Can UFE Treat Pedunculated Subserosal Fibroids?
Alicia Armeli

Pedunculated Subserosal Fibroid UFE

Uterine fibroid embolization (UFE) is a well-established, minimally invasive fibroid treatment that’s recommended for select women who want to retain their uterus. Improving -related symptoms in 85%­­­­­–90% of women treated, UFE targets fibroids of different sizes and locations in the uterus, relieving symptoms like heavy periods, pelvic pain, and urinary dysfunction.1 Watch a helpful video about how the UFE procedure works.

And yet, despite these advantages, whether UFE should be used to treat pedunculated subserosal (PS) fibroids—a type of fibroid that grows on a stalk on the outer uterine wall—is still debated. Research has shown a very low risk—only three major complications related to treating PS fibroids with UFE have been reported2-4 —that involves a PS fibroid separating from the uterus, causing infection and subsequent sepsis if not naturally discharged from the body.5 To better address concerns, researchers at Yonsei University College of Medicine in Seoul, Korea, evaluated UFE’s treatment of PS fibroids and found it to be safe and effective even in cases considered high risk.5

“More data on [UFE] for PS [fibroids] may help in making better treatment recommendations,” the researchers write in the Journal of Vascular and Interventional Radiology study.5

The 9-year study enrolled 55 women with PS fibroids who underwent UFE.5 Researchers labeled each PS fibroid by risk, depending on the thickness of the fibroid stalk: High-risk PS fibroids have thinner stalks, whereas low-risk PS fibroids have thicker stalks. Three months following UFE, the women had MRIs to measure how well the procedure worked. Any complications were also noted.

Results showed that over 96% of the women experienced symptom improvement.5 Minor complications occurred in three women and included fibroid expulsion—or the passing of fibroids from the body—and temporary pelvic pain. None of the women had major complications related to PS fibroids.

“This report dismisses the commonly held idea that [UFE] in patients with PS fibroids is associated with unique and significant risk of complications,” the researchers conclude. “[UFE] is safe and effective even in PS [fibroids] having extremely narrow stalks.”5

Because this study had a relatively short follow-up period of 3 months, “the university maintains a website where patients can report complications over the long term. However, the researchers note that complications related to PS fibroids haven’t been reported.

ABOUT THE AUTHOR   Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English education and nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. She is a paid consultant of Merit Medical.

REFERENCES

  1. Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: A focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675-692.
  2. Braude, P., Reidy, J., Nott, V., et al. (2000). Embolization of uterine leiomyomata: Current concepts in management. Hum Reprod Update, Nov-Dec;6(6):603–608.
  3. Tropeano, G., Amoroso, S., Di Stasi, C., et al. (2014). Incidence and predictive factors for complications after uterine leiomyoma embolization. Hum Reprod, Sep;29(9):1918–1924.
  4. Ravina, J., Aymard, A., Ciraru-Vigneron, N., et al. (1998). Embolisation artérielle particulaire: Un nouveau traitement des hémorragies des léiomyomes utérins. Presse Med, 27(9):299–303.
  5. Kim, Y. S., Han, K., Kim, M. D., et al. (2018). Uterine artery embolization for pedunculated subserosal leiomyomas: Evidence of safety and efficacy. J Vasc Interv Radol, Apr;29(4):497-501.

Meet UFE Pioneers Who Are Still Fighting for Your Uterus
It's been more than two decades since the first UFE, and the fight for awareness continues.

UFE Fibroid Pioneers Header

More than 20 years ago, the first uterine fibroid embolization (UFE) was performed in the U.S. for the treatment of uterine fibroids.1 Although an effective alternative to hysterectomy, this uterine-sparing, minimally invasive option was first met with some skepticism by the medical community. Since then, UFE has grown in popularity—but not without a fight.

Even today, uterine fibroids remain the number one reason women have a hysterectomy.2,3 To understand the struggle to get UFE on the list of possible treatment options for more women who suffer with fibroids, we spoke with two interventional radiologists who’ve advocated for UFE since day one.

