- A small guidewire is threaded into the abdominal aorta and a tapered sheath (i.e. short straw) is put into place which will be used as a guide when inserting the catheter into the body.
- The IR guides the catheter over the guidewire and into each internal iliac artery (IIA) one at a time. The IIA has an anterior and posterior
division. Typically, the uterine artery is the 1st branch of the anterior division. Special contrast dye is injected to provide a “road map” of the blood flow to each of the uterine arteries.
- A microcatheter is then advanced over a tiny (0.016”) microwire into each of the uterine arteries. The IR injects contrast to get a picture of the arterial blood supply to all of the fibroids and compares that to MRI imaging to make sure they correlate. Next, the embolic agent is mixed with contrast that is visible under x-ray and slowly injected to block the blood flowing into the adenomyotic area.
- The procedure is typically performed on both sides as there are usually two uterine arteries present.
- The catheter and guidewire are removed and a bandaid is placed on the tiny entry site. There are no stitches required.
- The patient will rest in a recovery room for up to 4 hours during which they will be assisted out of bed to take short walks around the room. After a few hours of observation, they will be discharged to go home.
Recovery From Uterine Artery Embolization For Adenomyosis
Patient recovery at home is typically 5-7 days however, many patients return to non-strenuous work well before the 7-day mark.
- The aftercare instructions provided by the nurses and the doctor will help facilitate a smooth recovery. Pay attention to any of the signs that may indicate complications are arising.
- While avoiding strenuous activity for 14 days, patients should walk a lot beginning the morning after the procedure.
- Patients may experience small to moderate amounts of vaginal discharge that may last for several days.
- Keep the groin entry area clean, dry, and bandaged for the time allotted by the aftercare instructions provided to you by the IR.
- Patients may experience cramps, or aching at the entry site and in the muscles of the abdomen and pelvis. Use only the pain relievers recommended by the doctor to alleviate the discomfort.
- Including fiber in your diet and staying hydrated will help avoid constipation and straining during bowel movements
- Avoid using douche, tampon use, and sexual intercourse for two weeks following the procedure.
UAE Offers A Short Recovery Alternative To Surgery And Fewer Minimal Complications
UAE helps women suffering from adenomyosis and fibroids to avoid hysterectomy, allows them to keep their uterus, preserve fertility, and avoid the risks and long recovery times associated with major surgery.
If you have questions about the procedure and the use of uterine artery embolization to treat adenomyosis or uterine fibroids, contact Dr. John Lipman or Dr. Ermentrout, the country’s leading experts in UAE and UFE. Call (770) 214-4600 or make an appointment using our convenient online form.