Alicia Armeli

You’ve been diagnosed with uterine fibroids, and you’ve been given one option: hysterectomy. Thirty years ago, this scenario would be a common nightmare turned reality for women suffering with fibroid-related symptoms.

Fortunately, other minimally invasive treatment options have emerged. Uterine fibroid embolization (ufe) is one such option. Since introduced within the US in 1997 as a novel approach to treating fibroids, ufe has improved dramatically. From better tools to improved pain management, ufe continues to be a non-surgical, safe, and effective fibroid treatment option.

Unlike surgery, ufe requires nothing more than a small nick made in the wrist or groin area. A doctor called an interventional radiologist inserts a slim tube called a catheter and guides it to the uterine arteries. Tiny particles called embolic are then delivered through the catheter to block the blood flowing to the fibroids. Once deprived of blood, fibroids begin to shrink, relieving symptoms like heavy periods, pelvic pain, and urinary frequency for 90% of patients.¹

Since its debut more than 20 years ago, ufe has continued to progress. Technological advancements of materials and tools used during the procedure have benefited both physicians and patients.

One area of ufe that has progressed by leaps and bounds has been that of the embolic material used. Initially, doctors only had two main choices: non-spherical polyvinyl alcohol (pva) particles and gelatin sponge. But these products seemed to come up short. Non-spherical PVA particles differed in size, making it difficult to use. Challenges like uncontrolled embolization during ufe and clogged catheters were common.^2,3 The other option, gelatin sponge, was time consuming for doctors to prepare and trying to achieve same-size gel foam particles wasn’t easy.³

Given these setbacks, it was time for a next generation embolic. This led to the launch of Embosphere Microspheres, a spherical embolic that—to this day—is the most studied and clinically used embolic. It’s also considered the standard of care for ufe.⁴

What makes it different? Embosphere Microspheres particles are round and uniform in shape, giving doctors more control when treating women with ufe. Research has shown that all or nearly all (90% or more) of fibroid blood vessels are successfully blocked in 96% of ufe patients treated with Embosphere.⁵ This level of treatment is important because it has been shown to result in long-term clinical success and a lower rate of retreatment.^6,7,8

Advances in imaging techniques have also made ufe an excellent approach to fibroid treatment. Ultrasound has generally been used to diagnose fibroids, but over time other imaging techniques have been proven to be more accurate. Magnetic resonance imaging (Mri), the current primary choice among interventional radiologists, provides information that ultrasound can’t. Studies have shown it to be better than ultrasound when it comes to observing uterine size, fibroid location, and number of fibroids.^9,10 These pieces of information are important when determining if a woman is a good candidate for ufe and ruling out other causes of pelvic pain and bleeding.⁹

Managing pain during and after the procedure has also improved. “There have been several technical changes over the years to improve the ufe patient experience,” says Dr. Keith Pereira, assistant professor in the Division of Vascular & Interventional Radiology at Saint Louis University School of Medicine and a minimally invasive specialist at Saint Louis University Care Physician Group in Saint Louis, Mo., “During the procedure, we use a ‘flip of the wrist approach.’ This involves performing the entire procedure via a tiny pinhole in the artery in the wrist rather than the traditional approach through the groin. Patients are able to walk home with just a band-aid on their wrist.”

To counteract any discomfort felt after the procedure, Dr. Pereira describes applying a nerve block. “We use a temporary nerve block around the uterus for managing post-procedure pain. By numbing the nerves closest to the uterus, we’re able to offer patients pain-free ufe.”

Because of changes like these, Dr. Pereira explains that ufe has gone from being an inpatient procedure to an entirely outpatient procedure. “At our practice, no patient in the last year and a half has stayed more than three hours after a procedure. For example, a patient comes in skipping breakfast but goes home early enough to have lunch,” Dr. Pereira continues. “It has been a truly positive experience for our patients.”

Last but certainly not least, women can give themselves a pat on the back. By doing personal research, informing other women, and demanding better care, women have been a catalyst for change.

“Over the past ten years or so, we’ve had a renaissance of minimally invasive fibroid treatments, including ufe, that have made it possible for women to find relief without surgery,” says Dr. Todd Harris, surgeon and fibroid specialist at The Fibroid Treatment Center in Newport Beach, Calif., and founder of The Fibroid Treatment Network. “Online education has revolutionized the ability for women to find doctors who provide the entire spectrum of care or who are willing to refer out to other doctors to make sure they get the treatment they need.”

This progress demonstrates significant steps forward in fibroid care and women’s health. We’re looking forward to even more improvements being made in the years to come.

 

ABOUT THE DOCTORS 

Keith Pereira, MD, is assistant professor in the Department of Radiology, Division of Vascular & Interventional Radiology, at Saint Louis University School of Medicine and a minimally invasive specialist at Saint Louis University Care Physician Group. Besides being among the first to perform ufe via the radial artery in the wrist and combining this with the uterine nerve block, he uses minimally invasive, non-surgical procedures to treat conditions like blocked arteries and veins in the legs, prostate enlargement in men, and liver and kidney cancer.

Todd S. Harris, MD, is medical director of The Fibroid Treatment Center. Board certified in general surgery, as well as fellowship trained in interventional radiology, Dr. Harris is highly experienced in fibroid surgery. Dr. Harris shares his knowledge and expertise by actively engaging in research and participating in volunteer work around the globe.

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. Pelage, J., Laurent, A., Wassef, M., et al. (2002). Uterine artery embolization in sheep: Comparison of acute effects with polyvinyl alcohol particles and calibrated microspheres. Radiology, Aug;224(2):436-445.
3. Worthington–Kirsch, R. (2008, Jun). Do Particle Size and Type Matter? Endovascular Today.
4. Siskin, G. (2016). Mastering Embolic Choices in ufe: Current Evidence. Global Embolization Cancer Symposium Technologies. [PowerPoint slides]. Retrieved from http://www.gestweb.org/symposium/images/Presentations/am1050_SiskinDr_Embolic_Thursday.pdf
5. Duvnjak, S., Ravn, P., Green, A., et al. (2017). Assessment of uterine fibroid infarction after embolization with tris-acryl gelatin microspheres. Cogent Med, Aug;4(1):1360543.
6. Katsumori, T., Kasahara, T., Kin, Y., et al. (2008). Infarction of uterine fibroids after embolization: Relationship between postprocedural enhanced Mri findings and long-term clinical outcomes. Cardiovasc Intervent Radiol, Jan-Feb;31(1):66–72.
7. Koesters, C., Powerski, M. J., Froeling, V., et al. (2012). Uterine artery embolization in single symptomatic leiomyoma: Do anatomical imaging criteria predict clinical presentation and long-term outcome? Acta Radiol, May;55(4):441–449.
8. Kroencke, T. J., Scheurig, C., Poellinger, A., et al. (2010). Uterine artery embolization for leiomyomas: Percentage of infarction predicts clinical outcome. Radiology, Jun;255(3):834–841.
9. Gonsalves, C. (2008). Uterine artery embolization for treatment of symptomatic fibroids. Semin Intervent Radiol, Dec;25(4):369-377.
10. Spielmann, A. L., Keogh, C., Forster, B. B., et al. (2006). Comparison of Mri and sonography in the preliminary evaluation for fibroid embolization. AJR Am J Roentgenol, Dec;187(6):1499-504.

For more information please refer to Instructions for Use. Consult product labels for any indications, contraindications, potential complications, warnings, precautions and directions for use. Dr. Siskin is a paid consultant of Merit Medical Systems, Inc.