Uterine artery embolization

Uterine artery embolization (UAE) is a modern minimally invasive method for the treatment of uterine fibroids, aimed at stopping blood supply to fibroid nodules while preserving healthy uterine tissue. This effect is achieved due to the specific vascular anatomy of fibroids, which receive blood primarily from the perifibroid vascular plexus surrounding the myomatous nodes.

How is uterine artery embolization performed?

The procedure is performed on an empty stomach. Premedication is administered, after which the patient is transferred to an interventional radiology suite. The puncture site (most commonly the right femoral artery) is treated with an antiseptic solution and covered with sterile drapes. The surgeon punctures the artery and inserts an introducer — a specialized device that allows safe introduction of catheters and other endovascular instruments while protecting the vessel wall.

Under fluoroscopic guidance, the catheter is advanced into the aorta, and angiography is performed to identify the uterine arteries and assess their branching pattern. Using a catheter–guidewire system, selective catheterization of the uterine artery is carried out. Proper catheter positioning is essential to prevent embolic material from entering non-target vessels. Embolic particles suspended in saline are then slowly injected through the catheter. Angiography is performed intermittently to monitor the degree of embolization. The catheter is subsequently repositioned into the contralateral uterine artery, and the procedure is repeated.

After completion of embolization, the catheter and introducer are removed. Manual compression is applied to the puncture site for hemostasis (typically for 5–10 minutes), followed by placement of a pressure dressing. The total procedure time ranges from 30 to 60 minutes, depending on individual vascular anatomy.

Following the intervention, the patient is advised to remain on bed rest until the following morning to reduce the risk of complications such as hematoma or thrombosis. The dressing is removed the next day, and the patient remains under inpatient observation for 2–3 days before being discharged for outpatient follow-up.

Post-embolization period

Uterine artery embolization is generally well tolerated, and the procedure itself is almost painless. The main discomfort is associated with arterial puncture and contrast administration. However, during the first 4–8 hours after UAE, patients may experience significant pelvic pain caused by acute ischemia of the fibroid tissue, which may require analgesic and antispasmodic therapy. The pain gradually subsides, although mild discomfort may persist for several days and occasionally recur for up to one month, particularly after physical exertion or exposure to cold. Low-grade fever and scant vaginal spotting may also occur.

The first menstrual period after UAE may occur earlier or later than usual and may be accompanied by small clots and moderate cramping. Subsequently, the menstrual cycle typically normalizes. In most cases, a reduction in menstrual blood loss and duration is observed shortly after the procedure. Within one month, a decrease in uterine and fibroid volume becomes evident. Degeneration of fibroid nodules and their replacement with fibrous tissue continues over an average period of 8–10 months. Ultrasound and MRI confirm progressive shrinkage of the fibroids and relief of compression-related symptoms. The average reduction in uterine volume ranges from 40% to 70% and depends on the intensity of pre-procedural blood flow within the fibroids. Long-term follow-up shows stable fibroid size, and the risk of new fibroid formation after UAE is significantly lower than after myomectomy. According to clinical studies, 78–94% of women experience complete resolution or marked improvement of fibroid-related symptoms following UAE.

Advantages of uterine artery embolization in Belarus

The procedure is performed under local anesthesia; therefore, arterial puncture causes minimal discomfort. During embolization, patients may experience a sensation of warmth or mild burning in the lower abdomen or lower back due to contrast injection.

It is important to note that the embolic agents used are safe, biologically inert, and do not provoke allergic reactions.

Uterine artery embolization is an effective, minimally invasive treatment option that allows control of fibroid-related symptoms and restoration of normal uterine condition without open surgery or prolonged recovery.