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FIBROID EMBOLIZATION . . . how the embolization technique works The Fibroid Embolization
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Cut off the blood supply to a tissue, and it will break down and be reabsorbed by the body. There have been several different ways tried to do this such as: (1) Through an abdominal incision, tie off the blood supply to the fibroid, or (2) During a laparoscopy procedure insert electrodes into a fibroid and injure its blood supply. All of these have had varying degrees of success. Adaptation of a new technique using a patient's blood vessel as a highway! By now, Interventional Radiologists had developed techniques to enter the arterial supply of the patient through a tiny needle placed in the large artery in the right groin. An even smaller catheter (a tiny plastic tube the size of a #8 spaghetti) was manipulated under X-Ray control through the artery straight to the uterine blood supply. It was as if the larger blood vessel had become a highway to lead the radiologist to the right spot! Materials were then injected to stop the blood flow in this vessel. The experiment worked. The technique became very useful in certain cases of hemorrhage after delivery, or in case of bleeding complications from pelvic cancer . The "Grain of Sand" In 1990, French physicians reasoned: Why not introduce "grain of sand" size particles into the fibroid blood supply to block it? A special Poly-Vinyl Alcohol (PVA) had just the right properties. But they encountered a problem. Even though the Radiologists were able to introduce tiny catheters into the patient's uterine arteries, they were unable to separately enter the blood supply of the fibroids. Then a breakthrough. The physicians noticed that all Fibroids had their major blood supply through a single vessel, and that vessel was VERY large! They reasoned: "If we could introduce tiny particles into the blood supply of the uterus, perhaps the large size of the Fibroid vessels would draw in the majority of the particles?!" It was tried, and miraculously it worked! Most of the particles injected into the uterine artery ended up in the large caliber fibroid vessels. These vessels were rapidly plugged. The smaller blood vessels supplying the normal muscular wall of the uterus were spared almost completely. And very importantly: It worked EVEN in the event of multiple fibroids! Each fibroid would selectively draw in the majority of the little particles. As the physicians watched, they observed that the blood supply to the fibroids was blocked; the blood supply to the uterine wall was not compromised; AND afterwards, the Fibroids began to decrease in size! They had achieved success. (For a discussion of uterine wall blood supply preservation, refer to an answer in our FAQ which elaborates further on the mechanism called "collateral blood supply".)
Why does a fibroid decrease
in size once its blood supply Any tissue depends upon its blood supply for Oxygen and Nutrients. When it loses these essential ingredients, the tissue begins to degenerate and break up. The body has the remarkable ability to reduce these tissues to simpler chemicals, which in turn are washed away and removed. This is the cause of the decrease in fibroid size which is observed. There are several reactions which result from this process that explain two symptoms our patients observe: (1) Pain - begins shortly after the procedure, and is caused because the oxygen supply of the tissue drops. This can last about 7-10 hours before it begins to lessen. After this, the pain is controllable by Motrin (Ibuprofen) or by taking with the Motrin other oral pain medications such as Percocet. In order to keep our patients comfortable, we use epidural anesthesia for the procedure (the same anesthesia used at our hospital for patients in labor.) This provides complete pain relief during the procedure. At the same time, our anesthesiologists inject a tiny dose of Morphine into the epidural catheter when it is removed. Thus when the epidural wears off in 1-3 hours, this medicine keeps the patient virtually pain free for another 12-18 hours. And she is wide awake and chatting with visitors as well. By the time this wears off, the heavier pain associated with the procedure has dissipated, and she can easily be discharged with simple oral pain medications. (For a brief discussion of alternative pain relief methods and their effectiveness, read this pertinent question in our FAQ.) (2) Fever - The "Post-Embolization Fever Syndrome" occurs in a minority (20%) of all cases. Yet this group of patients may run a fever (occasionally as high as 102 degrees F) from any time after the procedure up until 10 days afterwards. Usually if 36 hours goes by, and there is no fever, the syndrome generally will not appear. However, once begun, the fever can take 7-10 days to subside. This is not a complication, but results from the patient's body reacting to the breakdown products from the fibroid. It is more common when very large fibroid masses are embolized. Fever should always be reported and carefully evaluated by the Gynecologist for possible infection. However, usually the good news is that there is no infection and antibiotics are not required. Sitting it out with Motrin (Ibuprofen) is the treatment of choice, and this seems to work well. Results: The degree of Post-Treatment shrinkage of the fibroid is somewhat related to the size of the fibroid at the start. In our experience, if the fibroid is at or below the level of the navel - we expect a 40-60% decrease in size. If it is above the navel in size, there is a more modest 0-20% change. The reason for this is not clear, but may be related to the fact that though the major blood supply is one vessel - larger fibroids may develop blood supply through its capsule from other vessels (a so-called collateral blood supply) arising from the wall of the uterus. |
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We have documented two interesting cases by repeat MRI examination. Click on the picture to take a brief course in understanding MRIs, and then view the two animated GIFs showing how the fibroid changed in size over the weeks following the treatment. (27wks in the first; 40 weeks in the second) The white arrows outline the
original mass of 
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