This website presents information on uterine fibroids and current methods of treatment particularly Uterine Fibroid Embolisation. ( embolization ). Also called UAE - uterine artery embolisation.
It presents data related to the treatment of uterine fibroids by Dr. W. Walker carrying out a procedure known as uterine fibroid embolisation. The data have been collated from the Royal Surrey County Hospital and The London Clinic, Harley Street trial. Dr. Walker has carried out over 2,400 fibroid embolisations as part of the trial and his results and publications are presented including a synopsis of the World Experience of UFE and other related matters.
Dr. Walker works in central London and Guildford and his office can be contacted by telephoning 07795 643019.
To the best of our knowledge the information contained in this website is factual and correct.
Uterine fibroids are benign growths of the uterine muscle occurring in 30-40% of women. The aetiology of fibroids remains the subject of research but genetics is an important factor the condition being more common in Afro Caribbean women.
The tumours are sensitive mainly to oestrogen and progesterone. Most fibroids do not cause any problems and do not require treatment. Some fibroids, however, can cause heavy periods which can lead to anaemia and debilitation, or if the fibroids grow large they can lead to 'compression syndrome' in which adjacent organs may be compressed such as the bladder leading to frequency of urination, the bowel leading to constipation and bloating. Fibroids may press on nerves causing backache and sciatica and can cause cosmetic unsightliness by bulging the abdomen.
The usual treatment for fibroids is hysterectomy which is carried out in approximately 30,000 women a year in the UK and 180,000 in the US.
Uterine fibroid embolisation (embolization) for fibroids is no longer a new procedure. It was first carried out in France in a small number of cases in the early 1990s. Since then there have been numerous publications on the technique (2,5,9,10,11,12,15,18,20,21,22,23,24,25,26,42,43,44). The procedure which is non surgical involves the occlusion of blood vessels supplying uterine fibroids and certainly over 100,000 and probably several hundreds of thousands of fibroid embolisations have been carried out worldwide.
Fibroid embolisation is carried out by an Interventional Radiologist and is technically demanding, requiring significant experience in the technique.
Under local anaesthesia and intravenous sedation a tiny catheter is
inserted under local anaesthetic into an artery in the right groin.
Under X-ray control a micro catheter is introduced selectively into each
of the two arteries that supply the uterus. The micro catheter is passed
approximately half way down the artery and then fine particles of a
solid substance called PVA (Poly Vinyl Alcohol) are injected through the
catheter into the uterine artery. The particles are carried to the leash
of vessels supplying the fibroids. These vessels become silted up
thereby depriving the fibroid of blood which dies and shrinks. PVA is an
inert harmless material which has been used to occlude vessels in other
parts of the body for decades (29).
Following the procedure the patient usually experiences pain over the next 12 to 24 hours. The pain varies from mild to severe and is controlled by intravenous and oral analgesics. Occasionally over the next 1-2 weeks the patient may experience cramps and occasionally some bleeding and often run a mild intermittent temperature in the first week. Patients spend 2 days in hospital and are usually advised to take 2 weeks off work. In our series the average time to patients feeling completely 'normal' was 2.2 weeks. During the procedure intravenous sedation is administered as required.
The complete process of fibroid shrinkage or in a small percentage of cases expulsion takes about 6 to 9 months; however most patients notice a considerable improvement in their symptoms within 3 months (expulsion usually occurs early in the first 6-8 weeks).
The commonest surgical treatment for fibroids is hysterectomy. Approximately 30,000 hysterectomies are carried out for fibroids in the UK alone and 180,000 in the USA, Wallach EE(30). Over the years before other treatments became available a large number of women obtained considerable benefit from hysterectomy. It is however a major surgical operation usually requiring approximately 5-7 days in hospital and 2-3 months convalescence. Hysterectomy for fibroids carries a serious complication rate of 4-6% and a mortality of 1:1,000–1,500(27,34). Serious complications of hysterectomy include bladder, bowel and ureteric damage, infection, haemorrhage, wound dehiscence and chronic problems such as bowel dysfunction and bowel obstruction and vaginal prolapse(27,35). Most serious complications of hysterectomy require further major surgery.
The medical alternative to hysterectomy is drug treatment with GNRH analogues such as Zoladex and Synarel but such drugs can only be used temporarily, are only effective on <50% of women and may have unpleasant side effects. On stopping treatment the fibroids grow back quickly.
The usual surgical alternative to hysterectomy is abdominal myomectomy. In the latter procedure the surgeon attempts to cut out the fibroids leaving the normal part of the womb intact. Myomectomy has been used widely for decades but it is a difficult operation with a significant complication rate. In addition, importantly, there is a high recurrence rate of >70% (6) that occurs in patients with multiple fibroids. A high percentage of patients having myomectomies will require re-operation for recurrence usually hysterectomy. Complications include bowel perforation, damage to the urinary tract, adhesion formation, infection and haemorrhage. You should ask your gynaecologist whether he or she feels that abdominal myomectomy would be of benefit in your particular case and likely to succeed.
