Too few gynecologists tell their
patients about uterine fibroid embolization (UFE) as
a treatment option for their fibroids. Interventional
radiologists, who perform the procedure, levelled this
charge on March 18, during the 33rd Annual Scientific
Meeting of the Society of Interventional Radiology.
Their study looked at 105 women
with fibroids, those benign growths in the muscle layer
of the uterus, and found that only 18% were offered
UFE, even though it's a less invasive treatment than
traditional surgery. But that doesn't make it the top
option, argues U of T gynecologist Christine Derzko.
"I think we go overboard when we get too enthusiastic
about a treatment and forget that there are complications,"
she says.
UFE
SIGHTINGS
The procedure shrinks fibroids by blocking off their
blood supply. The radiologist makes a small cut in the
groin and inserts a catheter into the femoral artery.
The catheter is guided up to the uterine arteries, and
a mixture of plastic particles and x-ray dye is then
injected. The tiny beads flow into the fibroid and pile
up until the blood supply is cut off. The whole process
is monitored by x-ray to make sure the beads are blocking
the right spot.
But even with careful monitoring,
mistakes can happen. "If you block the wrong artery,
you'll be hitting down the leg, then you're in trouble,"
says Dr Derzko. Fertility preservation is not guaranteed,
she adds, because there's a risk the ovaries might fail
due to a blocked blood supply. And because the fibroids
shrink and occasionally fall inside the uterus without
getting expelled, infection is yet another potential
danger. Once that sets in, hysterectomy is the only
solution.
FIBROID
OPTIONS
Fibroids are very common, and mostly small, but up to
40% of women over the age of 35 will have large ones
(some as big as a cantaloupe) — though they don't
all have to be treated. "You would treat if the fibroids
cause problems like pain, heavy bleeding or pressure
on surrounding tissue, like the bladder or the rectum,"
says Dr Derzko.
Depending on the size, location
and number of fibroids, treatments include their surgical
removal, or myomectomy, and hysterescopic resection
— the clipping off of fibroids by chunks. Both
largely preserve fertility. UFE is a good alternative
for women who want to keep their fertility and whose
only other option is a hysterectomy. "It needs to be
explored with patients," says Dr Derzko, who does refer
some patients for UFE. "It's not something that we've
got the final word on; it may very well end up to be
one of the recommended treatments."
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