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Uterine Fibroids & Uterine Artery Embolization for Fibroids



Treatment Options

Uterine Artery Embolization for Fibroids (UAE/UFE)

How Can I Get (UAE/UFE)?

Common Questions & Answers




Uterine Artery Embolization for Fibroids (UAE/UFE)


Uterine artery embolization represents a fundamentally new approach to the treatment of fibroids. Embolization is a minimally invasive means of blocking the arteries that supply blood to the fibroids. It is a procedure that uses angiographic techniques (similar to those used in heart catheterization) to place a catheter into the uterine arteries. Small particles are injected into the arteries, which results in their blockage. This technique is essentially the same as that used to control bleeding that occurs after childbirth or pelvic fracture, or bleeding caused by malignant tumors. The procedure was first used in fibroid patients in France as a means of decreasing the blood loss that occurs during myomectomy. It was discovered that after the embolization, while awaiting surgery, many patient's symptoms went away and surgery was no longer needed. The blockage of the blood supply caused shrinkage of the fibroids resulting in resolution of their symptoms. This has led to the use of this technique as a stand-alone treatment for symptomatic fibroids.

The Procedure

The procedure is usually done in the hospital with an overnight stay or same day discharge post-procedure. The patient is sedated and very sleepy during the procedure. The uterine arteries are most easily accessed from the femoral artery, which is at the crease at the top of the leg (Figure Below). Initially, a needle is used to enter the artery to provide access for the catheter. Local anesthesia is used, so the needle puncture is not painful. The catheter is advanced over the branch of the aorta and into the uterine artery on the side opposite the puncture.

Before the embolization is started, an arteriogram (an injection of contrast material while X-rays are performed) is performed to provide a road map of the blood supply to the uterus and fibroids. After the arteriogram, particles of polyvinyl alcohol (PVA) are injected slowly with X-ray guidance (see figure at left). These particles are about the size of grains of sand. Because fibroids are very vascular, the particles flow to the fibroids first. The particles wedge in the vessels and cannot travel to any other parts of the body. Over several minutes the arteries are slowly blocked. The embolization is continued until there is complete blockage of flow to the fibroids.

Both uterine arteries are embolized to ensure the entire blood supply to the fibroids is blocked. After the embolization, another arteriogram is performed to confirm the completion of the procedure. Arterial flow will still be present to some extent to the normal portions of the uterus, but flow to the fibroids is blocked. The procedure takes approximately 1 to 1 1/2 hours.


Serious complications are rare after UAE, occurring in less than 4% of patients. These include injuries to the arteries through which the catheters are passed, infection or injury to the uterus, blood clot formation, and injury to the ovary.

The most severe complications to date have been 4 deaths reported after UAE, 3 in Europe and 1 in the United States. In England, a patient developed a very serious infection in the uterus 10 days after the procedure. Despite a hysterectomy, the patient developed septicemia (blood stream infection) and died 2 weeks later. Another patient recently died in the Netherlands from a similarly severe infection. There have been 2 deaths from pulmonary embolus, which is the passage of a blood clot from the veins in the legs or the pelvis to the lungs. Pulmonary embolus may occur after any of a number of different surgical procedures, including most gynecologic surgeries. It does not appear that a patient treated with UAE is at any greater (or lesser) risk for pulmonary embolus than surgery patients. While pulmonary embolus usually does not result in permanent injury, it can cause death in rare instances. These very serious complications are the only deaths that have occurred in the 20,000 to 25,000 patients treated worldwide thus far.

About 1% of the time, a patient might have an injury to the uterus or infection in the uterus that might necessitate a hysterectomy. Injuries to other pelvic organs is possible but has not yet been reported. There have been a few patients that have had a nerve injury, either in the pelvis or at the puncture site, although happens in less than 1 in 200 patients. An injury to the puncture site, such as clot formation or bleeding, is also similarly rare.

The most likely problem to develop in the first several months after the procedure is the passage of fibroid tissue. This is only likely to happen with submucosal or intramural fibroids that touch the lining of the uterus. In our experience, this occurs in about 2 or 3 % of cases. While the fibroids may pass on their own, a D and C may be needed to remove the tissue. While the passage of tissue may be beneficial in the long run, it may be associated with infection or bleeding and this may be severe enough to require hospitaliation. For this reason, it is important to monitor this process carefully to avoid more serious problems.

