Uterine Artery Embolization (UAE) treats adenomyosis and is the most effective, uterus-sparing, minimally invasive treatment option. Today we will follow the UAE procedure step by step and understand how this state-of-the-art interventional technique works.
How Does UAE Treat Adenomyosis?
In an earlier article, we talked about treatment options for adenomyosis. These commonly include first-line medical treatment aiming to relieve symptoms and maintain fertility. But its effect is temporary and comes with potential side effects. Conservative surgery (aka hysterectomy) is for women who are not interested in future pregnancy. The only minimally invasive technique that has proven to be effective in clinical trials is uterine artery embolization (UAE).
UAE is a safer, effective, non-invasive, uterus-preserving alternative to hysterectomy. The technique used for UAE (adenomyosis treatment) is very similar to the one used in fibroid treatment (UFE or uterine fibroid embolization), which we comprehensively explained in the “What to Expect During a UFE Procedure” article, with a few technical differences that we want to cover today.
Is There Any Difference Between UAE and UFE?
Generally speaking, embolization is a procedure used to treat a number of medical conditions by blocking the blood flow to a particular target organ or area in the body. It was first done to stop bleeding blood vessels in a trauma situation. Uterine artery embolization (UAE) began with post-partum bleeding with a very high clinical success and is still being performed for that indication today. The most publicized example was in 2003. Fortunately for Phil Mickelson and his wife Amy, the hospital she gave birth to had an Interventional Radiologist who was able to perform UAE to stop her post-partum bleeding. Mickelson stated she was only 2-3 minutes away from bleeding to death.
With adenomyosis, the thickened area of adenomyosis is selectively treated in a very similar way to fibroids with embolic particles delivered through a microcatheter in each uterine artery supplying that area.
The clinical success of the UAE procedure for fibroids is somewhat higher than it is for adenomyosis. For fibroids, the success is 90%, while for adenomyosis it is 75-80%. Because the only other alternative for adenomyosis patients is hysterectomy, UAE should be the initial treatment for adenomyosis patients that want to avoid surgery.
How Is UAE Performed for Treating Adenomyosis?
An Interventional Radiologist typically performs the UAE procedure in an outpatient setting. The UAE procedure technique is identical to the UFE procedure with the exception of the size of the embolic used to treat adenomyosis vs. fibroids. For adenomyosis, the particle size of the embolic is smaller than that used for fibroids. For adenomyosis, the Atlanta Fibroid Center uses 250-355 micron polyvinyl alcohol (PVA) particles, whereas for fibroids they use 355-500 micron PVA.
During the UAE Procedure
The embolization process does not last long but requires certain professional skills and experience. Because Dr. John Lipman has completed over 9,000 procedures to date, it takes him about 35 – 40 minutes. The physician’s toolkit typically includes a catheter, guidewire, contrast material, and embolic agents. Here is the sequence of steps in the process:
- First, the physician accesses the right femoral artery. There are physicians which obtain access from the left radial artery, but this vessel 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 has to cross one of the great vessels to the brain (i.e. left vertebral artery) and therefore, there is a very small risk for causing a stroke.
- Once the needle punctures the artery, a small guidewire is advanced in to the abdominal aorta. The needle is then removed and replaced with a tapered sheath (i.e. short straw) through which different catheters are placed through over guidewires.
- The Interventional Radiologist steers the catheter over a guidewire into each internal iliac artery one at a time. Through this catheter, a microcatheter is advanced over a microwire to selectively advance in to each uterine artery. Once in the uterine artery, the microwire is removed and a hand injection with contrast is taken to provide a road map of the blood supply to all of the fibroids and/or adenomyosis. .
- If the Interventional Radiologist is satisfied with the position of the microcatheter, the embolic (PVA) is mixed in with contrast and saline and injected slowly in to the uterine artery. The contrast is visible on xray and shows exactly where the embolic particles are going.
- As the contrast material is injected, the flow in the uterine artery slows down and there is a visible blush or stain in the fibroids. Contrast alone is injected to confirm the slow forward flow in the uterine artery with no filling of the fibroid vessels or branch supplying the adenomyosis.
- Both uterine arteries are typically embolized, therefore, once the procedure is done in one uterine artery, the microcatheter is withdrawn and the catheter is used to select the contralateral internal iliac artery. Once there, the microcatheter is advanced again over the microwire to selectively advance in to this uterine artery.
After the UAE Procedure
When the embolization of adenomyosis is completed, the catheter and the guidewire are removed, and a bandaid is placed on the site of entry at the top of the right leg. No stitches are required, just a tiny bandaid! The patient rests in the recovery room for up to 4 hours and then is discharged home. Recovery at home is typically 5-7 days; with many patients returning to work before the 7 day mark.
UAE is a Short Recovery Alternative to Surgery with Minimal Complications
UAE helps women suffering with adenomyosis and fibroids avoid hysterectomy. It’s a chance to preserve fertility and avoid risks associated with major surgery. If you have questions about the UAE procedure and how it treats adenomyosis, contact Dr. John Lipman, one of the world’s leading experts in UAE and UFE. Schedule a consultation with Dr. Lipman at the Atlanta Fibroid Center by calling 770-214-4600, or make an appointment on ATLii.com.