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The patient will need to have symptomatic fibroid disease such as heavy bleeding, pain and bladder and bowel fullness, then undergo consultation with the interventional radiologist at some date prior to the planned procedure. The majority of fibroid uteruses can be managed with UFE. However, the interventional radiologist will be aware that sometimes another form of management may be in the patient’s best interest. This will be discussed with other options during the informed consent process at the consultation.
One of the criticisms of UFE in the past is that there has been a lack of evidence for both safety and effectiveness. The American College of Obstetricians and Gynaecologists (ACOG) has formally recognised UFE as effective and safe for short and long term treatment of symptomatic fibroids. The Australian and New Zealand College of Obstetricians and Gynaecologists has now followed suit.
Asymptomatic fibroid disease, leiomyosarcoma of the uterus and pregnancy are absolute contraindications and will be worked up as part of the consultation process. Relative contraindications include allergies to iodinated contrast and infection, but these can be premedicated or treated prior to undergoing the procedure.
Iodine contrast allergy (see Iodine-containing contrast medium), renal failure and coagulopathy.
Post embolisation syndrome is common in the immediate post procedure period. It is usually managed within the hospital before discharge. Patients will be discharged with a management plan and medications. Post embolisation syndrome is a triad of pelvic pain, low grade fever and nausea and is thought to be due to ischaemis/infarction of the fibroids.
Infection of the infarcted fibroid is the complication that needs to be watched for and the patient adequately informed about. It is uncommon (less than 2%) and the patient will usually get antibiotics during the procedure and for 5-10 days after the procedure. However, the exact mechanism for infection is not clear and it is also unclear whether antibiotics will reduce the risk.
Classically it occurs 4-6 weeks post embolisation, in a previously well patient who then develops fever, sweats and/ or pelvic pain. It is important that the patient see the interventional radiologist as soon as possible. Hysterectomy may be required in those patients not responding to other forms of management.
The period is often disrupted for a number of cycles post procedure. If the period has not returned after 3 cycles then the concern is one of permanent amenorrhoea and consultation to a gynaecologist should be performed either through yourself or usually the radiologist.
There are a number of alternatives and these will be discussed at the initial consultation as part of the informed consent process.
RACGP “Uterine artery embolisation – a treatment alternative for women with fibroids” AFP vol 35(5) 273-368
Page last modified on 26/9/2016.
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