Uterine Fibroid Embolization Reviews and Notable Findings

Uterine fibroid embolization (UFE) is a minimally invasive procedure used to treat fibroids, noncancerous growths in the uterus that can cause heavy bleeding, pain, and other symptoms. It has gained attention as an alternative to surgery, offering shorter recovery times and lower complication risks.

As research continues, patient reviews and clinical findings provide insight into its effectiveness and potential drawbacks.

Procedure Steps

UFE begins with a consultation to assess fibroid size, location, and symptoms. Pre-procedural imaging, often using MRI or ultrasound, helps interventional radiologists map the fibroid’s blood supply. Patients receive mild sedation but remain awake to avoid risks associated with general anesthesia. A local anesthetic is applied to the groin or wrist for catheter insertion.

The interventional radiologist makes a small incision to access the femoral or radial artery. A catheter, guided by fluoroscopic imaging, is threaded through the arterial system toward the uterine arteries. Contrast dye is injected to confirm the fibroid’s vascular supply, ensuring precise embolic agent delivery.

Once the catheter is positioned, embolic materials—typically biocompatible microspheres or polyvinyl alcohol (PVA) particles—are introduced into the uterine arteries. These particles block blood flow, causing fibroids to shrink over time. Embolization is performed on both uterine arteries to maximize effectiveness.

Embolic Materials

The success of UFE depends on embolic materials that block blood flow to fibroids while minimizing unintended tissue damage. These materials are biocompatible to ensure stability and prevent inflammation. The most commonly used agents are non-resorbable microspheres and PVA particles.

Microspheres, made of tris-acryl gelatin or hydrogel, offer precise embolization due to their uniform size. This controlled distribution reduces excessive ischemia and preserves surrounding tissue. Studies show tris-acryl gelatin microspheres lead to an average fibroid volume reduction of 50-60% within six months, with significant symptom relief in over 85% of cases.

PVA particles, while effective, are irregularly shaped and can aggregate unpredictably. A meta-analysis in Obstetrics & Gynecology found both microspheres and PVA achieved similar fibroid shrinkage rates, but microspheres were linked to lower post-procedural pain and complications due to their controlled occlusion.

Newer materials, such as drug-eluting beads and biodegradable microspheres, are being studied. Drug-eluting beads release anti-proliferative agents directly into fibroids, potentially enhancing treatment outcomes. Biodegradable microspheres dissolve over time, offering temporary embolization when permanent occlusion is not ideal.

Imaging Guidance

Successful UFE relies on imaging to guide embolization with precision. Fluoroscopy, a real-time X-ray method, is the primary tool. Contrast dye highlights uterine arteries, ensuring embolic materials are accurately placed. Digital subtraction angiography (DSA) enhances this process by filtering out background structures for a clearer view.

Pre-procedural imaging also plays a key role. MRI is the gold standard for assessing fibroids due to its superior soft tissue contrast. T2-weighted MRI helps predict how well a fibroid will respond to embolization, while diffusion-weighted imaging (DWI) can assess ischemic changes post-procedure. Ultrasound, though useful for initial fibroid detection, lacks MRI’s detailed vascular mapping.

Cone-beam computed tomography (CBCT) is gaining use for its ability to provide three-dimensional visualization of the uterine vasculature. Unlike traditional fluoroscopy, CBCT captures volumetric data in a single scan, improving embolization precision. Some centers are also exploring contrast-enhanced ultrasound (CEUS) as a radiation-free alternative for real-time treatment assessment.

Recovery Process

Patients typically experience moderate cramping and pelvic discomfort in the first few hours after UFE as fibroids lose their blood supply. Post-embolization syndrome, which includes pain, nausea, and low-grade fever, peaks within 24 to 48 hours. Pain is managed with NSAIDs and, if necessary, opioids. Hydration and anti-nausea medications help mitigate side effects.

Most patients return home the same day or after brief observation. Recovery lasts one to two weeks, with fatigue common as the body adjusts. Some experience temporary vaginal discharge containing tissue fragments as fibroids shrink. Light activity, such as short walks, is encouraged, but strenuous exercise and heavy lifting should be avoided for at least two weeks to prevent complications.