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Uterine Artery Embolization (UAE)

Stomach Pain

Uterine Artery Embolization (UAE) is a minimally-invasive, uterine-sparing,  interventional radiology procedure that is used to treat women with medical conditions that affect the uterus including:

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Uterine fibroids: These are noncancerous growths that develop in the uterus and can cause heavy menstrual bleeding, pelvic pain, and pressure on the bladder or bowel.

Adenomyosis: This is a condition in which the tissue that normally lines the uterus grows into the muscular wall of the uterus. This can cause heavy menstrual bleeding, pain during menstruation, and an enlarged uterus.

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UAE is a non-surgical alternative to invasive procedures including hysterectomy, myomectomy, and hysteroscopic resection.

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Also referred to as Uterine Fibroid Embolization (UFE) when treating only symptomatic uterine fibroids.

A&I Protocol

  • Seldinger technique is used to gain access into the common femoral artery (CFA)

  • A 5 French (F) sheath and an 0.035" wire are inserted into the artery and then a 5 F Pigtail catheter is navigated up the abdominal aorta and positioned above lumbar vertebrae 1/2 (L 1/2).

  • A contrast injector digital subtraction angiography (DSA) run is performed of the aortogram, which is used as a roadmap to navigate a 5 F curved catheter (e.g. Cobra) over the aortic bifurcation and to the contralateral internal iliac artery (IIA).

  • The aortogram is used to also check for any ovarian artery association (OAA) that may be contributing to the uterine growth and blood supply.

  • Once the catheter is positioned in the left IIA, a DSA run is performed to visualize the origin of the left uterine artery. This is used as a roadmap.

  • A micro-catheter (e.g. 0.027" diameter) and micro-wire are inserted through the 5 F catheter, and navigated into the left uterine artery.

  • A catheter position check can be performed using DSA to highlight the vasculature of the uterine fibroid or adenomyosis, and non-target vessels can be bypassed.

  • Embolic particles are prepared and injected into the left uterine artery to deprive the tissue of blood and nutrients, causing the growths to undergo cell death and shrink, leading to symptom relief.

  • After the left uterine artery is embolised, the catheter system is retracted. The 5 F curved catheter is inserted into the ipsilateral side or right internal iliac artery.

  • A DSA run is performed to visualize the origin of the right uterine artery. This is used as a roadmap.

  • The micro-catheter and micro-wire are navigated into the right uterine artery.

  • A catheter position check can be performed using DSA to highlight the vasculature of the uterine fibroid or adenomyosis, and non-target vessels can be bypassed.

  • Embolic particles are injected into the right uterine artery until stasis is achieved.

  • If OAA was seen on the aortogram, then a 5 F hooked catheter (e.g. Shepards hook) is used to access the ovarian artery origin/s (left or right or bilateral) and are embolized with particles if adequate flow to the uterus is demonstrated using contrast.

  • If no OAA was seen on the aortogram, then a 5 F closure device is deployed to close the CFA access site.

DSA aortogram showing blood supply to uterine fibroids.

References

  1. McPherson K, Cooper KG, French L, et al. Uterine artery embolization versus surgery for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2020 Nov 20;11(11):CD005073. doi: 10.1002/14651858.CD005073.pub5. PMID: 33216448.

  2. Elraiyah T, Abu Dabrh AM, Ali A, et al. Comparative Effectiveness of Uterine Artery Embolization versus Hysterectomy in the Treatment of Symptomatic Uterine Fibroids: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol. 2021 Mar;32(3):365-375.e1. doi: 10.1016/j.jvir.2020.08.008. Epub 2020 Oct 13. PMID: 33065384.

  3. Wu J, Chen M, Zhao Y, et al. Uterine artery embolization versus myomectomy for symptomatic uterine fibroids: a systematic review and meta-analysis. J Obstet Gynaecol. 2021 May;41(4):475-482. doi: 10.1080/01443615.2020.1824171. Epub 2020 Oct 20. PMID: 33081638.

  4. Wang Y, Luo C, Xu L, et al. Uterine Artery Embolization versus Hysterectomy for Treatment of Symptomatic Uterine Fibroids: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Vasc Interv Radiol. 2021 Jul;32(7):1007-1015.e1. doi: 10.1016/j.jvir.2021.02.016. Epub 2021 Apr 16. PMID: 33865546.

  5. Jiang W, Zhou Z, Cheng Y, et al. Safety and Efficacy of Uterine Artery Embolization in the Treatment of Symptomatic Fibroids: A Meta-Analysis. J Minim Invasive Gynecol. 2021 Aug 7;S1553-4650(21)00727-2. doi: 10.1016/j.jmig.2021.07.032. Epub ahead of print. PMID: 34371194.

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