Fibroid Embolisation
The treatment began in Paris in the late 80’s to reduce some of the complications from Hysterectomy, particularly post and intraoperative bleeding. It was soon discovered the patients no longer required the surgery as their fibroids were completely treated from the embolisation. Now this procedure is performed all over the world with more than 100,000 cases being performed in 2009. A/Professor Lyon has been performing fibroid embolisation for over 16 years.
Embolisation is a medical term meaning blocking of blood vessel supply to tissues or organs, usually from injection within the supplying blood vessel. Fibroid embolisation is also called uterine artery embolisation, as this is the most common blood vessel supplying the fibroids. Dr Lyon performs uterine artery embolisation (fibroid embolisation) in Melbourne at a number of private hospitals.
The procedure is performed in an operating theatre with modern x-ray equipment called an angiography suite or cath lab. Patients usually stay overnight, as some monitoring is required as well as treatment of post embolisation pain and nausea. 95% of patients are ready and keen to go home the next morning.
Fibroid Embolisation takes approximately 30-60 minutes and is performed by placing a fine plastic tube called a catheter into the arteries via the right groin (right common femoral artery). The blood supply to the fibroids is carefully worked out using x-ray (angiogram) and then blocked to starve the fibroids of their blood supply. The blood supply is blocked with particles (PVA) or gelfoam. These are inert, safe and have been used for decades. After the procedure, the small access site (puncture) in the right groin is closed or compressed and the patient will go back to the ward for high quality nursing care.
Why have fibroid embolisation? Many women would like to avoid surgery and the longer recovery times for myomectomy and hysterectomy. It has been published in Cardiovascular and Interventional Radiology that " Uterine artery embolisation (UAE) is a true alternative to hysterectomy in women who want to preserve their uterus", a statement that is backed by level one evidence. Further, they find that the highest quality of evidence shows that the five-year outcome in quality of life is equal in groups treated either by hysterectomy or by UAE, with no difference in major complications. In the short term, UAE had lower blood loss, shorter hospital stay and quicker return to work.
The American College of Obstertricians and Gynaecologists in their 2008 practice bulletin have recommended this as a safe and effective treatment for uterine fibroids, with the highest level of evidence. They also recommended this should be discussed as a potential treatment option with all patients who are considering fibroid treatment.
In its August practice bulletin, “Alternatives to Hysterectomy in the Management of Leiomyomas,” ACOG listed UFE among Level A treatment options, meaning that the minimally invasive treatment is considered safe and effective based on long- and short-term outcomes data. Level A evidence is the highest grade possible. The ACOG practice bulletin is used by doctors to aid in making decisions about appropriate patient care. “This is especially significant news for the 200,000 women who have hysterectomies performed annually in the United States to treat symptomatic uterine fibroids. Many of these women can confidently choose uterine fibroid embolisation.” noted Kaufman.
For further information about fibroid embolisation or to book an appointment with Dr Stuart Lyon to discuss treatment of your fibroids, please contact us on 8060 4279 or info@melbourneendovascular.com.au or room-information
Additional information on the treatment of fibroids can be found at http://www.sirweb.org/patients/uterine-fibroids/ and in this article from Inside Radiology.
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