Laparoscopic (keyhole surgery) myomectomy is an effective, much less
invasive, procedure but there are major limitations on the size and number of
fibroids that can be treated.
Again this surgery has a higher complication rate than UAE including damage to adjacent organs
which may involve a further major operation.
Other recent techniques are MRI guided laser ablation and MRI guided focussed ultrasound. Essentially both of these techniques cause a burn within the fibroid which then changes to scar tissue. Only a few fibroids can be treated at particular sites and the procedure takes around 2-3 hours. It often only destroys part of the fibroid or fibroids. Only short term results are available. These would be expected to demonstrate initial improvement but the concern is that this will not be sustained as the residual fibroid tissue re-grows. Embolisation has the advantage of completely destroying all fibroids no matter how numerous at one session lasting between 45 minutes and one hour. Post-procedure pain and discharge are probably greater than with MRI ablation but this is probably because in the latter procedure not all the fibroid tissue is killed.
An article in the American Journal of Roentgenology ‘MRI guidance of Focused Ultrasound Therapy of Uterine Fibroids: Early Results’ 2004;183:1713-1719 showed a mean reduction in fibroid volume at 6 months of only 13.5% which would normally be regarded as treatment failure. Average for UAE is 60%. But more importantly in UAE in the overwhelmimg majority all of the fibroids are killed and cannot regrow
So far the world experience of uterine fibroid embolisation for fibroids would indicate a success rate of over 90%. Until recently we only had short and medium term follow up but now long term follow up data is available(2,5). UFE is now widely established particularly in the US and latterly Condoleezza Rice's UFE was widely reported in the US press. Hundreds of thousands of patients have had UFE worldwide. The procedure kills all the fibroids at one session with a very low recurrence rate i.e. the cure is permanent in the overwhelming majority of cases. The two major complications of the procedure are infection leading to hysterectomy and this has an incidence of <0.5% and ovarian failure (ie a premature menopause). Again, the incidence of this complication is extremely low (less than 1% of patients under the age of 45) and when it does occur does not appear to affect satisfaction rates.
A survey by the Society of Cardiovascular & Interventional Radiology in the United States in 1999 of 10,500 procedures revealed less than 1% of serious complications requiring emergency surgery after embolisation and one death i.e. a mortality rate of one in 10,000(37). From this data and numerous other papers (see table below) in this contect it would appear that fibroid embolisation has a much lower complication rate than hysterectomy which has a serious complication rate of 4-6% and a mortality rate for hysterectomy for fibroids of one in 1,000 - 1,500(27,34).
Kundu et al(4) compared 312 patients undergoing surgery (total abdominal hysterectomy, myomectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy) for fibroids with 65 women undergoing UFE. In the surgery group there were 20 cases of major complication and one death. There were no major complications in the UFE group. Also 3 patients suffered pulmonary embolism in the surgery group and 27 cases of infection related to surgery but none in the UFE group.
|Author (year)||Study design||Procedures (No of|
pts at procedure
|Months of follow-up|
(No of patients)
|Broder et al (2002)||Retrosp||UAE 59|
|Edwards et al (2007)||RCT||UAE 106|
|Goodwin et al (2006)||Retrosp||UAE 149|
|Hehenkamp et al (2005)||RCT||UAE 88|
|Pinto et al (2003)||RCT||UAE 38|
|Ravazi et al (2002)||Retrosp||UAE 67|
|Spies et al (2004)||Retrosp||UAE 102|
|Volers et al (2007)||RCT||UAE 88|
1. Walker WJ, Bratby . Magnetic Resonance
Imaging (MRI) Analysis of Fibroid Location
in Women Achieving Pregnancy After Uterine
Artery Embolisation. Cardiovascular
interventional Radiology - August 2007
2. Walker WJ, Barton-Smith P. Long-term follow up of uterine artery embolisation - an effective alternative in the treatment of fibroids. British Journal of Obstetrics and Gynaecology 2006;113:464-468
3. Walker WJ, McDowell SJ. Pregnancy after uterine artery embolisation for leiomyomata: at series of 56 completed pregnancies. American Journal of Gynecology & Obstetrics November 2006 195(5) 1266-71
4. Kundu S, Gadani S, Clements R, Asisa J, Wilcock G, Barnwell D Comparison of surgical periprocedural Morbidity/Mortality & Length of Stay with UAE for Symptomatic Uterine Fibroids. Presented SIR Canada 2006
5. Spies JB, Bruno J, Czyda-Pommersheim F, Magee ST, Ascher S, Jha RC. Long-Term outcome of Uterine Artery Embolisation of Leiomyomata. Obstetrics and Gynaecology 2005;106:933-9.
