HYSTERECTOMY MAY STILL BE REQUIRED AFTER A FIBROID EMBOLIZATION PROCEDURE
Embolization is a risk for women with large fibroids: UFE and UAE are not recommended
Many studies have shown that embolization of large fibroids is not optimal. Before agreeing to a fibroid embolization procedure for large fibroids, women need to know the possible complications that can follow the procedure.
Fibroids require blood to grow. Without it, some or all of the tumor will die. With uterine fibroid embolization (UFE) or (uterine artery embolization) UAE, an interventional radiologist accesses the blood vessel that feeds the tumor through a small incision in the groin. Plastic particles are injected into the blood vessel to starve the fibroid, resulting in some shrinkage of the tumor.
FIBROID EMBOLIZATION PROCEDURES FOR LARGE FIBROIDS ARE NOT EFFECTIVE
Unfortunately, embolization used on large fibroids can result in die-off and expulsion of the fibroid tumor, which can result in an infection. Material from the fibroid sloughing off from the lining of the uterus can provide a site for bacterial growth and lead to infection of the uterus (endomyometritis). While many uterine infections can be treated with antibiotics, in extreme cases, the infection if unresponsive to antibiotics may require a hysterectomy.
Several early case reports described rare but serious complications shortly after UAE for large fibroids, such as unbearable pain, septic uterine necrosis, and lethal sepsis.
Infection after embolization is typically characterized by fever, increasing pain and discharge. Uterine infection has been reported in 1 in 200 women who have undergone UFE.
UFE OR UAE IS NOT AN EFFECTIVE TREATMENT FOR LARGE FIBROIDS
UFE results in shrinkage of fibroids of approximately 30 to 46 percent. For substantially large fibroids, this may not be enough of a reduction in size to alleviate symptoms.
In several studies, response to embolization was not as effective in patients with a large fibroid, greater than 8 cm. Those patients also experienced a higher rate of need for additional therapy after UAE.
UFE and UAE procedures have more complications, unscheduled visits, and readmissions than hysterectomy or myomectomy procedures. Data also suggest that women with larger uteri and/or more leiomyomas at baseline are at greater risk of failure with embolization. There is a relatively high rate of reintervention for treatment failure. Alternatively, myomectomy and hysterectomy remove the fibroids entirely, offering fewer post-surgical complications.
LAPAROSCOPIC MYOMECTOMY & HYSTERECTOMY PROCEDURES OUTPERFORM UFE
Fibroids can be removed surgically via either a myomectomy, removal of the fibroids from the uterus or hysterectomy, removal of the uterus. If women can maintain fertility, a laparoscopic myomectomy may be possible, however, fibroids can return. A hysterectomy is a cure for fibroids.
If a myomectomy or hysterectomy is performed as a laparoscopic procedure, depending on the placement and size of the incisions, the surgery can provide patients with immediate relief and faster recovery than even UFE procedures.
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