Uterine Artery Embolization: A Versatile Approach to Treating More Than Fibroids
Alicia Armeli

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Before it was known as uterine fibroid embolization (UFE), this highly effective nonsurgical procedure was referred to as uterine artery embolization (UAE) and treated much more than uterine fibroids.

At the 2016 Society of Interventional Radiology Annual Scientific Meeting in Vancouver, British Columbia, UAE was presented as a safe and effective uterus-sparing treatment for both gynecological and obstetric conditions.

“The existing literature indicates that UAE for adenomyosis is associated [with] symptom reduction in 70%,” reported Dr. Nainesh S. Parikh, MD, of Brigham and Women’s Hospital in Brookline, Mass.1 “UAE for peri and postpartum hemorrhage has about a 90% rate of clinical success with major complication rate of about 5%, and a subsequent viable gestational outcome of about 80%.”

During UAE, a doctor called an interventional radiologist makes a tiny nick in the wrist or groin, and through real-time imaging guides a thin catheter into the arteries that lead to the uterine arteries. The doctor then injects tiny particles to stop blood flow to affected uterine tissue—as seen with fibroids or adenomyosis—or to control bleeding accompanied by birthing complications.

Adenomyosis—a noncancerous disease that causes the lining of the uterus to grow into the uterine wall—affects up to 70% of women and has many of the same symptoms as fibroids, like heavy painful periods and a swollen uterus.2 Adenomyosis and fibroids can coincide, often making it difficult to know which is the culprit. Medications and hormonal therapy are temporary options to manage symptoms, but hysterectomy has been by far the most common treatment.

Hysterectomy has been linked to poor quality of life outcomes and high financial burdens. To avoid such adverse effects, minimally invasive treatment options are being explored—like UAE.

A study published in CardioVascular and Interventional Radiology tracked UAE’s potential long-term success treating adenomyosis among 40 women between 1999 and 2006.3 Half of these women also had uterine fibroids.

Smeets et al. used magnetic resonance imaging (MRI) to assess each woman at the time of UAE, 3 months afterward, and then surveyed their symptoms and quality of life scores approximately 5 years following the procedure. The 5-year follow-up showed that over 70% reported complete symptom relief.

UAE has also been a historically life-saving treatment for women who suffer from postpartum hemorrhage or heavy bleeding following delivery.

Postpartum hemorrhage is rare, affecting 1% to 5% of women giving birth, and usually occurs right after delivering the placenta but can also happen weeks later.4 Some women are at an even higher risk for postpartum hemorrhage, including those delivering through cesarean section and pregnancies with placental abnormalities. Left untreated, postpartum hemorrhage can lead to dangerously low blood pressure levels, shock, and even death.

UAE has been seen to treat both immediate and delayed postpartum hemorrhaging with some studies showing success rates greater than 90%.5,6,7,8

But instead of waiting to treat postpartum hemorrhage after giving birth, doctors are now reducing this risk by performing UAE weeks before delivery—especially among high-risk patients. Between 2013 and 2015, Niola et al. recruited 50 pregnant women with placental abnormalities who then underwent UAE at 35-36 weeks gestation.9

Results published earlier this year in the Journal of Vascular and Interventional Radiology showed that UAE was successful in every case and reduced postpartum bleeding—with nearly two-thirds of patients not needing a blood transfusion. The procedure also had no negative effects on newborns. At a 6-month follow-up, the 42 infants available for assessment all functioned at normal cognitive levels.

Given its history and long-standing safety and efficacy in treating non-fibroid conditions, many wonder why UAE isn’t used more. “The role of UAE in the treatment of non-fibroid disease is less well known and less utilized,” Dr. Parikh explained. “Requests for UAE for these indications” are “not widespread, possibly from lack of referring clinician awareness and lack of an established collaborative approach to these patients.”

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, 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. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community. She is a paid consultant of Merit.

 

REFERENCES

  1. Parikh, N., & Fan, C. (2016). Non-fibroid indications of uterine artery embolization. Journal of Vascular and Interventional Radiology, 27(3), S215-216. doi:http://dx.doi.org/10.1016/j.jvir.2015.12.556
  2. Taran, F., Stewart, E., & Brucker, S. (2013). Adenomyosis: epidemiology, risk factors, clinical phenotype and surgical and interventional alternatives to hysterectomy. Geburtshilfe Und Frauenheilkunde, 73(09), 924-931. doi:10.1055/s-0033-1350840
  3. Smeets, A., Nijenhuis, R., Boekkooi, P., Vervest, H., van Rooij, W., & Lohle, P. (2011). Long-term follow-up of uterine artery embolization for symptomatic adenomyosis. Cardiovascular And Interventional Radiology, 35(4), 815-819. doi:10.1007/s00270-011-0203-1
  4. University of Rochester Medical Center. (2016). Health Encyclopedia—Postpartum Hemorrhage. Retrieved August 30, 2016, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P02486
  5. Inoue, S., Masuyama, H., & Hiramatsu, Y. (2014). Efficacy of transarterial embolisation in the management of post-partum haemorrhage and its impact on subsequent pregnancies. Australian & New Zealand Journal of Obstetrics & Gynaecology, 54(6), 541-545. doi:10.1111/ajo.12228
  6. Xu, J. (2015). Effectiveness of embolization of the internal iliac or uterine arteries in the treatment of massive obstetrical and gynecological hemorrhages. European Review for Medical and Pharmacological Sciences, 19(3), 372-374.
  7. Kim, T., Lee, H., Kim, J., Ryu, A., Chung, S., & Seok, L. (2013). Uterine artery embolization for primary postpartum hemorrhage. Iranian Journal of Reproductive Medicine, 11(6), 511-518.
  8. Li, X., Wang, Z., Chen, J., Shi, H., Zhang, X., & Pan, J. et al. (2012). Uterine artery embolization for the management of secondary postpartum haemorrhage associated with placenta accreta. Clinical Radiology, 67(12), e71-e76. doi:http://dx.doi.org/10.1016/j.crad.2012.07.021
  9. Niola, R., Giurazza, F., Nazzaro, G., Silvestre, M., Nasti, G., & Di Pasquale, M. et al. (2016). Uterine artery embolization before delivery to prevent postpartum hemorrhage. Journal Of Vascular And Interventional Radiology, 27(3), 376-382. doi:10.1016/j.jvir.2015.12.006