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Massachusetts General Hospital Imaging provides uterine fibroid embolization (UFE), a minimally invasive, image-guided treatment for fibroid tumors of the uterus, on the Mass General main campus in Boston. Performed by specially trained radiologists using real-time image guidance, interventional-radiology procedures such as UFE often require smaller incisions, have fewer risks of complication, and take less recovery time than traditional surgery.
UFE in depth
Uterine fibroid embolization (UFE), sometimes known as uterine artery embolization (UAE), is a minimally invasive procedure that treats fibroids by blocking their blood supply, causing them to shrink. UFE is an alternative treatment to other available courses, such as hormonal therapy or surgery.
When should I consider uterine fibroid embolization?
Fibroids which are not causing significant symptoms and are smaller in size than a twelve week gestation uterus do not need to be removed and may be followed clinically. Fibroids which cause symptoms such as pain, pressure, bleeding or impaired fertility should be considered for treatment.
The interventional radiologists who perform procedures at Mass General Imaging are specialists in the area of the body and the condition under treatment, as well as the procedure itself. In addition to the training that all radiologists receive, these specialists have additional education, plus extensive real-world experience. In many cases, our doctors helped to pioneer many of the interventional treatments that we offer.
Our team of interventional radiologists and nurse practitioners coordinates a patient's complete care—from imaging evaluation to post-procedure followup—maintaining a high level of communication with the patient throughout the process. In addition, Mass General Imaging works in close coordination with experts from across Mass General when necessary.
What should I expect BEFORE uterine fibroid embolization?
Imaging of the uterus by magnetic resonance imaging (MRI) or ultrasound will be performed prior to the procedure to ensure that fibroid tumors are the cause of symptoms and to fully assess the size, number and location of the fibroids.
Occasionally, your gynecologist may want to take a direct look at the uterus by performing a laparoscopy. If bleeding is a major symptom, a biopsy of the endometrium, the inner lining of the uterus, may be performed to rule out cancer.
You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to anesthesia or to contrast materials (also known as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin or a blood thinner for a specified period of time days before your procedure.
Also inform your doctor about recent illnesses or other medical conditions.
Women should always inform their physician if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy because radiation can be harmful to the fetus. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.
You may be instructed not to eat or drink anything after midnight before your procedure. Your doctor will tell you which medications you may take in the morning. You will be given a gown to wear during the procedure.
What should I expect DURING uterine fibroid embolization?
The uterus gets its blood supply mainly from the uterine arteries, which are a pair of blood vessels running up the sides of the uterus. Fibroids derive almost all their blood supply from branches of the uterine arteries. When the uterus contains large fibroids, the uterine arteries enlarge significantly in response to the increased blood flow. The process of blocking the uterine arteries with small particles is known as embolization. These particles are made of inert materials and do not react in the body.
In order to safely deliver the particles to the uterine arteries, the physician first makes a small incision in the artery near the groin under local anesthesia and inserts a small tube called a catheter. The catheter is then threaded under x-ray guidance into the pelvic vessels and x-ray dye is injected to help locate the uterine arteries.
This step is called an angiogram. The catheter is then threaded into one uterine artery and embolization particles are injected into the artery until blood flow slows to a stop. The catheter is then repositioned into the other uterine artery and the process is repeated. When the embolization is complete on both sides, the catheter is removed and pressure is applied to the incision until all bleeding stops. The patient must then remain at bed rest for 6 hours to allow the puncture site to heal sufficiently.
What should I expect AFTER uterine fibroid embolization?
All women who undergo uterine fibroid embolization will experience varying degrees of pelvic pain and discomfort. This discomfort is related to the fact that the fibroid tissue is deprived of blood flow and oxygen and is dying. The discomfort is most severe in the first 24 hours, and gradually resolves over the following one to two weeks. During this time, some women may also experience mild to moderate fatigue. At Massachusetts General Hospital, all women undergoing the procedure are admitted to the hospital overnight to insure that they receive adequate pain control and are comfortable following the procedure. Patients are discharged home with prescriptions for both narcotic pain medication to be used as needed and ibuprofen to help control uterine cramping. The Nurse Practitioner assigned to you will follow up with frequent telephone calls and keep in close contact with you.
The fibroids will shrink on average approximately 40-45% over the first six months. This reduction may be greater in some patients and less in others. Bleeding symptoms usually resolve immediately after the procedure.
Fibroids are the most frequently seen tumors of the female reproductive system.
The Fibroid Program at Massachusetts General Hospital offers patients access to a full range of multidisciplinary options to treat uterine fibroids.
Department of Radiology Chairman Emeritus James H. Thrall, MD, explains how the ability to see deep inside the body has driven the development of minimally invasive methods of treatment—a trend in which Mass General Imaging has played a key role.
A patient whose life was regularly disrupted by fibroids, Delva Campbell decided to take action and opted for UFE (uterine fibroid embolization).
Melissa Leverett King is an active mom and teacher who lived with limiting discomfort and pain until she got treated for fibroids with UFE (uterine fibroid embolization).
Painful fibroids kept opera singer Denyce Graves from conceiving. With the help and expertise of John Petrozza, MD, director of the Division of Reproductive Medicine and In Vitro Fertilization and co-director of the Mass General Fibroid Program, she gave birth to a baby girl. "He was the most hopeful of all the doctors I'd seen," she said.
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