Embolization is a risk for women with large fibroids: UFE and UAE are not recommended
Many studies have shown that embolization of large fibroids is not optimal. Before agreeing to embolization treatment for large fibroids, women need to know the possible complications that can follow the procedure.
Fibroids require blood to grow. Without it, some or all of the tumor will die. With uterine fibroid embolization (UFE) or (uterine artery embolization) UAE, an interventional radiologist accesses the blood vessel that feeds the tumor through a small incision in the groin. Plastic particles are injected into the blood vessel to starve the fibroid, resulting in some shrinkage of the tumor.
Unfortunately, embolization used on large fibroids can result in die-off and expulsion of the fibroid tumor, which can result in an infection. Material from the fibroid sloughing off from the lining of the uterus can provide a site for bacterial growth and lead to infection of the uterus (endomyometritis). While many uterine infections can be treated with antibiotics, in extreme cases, the infection if unresponsive to antibiotics may require a hysterectomy.
Several early case reports described rare but serious complications shortly after UAE for large fibroids, such as unbearable pain, septic uterine necrosis, and lethal sepsis.
Infection after embolization is typically characterized by fever, increasing pain and discharge. Uterine infection has been reported in 1 in 200 women who have undergone UFE.
UFE OR UAE IS NOT AN EFFECTIVE TREATMENT FOR LARGE FIBROIDS
UFE results in shrinkage of fibroids of approximately 30 to 46 percent. For substantially large fibroids, this may not be enough of a reduction in size to alleviate symptoms.
In several studies, response to embolization was not as effective in patients with a large fibroid, greater than 8 cm. Those patients also experienced a higher rate of need for additional therapy after UAE.
UFE and UAE procedures have more complications, unscheduled visits, and readmissions than hysterectomy or myomectomy procedures. Data also suggest that women with larger uteri and/or more leiomyomas at baseline are at greater risk of failure with embolization. There is a relatively high rate of reintervention for treatment failure. Alternatively, myomectomy and hysterectomy remove the fibroids entirely, offering fewer post-surgical complications.
Fibroids can be removed surgically via either a myomectomy, removal of the fibroids from the uterus or hysterectomy, removal of the uterus. If women can maintain fertility, a laparoscopic myomectomy may be possible, however, fibroids can return. A hysterectomy is a cure for fibroids.
If a myomectomy or hysterectomy is performed as a laparoscopic procedure, depending on the placement and size of the incisions, the surgery can provide patients with immediate relief and faster recovery than even UFE procedures.
The LAAM myomectomy is a hybrid approach of laparoscopic and open surgeries, taking the best of both techniques: smaller incisions of a laparoscopic procedure combined with the thoroughness of the open procedure.
Using advanced techniques to control for blood loss and to improve visibility, the LAAM laparoscopic assisted abdominal myomectomy is one of the most minimally invasive fibroid removal procedures that also ensures removal of all fibroids. Patients with large fibroids or small, hard to see fibroids, can be treated thoroughly with LAAM.
The additional advantage of LAAM is that the uterus is repaired by hand, ensuring that once it heals, the uterus can be strong enough to maintain a pregnancy. LAAM is performed as an outpatient procedure, so there is no hospital stay. Women recover at home and are back to themselves in about 10-14 days. With controlled blood loss and improved visibility, the procedure is performed efficiently, which means less time under anesthesia compared to other myomectomy techniques.
The average DualPortGYN laparoscopic hysterectomy procedure at CIGC is less than an hour. Some procedures may take longer. The CIGC specialists use exclusive techniques to ensure efficiency in every surgical procedure, controlling for blood loss and mapping the pelvic cavity so that visibility is high.
A DualPortGYN hysterectomy is performed using just two tiny incisions. Their placement is important. Both incisions avoid the abdominal muscle, so the pain from surgery is significantly less than if it were performed as a standard laparoscopic or robotic procedure, where multiple incisions are placed through the abdominal muscles.
Most CIGC hysterectomy patients are back to their normal activities in about one week.
CIGC is dedicated to providing information and materials for women to help navigate the complicated healthcare system. CIGC minimally invasive GYN surgical specialists Dr. Paul MacKoul, MD and Dr. Natalya Danilyants, MD developed their advanced GYN surgical techniques using only two small incisions with patients’ well-being in mind. Book a consultation at The Center for Innovative GYN Care or call 888-787-4379.