By: Jean Johnson for Fibroids1
The idea behind uterine fibroid embolization (UFE) is that FDA-approved particles which block blood flow are injected into the arteries that supply the fibroid mass. Cut off from its source of nourishment, the fibroid shrinks and symptoms disappear.
This approach to treating uterine fibroids was first used in 1995 and has a very good track record. Thus, when it came time for Secretary of State Condoleezza Rice to have her fibroids treated in 2004, she opted for UFE.
|The following information on uterine fibroid embolization (UFE) is adapted from the Society of Interventional Radiology:|
Embolization of the uterine arteries is not new. While embolization to treat uterine fibroids has been performed since 1995, it had been used successfully by interventional radiologists for more than 20 years to treat heavy bleeding after childbirth.
UFE is covered by most major insurance companies and is widely available across the country.
Most women with symptomatic fibroids are candidates for UFE and should obtain a consult with an interventional radiologist. An ultrasound or MRI diagnostic test will help the interventional radiologist determine if the woman is a candidate for this treatment.
Questions to ask your doctor:
What options do I have for treating my fibroids?
Can you explain the risks and benefits of each option?
What is your recommendation?
What is the recovery period for the recommended option?
What about short term versus long term treatment options?
Remember, you can always seek a second opinion if you feel your doctor did not answer your questions fully or appropriately.
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So too did Pamela Green of Las Vegas. Her story, “Symptom-Free at Last – A Patient’s Praise for Uterine Fibroid Embolization,” was profiled on Fibroids1 in August 2006. Go to http://www.fibroids1.com/news/mainstory.cfm/117 to read her story. As Green explained, she did not need any pain medicine after the first day and was back to work in a week. Rice’s choice played a role in Green’s decision as well. “I said to myself, ‘if it’s good for Condoleezza, it’s good for me.’”
Many women choose UFE because it does not require major abdominal surgery, unlike myomectomy and hysterectomy. The procedure only requires a small nick in the skin at the groin near the femoral artery. It is at this site that physicians called interventional radiologists thread tiny catheters the thickness of spaghetti through this nick to perform the procedure. Navigating through the blood vessels using x-ray technology, these experts on the circulation system locate the site of the fibroid and deploy embolytic particles that prevent the flow of blood from continuing to reach the fibroid mass.
Current Research Question
Though UFE is known to be successful, there is some debate over the best type of embolytic particle. To answer this question, Richard Shlansky-Goldberg, M.D., an associate professor of radiology at the University of Pennsylvania School of Medicine who specializes in interventional radiology, is leading a clinical trial comparing two types of embolytic particles.
The study will use magnetic resonance imaging (MRI) to evaluate the success of UFE both 24 hours after the procedure and three months afterward.
“It used to be that we weren’t concerned about imaging and after three months it was relief from symptoms like bleeding and pain for the most part that indicated whether or not the UFE was successful,” Shlansky-Goldberg told Fibroids1. “Now, we’re finding that the more of the fibroid we can kill, the better the durability will be.”
He added that in women who are five or six years away from menopause, there is little concern even if a significant part of the fibroid was growing after UFE. That’s because once menopause begins and estrogen levels drop, the fibroid will shrink naturally.
But for women who are 39 or 40, for example, the chances that they will have to be re-treated prior to reaching menopause increase in proportion to how much of the fibroid mass remains after the UFE.
“The last thing we want to do is treat someone and have them come back in three years,” said Shlansky-Goldberg.
“We already know that UFE has an 85 to 90 percent success rate, offering less complications and a shorter recovery time than surgical options,” he continued. “So in 2006, the question becomes, now that we know the procedure is effective and durable: which embolytic material would be better?
“We used to think all products were similar. Polyvinyl alcohol (PVA) particles look like little boulders and are the gold standard. They can clog the catheter, though, so another company came out with round material that was easier to inject. People did well clinically, but studies eventually showed that the rounded PVA particles didn’t kill as much of the fibroid.”
With the question of particle shape resolved for the time being, the question is now one of size. Thus, Shlansky-Goldberg’s clinical trial will evaluate two round-shaped products of different sizes, one from Boston Scientific (Editor’s note: Boston Scientific is a current sponsor of Fibroids1) and the other from BioSphere Medical. The randomized, single-center study will evaluate UFE in 60 participants, and is expected to last for nine months.
“Boston Scientific is funding the study because it’s their revised product,” added Shlansky-Goldberg. “They came out with the larger particle size.”
Formerly, UFE patients did not have MRIs on the day following their procedures. “When we look at MRIs at three months, almost everyone’s uterine tissue looks normal,” said Shlansky-Goldberg. “But we know we are cutting off some of blood supply to the uterus during embolization.
“So it will be interesting to see how changes in blood flow take place in the uterus. Fibroids do take the major hit and lose blood supply, but the uterus is left with less blood flow initially as well. Looking at the impact of embolization on the physiology of the uterus is a new area of inquiry, and we are looking forward to these results along with durability.”