“My initial experience with UFE was in the late-1990s working with the group of doctors at UCLA who first started performing the procedure,” explains Richard A. Reed, MD, interventional radiologist at Huntington Hospital in Pasadena, Calif. “Women were coming from all over the country, even outside of the country, to be treated. They wanted to avoid hysterectomy at all costs.”

UFE was a real game-changer for women who were told surgery was their only option for relief. Unlike hysterectomy that surgically removes the entire uterus, UFE allows women to be treated through a tiny puncture in the groin area. And currently, access site options have expanded to include being treated via the wrist.

Under conscious sedation, the UFE procedure begins with a doctor called an interventional radiologist inserting a catheter (thin tube) into the access site. Using specialized x-ray equipment, the catheter is guided to the uterine arteries that supply fibroids with blood. Tiny particles are then released that block blood flow to the fibroids, causing them to shrink over time and symptoms like heavy, painful periods to resolve.

“My actual first experience with UFE was as a patient. I was one of the first UFE patients at University of Southern California in 2001. After UFE, my symptoms resolved and never recurred,” recalls M. Victoria Marx, MD, FSIR, professor of clinical radiology at the Keck School of Medicine of University of Southern California in Los Angeles, Calif., and president of the Society of Interventional Radiology (SIR). “Shortly after that is when I performed my first UFE, and I’ve treated many patients over the years.”

As time went on, UFE was gaining awareness but was still viewed by the general medical community as new and investigative. This unfamiliarity often led to health insurance companies denying patients coverage for the procedure. “Many women were willing to pay cash to have the procedure done,” Dr. Reed tells Ask4UFE. “To help these patients, I met with the boards of several insurance companies who made decisions about whether procedures were considered investigational. Fortunately, around the early 2000s, most insurance companies were covering the procedure.”

According to both doctors, another major resistance point came from gynecologists. Along with hysterectomy, gynecologists are trained to perform myomectomy, a procedure that surgically removes fibroids from the uterus. UFE, on the other hand, is only performed by interventional radiologists, who specialize in nonsurgical procedures that treat disease by targeting specific blood vessels.

“For conditions like fibroids, the traditional source of information is a woman’s gynecologist, with whom she typically has a long relationship,” Dr. Marx says. “It has been a challenge because UFE is a treatment for a gynecologic condition that has come out of a completely different field of medicine.”

In 2008 the American College of Obstetricians and Gynecologists released a statement based on long- and short-term data that said UFE is a safe and effective option for women who want to keep their uteri and who are appropriate candidates for the procedure.4 According to Dr. Reed, despite this statement and its numerous clinical benefits, some gynecologists still don’t inform their patients about UFE.

To reach the patient community directly, interventional radiologists often get creative in their approach. Along with community women’s health talks, Dr. Marx and Dr. Reed used the power of the media to spread the word. “Our hospital worked with the LA Times and other local papers to do articles about the procedure,” Dr. Reed recalls.

“At the time, I was chairman of the SIR public relations committee, and I called our public relations consultant,” Dr. Marx adds. “She put me in touch with The Today Show, and I appeared with Katie Couric talking about UFE. It wasn’t all streaming like it is today, but UFE did get national airtime.”

And national airtime it deserved. UFE is a uterine-sparing, outpatient procedure that improves fibroid-related symptoms like heavy periods, pelvic pain, and urinary dysfunction—all with a nearly 90% success rate.5 In comparison to hysterectomy, UFE has virtually no blood loss and allows women to recover faster with a lower complication rate.6 Although the UFE procedure itself has changed little over the years, advances in pain management protocol and imaging techniques have only furthered UFE’s reputation as an effective, minimally invasive fibroid treatment option.

Given these advantages, it’s shocking to see that 600,000 hysterectomies are performed annually in the US, with the majority done to treat fibroids.2,7 What’s more, a recent Harris Poll surveying over 1,100 women found that among those diagnosed with fibroids, a staggering 44% had never heard of UFE.8 “We need to continue to educate women through community health talks and encourage gynecologists to offer UFE as an option,” Dr. Reed says. “When comparing fibroid-related symptom relief, UFE is comparable to the surgical options.”