6. Hanafi M. Predictors of leiomyomas recurrence after myomectomy. Obstetrics and Gynaecology 2005 Apr;105(4):877-81
7. Carpenter T, WJ Walker. Pregnancy following uterine artery embolisation for symptomatic fibroids: a series of 26 completed pregnancies. British Journal of Obstetrics and Gynaecology, 112, pp321-325 March 2005.
8. Walker WJ, Carpenter T, Kent ASH Persistent vaginal discharge after uterine artery embolisation for fibroid tumours: cause of the condition, magnetic resonance imaging appearance, and surgical treatment. American Journal of Obstetrics and Gynecology, Volume 190, Issue 5, May 2004, Pages 1230-1233
9.Walker WJ, Pelage JP. Uterine artery embolisation for symptomatic fibroids. Clinical results in 400 women with imaging follow up. British Journal of Obstetrics and Gynaecology. Nov 2002; 109: 1262-1272
10. Watson GMT, Walker WJ. Uterine Artery Embolisation for the treatment of symptomatic fibroids in 114 women: reduction of size of size of the fibroids and women’s views of the success of the treatment. British Journal of Obstetrics & Gynaecology 2002 Feb;109(2);129-35
11. Walker WJ, Pelage JP, Sutton C. Fibroid embolisation [review]. Clinical Radiology 2002 57(5); 325-31
12. Walker WJ. Bilateral Uterine Artery Embolisation for Fibroids - A Three and a Half Year Experience of over 300 Cases and Comparison with Data from other Centres. The Yearbook of Obstetrics & Gynaecology, Sturdee D, Oláh K, Keans D (Eds) RCOG Press 2001; Vol.9: 209-15
13. Walker WJ. Limitations of Fibroid Embolisation. Controversies in Obstetrics, Gynaecology & Infertility. Ben-Rafael Z, Shohan Z, Frydman R, Monduzzi Editore 2001: 427-33
14. Pelage JP, Le Dref O, Soyer P, et al. Fibroid related menorrhagia: treatment with super selective embolization of the uterine arteries and mid-term follow up. Radiology 2000,215 (2) 428-31
15. Walker WJ. Fibroid Embolisation. Gynaecological Endoscopy. 2000; 9: 343-344
16. Jones K, Walker WJ, Sutton C. Sequestration and Extrusion of Intramural Fibroids following Uterine Artery Embolisation. Gynaecological Endoscopy 2000; 9: 309-13
17. Jones K, Walker WJ. Access Procedures to Treat Menorrhagia in one patient. Gynaecological Endoscopy 2000; 9: 323-5
18.Walker WJ. Bilateral uterine Artery Embolization for Fibroids. Menorrhagia. Sheth C, Sutton C (Eds). Isis Medical Media, Oxford. April 1999: 185-93
19. Goodwin SG, McLucas B, Lee M, et al. Uterine artery embolization for the treatment of uterine leiomyomata: midterm results. Journal of Vascular and Interventional Radiology. 1999; 10: 1159-65
20. Spies JB, Scialli AR, Jha RC, et al. Initial results from uterine fibroid embolization for symptomatic leiomyomata Journal of Vascular and Interventional Radiology. 1999:10: 1149-57
21. Hutchins J FL, Worthington-Kirsch RL, Berkowitz RP. Selective uterine artery embolization as primary treatment for symptomatic leiomyomata uteri. Journal of the American Association of Gynecological Laparoscopists 1999; 6: 279-84
22. Walker W, Green A, Sutton C. Bilateral uterine artery embolisation for myomata: results, complications and failures. Journal of Minimally Invasive Therapy1999; Vol 8 (6): 449-54
23. Walker WJ. Bilateral Uterine Artery Embolization for Fibroids. Menorrhagia. Sheth C, Sutton C (eds). Isis Medical Media, Oxford. April 1999: 185-93
24. Walker WJ. Arterial embolisation in obstetrics and gynaecology with particular reference to uterine fibroids. Advances in Obstetrics and Gynaecology. 1999;16:2-8
25. Worthington-Kirsch RL, Walker WJ, Adler L and Hutchins Jr FL. Anatomic variation in the uterine arteries: a cause of failure of uterine artery embolisation for the management of symptomatic myomata. Journal of Minimally Invasive Therapy, December 1999, Vol 8 (6): 397-402
26. Goodwin SC, (UCLA) USA, Walker WJ (RSCH) UK. Uterine Artery Embolisation for the treatment of fibroids. Current Opinion in Obstetrics and Gynaecology 1998;10: 315-2 5.
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38. Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovasc Intervent Radiol 2008;31:73-85
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43. Hehenkamp WJ, Volkers NA, Donderwinkel PF, de Blok S, Birnie E, Ankum WM, Reekers JA. Uterine artery embolisation versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri- and postprocedural results from a randomised control trial. Am J Obstet Gynecol 2005 Nov;193(5):1618-29
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