X-rays are used to guide the procedure and this raises a concern about potential long-term effects. There have now been several studies of X-ray exposure during uterine embolization, and in most of these, exposure was found to be below the level that would be anticipated to have any health effect to the patient herself or to future children. It is always possible that very prolonged exposure could cause an injury, and there has been one patient reported that developed a skin burn after uterine artery embolization for fibroids. Most interventionalists limit the duration of X ray exposure in any procedure and will stop the procedure if it cannot be completed within a safe interval.

Another unresolved question is the effect, if any, of this procedure on the menstrual cycle. The overwhelming majority of women who have had embolization of fibroids have had decreased bleeding with normal menstrual cycles. There have been a few women (most of whom are near the age when menopause would be expected) who have lost their menstrual periods after uterine embolization. The most likely cause is decrease in blood supply to the ovaries as a result of the embolization. Most researchers have noted a 2 to 6% chance of losing menstrual periods and the onset of menopause as a result of UAE. There has been one study that noted a higher rate of menopause after the procedure (15% of patients treated) but the reason for this higher rate is not clear.

About 1% of the time, a patient might have an injury to or infection in the uterus that might necessitate a hysterectomy. Injuries to other pelvic organs is possible but has not yet been reported and the chance of other significant complications is less than 4%.

Expected result

As of this time, 20,000 to 25,000 patients have had this procedure world-wide. The results that have been published or presented at scientific meetings, suggest that symptoms will be improve in 85-90% of patients with the large majority of patients markedly improved. The improvement rate is similar for heavy menstrual bleeding and for pressure and pain symptoms. Most patients have rated this procedure as very tolerable and in almost all cases hospitalization is necessary for only one night. In some centers, the patients are treated and discharged the same day.

The expected average reduction in the volume of the fibroids is 40-50% in three months, with reduction in the overall uterine volume of about 30-40%. Over time, the fibroids continue to shrink. With several years follow-up now available, it does not appear that fibroids successfully treated regrow. It is not known whether patients may develop new fibroids.

If you would like to consider this procedure or would like more information about uterine artery embolization, please call The Toronto Endovascular Centre at 416-925-2676.

While UAE has not been used as a fertility procedure, there have been many pregnancies after uterine artery embolization.


Uterine Artery Embolization for Fibroids Case Study

Sanjoy Kundu BSc., M.D., F.R.C.P.(C), D.A B.R., FASA, Division of Interventional Radiology
Scarborough Hospital – General Division, Scarborough, Ontario, Canada

Case History:

47 year old female presented with a one year history of very heavy periods lasting for four days during each menstrual cycle. Her past medical and surgical history was otherwise unremarkable. A MRI demonstrated a dominant intramural fibroid in the uterine fundus (Figure 1). After assessing the different therapeutic options, the patient chose to go ahead with a

Interventional Procedure (Case performed at Scarborough General Hospital – General Campus):

Uterine Artery Embolization Procedure for her fibroids. The patient’s right common femoral artery was accessed. Using a C2 catheter, the patient’s left uterine artery was cannulated (Figure 2). One and a half vials of Contour SE PVA measuring 500-700um was injected, until there was complete stasis in the main left uterine artery (Figure 3). Cannulation of the right uterine artery was also performed followed by injection of one and half vials of Contour SE PVA.

Fig. 1 Fig. 2
Figure 1 Figure 2


A nine month follow up MRI demonstrated greater than 50 percent reduction in size of the index fibroid. The patient’s menstrual cycles also normalized with no episodes of heavy bleeding during her periods (Figure 4).


Uterine artery embolization for fibroids is a attractive, less invasive treatment for women with symptomatic fibroids. Uterine artery embolization is a viable and effective alternative to surgical myomectomy or hysterectomy, without the postoperative risks of bleeding, ureteric injury or pulmonary thromboembolism.

Fig. 1 Fig. 2
Figure 3 Figure 4