“The ideal setting is where doctors of all specialties work together, offer all options, and advise the patient on which treatment is best for her,” Dr. Marx continues. “UFE is a highly researched fibroid treatment. It’s very effective and can help women get back to their normal lives with minimal down time.”

Although the road to widespread UFE awareness has been long, progress is being made. Large studies comparing the long-term clinical outcomes of UFE and different fibroid treatment options have provided valuable information. For example, 10-year outcomes of the EMMY Trial, a landmark trial that compared UFE with hysterectomy, showed that health-related quality of life after both procedures remained comparably stable and that in about two thirds of patients treated with UFE, a hysterectomy was avoided.9

A national registry to collect information from women undergoing fibroid treatment is also currently underway. Conducted by researchers at Duke University, “Comparing Options for Management: Patient-Centered Results for Uterine Fibroids (COMPARE-UF),” is following 10,000 women from nine medical centers in the U.S. for about three years as they make decisions about their fibroid treatment.10 Researchers will use the registry information to compare treatment options and their ability to provide symptom relief, preserve reproductive function, and achieve patient needs and preferences.11 The goal is to help patients and clinicians make informed decisions about fibroid treatment.10

Given this progress, perhaps over the next 20 years, the vision of doctors working together to offer women the best fibroid care can become a reality.

 ABOUT THE DOCTORS

Victoria Marx, MD, FSIRis a professor of clinical radiology at the Keck School of Medicine of University of Southern California in Los Angeles, Calif., and president of the Society of Interventional Radiology (SIR). In addition to these positions, Dr. Marx leads an active clinical practice where collaboration of fibroid care is offered.

 Richard A. Reed, MD, is an interventional radiologist at Huntington Hospital in Pasadena, Calif. One of the first physicians in the US to perform UFE, Dr. Reed advocates for UFE public awareness and works to ensure women know all their fibroid treatment options.

ABOUT THE AUTHOR   Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. She is a paid consultant of Merit Medical.

REFERENCES

  1. Goodwin, S. C., Vedantham, S., McLucas, B, et al. (1997). Preliminary experience with uterine artery embolization for uterine fibroids. J Vasc Interv Radiol, Jul-Aug;8(4):517-526.
  2. The American College of Obstetricians and Gynecologists. (2015, Mar). Hysterectomy. Retrieved from https://www.acog.org/Patients/FAQs/Hysterectomy
  3. Broder, M. S., Kanouse, D. E., Mittman, B. S., et al. (2000). The appropriateness of recommendations for hysterectomy. Obstet Gynecol; 95:199-205.
  4. The American College of Obstetricians and Gynecologists. (2008, Aug). ACOG Practice Bulletin—Alternatives to Hysterectomy In the Management of Leiomyomas. Retrieved from http://www.mintir.com/page/pop_page1.pdf
  5. Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: a focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675-692.
  6. Spies, J. B., Cooper, J. M., Worthington-Kirsch, R., et al. (2004). Outcome of uterine embolization and hysterectomy for leiomyomas: Results of a multicenter study. Am J Obstet Gynecol, Jul;191(1):22-31.
  7. Centers for Disease Control and Prevention. (2017, Nov 20). Data and Statistics (Hysterectomy). Retrieved from https://www.cdc.gov/reproductivehealth/data_stats/index.htm
  8. Society of Interventional Radiology. (2017, Aug 29). The Fibroid Fix: What Women Need to Know. Retrieved from https://www.sirweb.org/globalassets/aasociety-of-interventional-radiology-home-page/patient-center/fibroid/sir_report_final.pdf
  9. de Brujin, A. M., Ankum, W. M., Reekers, J. A., et al. (2016). Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol, Dec;215(6):745.e1-745.e12.
  10. Comparing Options for Management: Patient-Centered Results for Uterine Fibroids (COMPARE-UF). (n.d.). Home. Retreived from http://www.compare-uf.org
  11. 11. U.S. National Library of Medicine. (2018, Feb 22). Patient Centered Results for Uterine Fibroids (COMPARE-UF). Retrieved from https://clinicaltrials.gov/ct2/show/NCT02260752