Introduction
Uterine Artery Embolization (UAE), also known as Uterine Fibroid Embolization (UFE), is a minimally invasive, image-guided procedure performed by interventional radiologists to treat symptomatic uterine fibroids and other uterine pathologies.
It is a recognized alternative to surgical options such as hysterectomy or myomectomy, offering uterus preservation and shorter recovery.
Principle of UAE
UAE works by blocking the blood supply to fibroids via targeted embolization of the uterine arteries.
- Fibroids are hypervascular, deriving most of their supply from the uterine arteries.
- Once embolized, the fibroid tissue undergoes ischemic necrosis, leading to shrinkage and symptom relief.
Indications
- Symptomatic uterine fibroids (menorrhagia, pelvic pain, bulk-related symptoms)
- Adenomyosis (select cases)
- Postpartum hemorrhage (life-saving indication)
- Uterine arteriovenous malformations
Contraindications
- Current pregnancy
- Active pelvic infection
- Suspected gynecologic malignancy
- Severe allergy to contrast media
- Desire for future fertility (relative, requires careful counseling)
Procedure Technique
- Pre-procedure Preparation – MRI or ultrasound for fibroid mapping, counseling, labs.
- Vascular Access – Common femoral artery puncture under local anesthesia.
- Catheterization – Selective catheterization of uterine arteries under fluoroscopic guidance.
- Embolization – Injection of embolic agents (PVA particles, microspheres) until near-complete stasis of flow.
- Completion – Bilateral embolization is standard; catheter is withdrawn, hemostasis achieved.
Imaging Guidance
- Fluoroscopy & Digital Subtraction Angiography (DSA) – For artery mapping and embolization control.
- Cone-Beam CT – Optional, for anatomical variation detection.
Post-Procedure Course
- Post-Embolization Syndrome – Pain, fever, malaise, nausea (managed conservatively).
- Return to normal activity within 7–10 days.
- Fibroid shrinkage: ~40–60% volume reduction over 6 months.
- Symptom improvement in >85% of patients.
Complications
- Groin hematoma
- Non-target embolization (ovarian arteries, vagina)
- Uterine infection or sepsis (rare)
- Amenorrhea due to ovarian failure (more common in women >45 years)
Advantages Over Surgery
- Uterus preservation
- Shorter hospital stay (often same-day discharge)
- No abdominal incision
- Quicker return to work and daily activities
Long-Term Outcomes
- High patient satisfaction (>85%)
- Low re-intervention rates (~10–15% over 5 years)
- Comparable quality-of-life improvements to surgery in most studies
Key Takeaways
- UAE is a safe, effective, uterus-preserving treatment for symptomatic fibroids.
- Requires careful patient selection and multidisciplinary discussion.
- Plays an important role in emergency postpartum hemorrhage control.
