Fibroid Embolisation

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This leaflet tells you about the procedure known as fibroid embolisation, explains what is involved and what the possible risks are. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion. It is almost certain that you are having the fibroid embolisation done as a pre-planned procedure, in which
case you should have plenty of time to discuss the situation with your Consultant and the Radiologist who will be doing the fibroid embolisation, and perhaps even your own GP. If you need the fibroid embolisation as an emergency, then there may be less time for discussion, but none the less you should have had sufficient explanation before you sign the consent form.

What is fibroid embolisation?
Fibroid embolisation is a way of treating fibroids by blocking off the arteries that feed the fibroids, the uterine arteries, and making the fibroids shrink. It is performed by a Radiologist (a Doctor that specialises in x-rays), rather than a surgeon, and is an alternative to an operation.

Why do I need fibroid embolisation?
Other tests that you have had done will have shown that you are suffering from fibroids, and that these are causing you considerable symptoms. Your Gynaecologist and your GP should have told you all about the problems with fibroids, and discussed with you ways of dealing with them. Previously, most fibroids have been treated by an operation, generally a hysterectomy, where the womb is removed altogether. In your case, it has been decided that embolisation is the more appropriate treatment.

Who has made the decision?
The Doctors in charge of your case, and the Radiologist doing the fibroid embolisation, will have discussed the situation, and feel that this may be the most suitable treatment. However, it is very important that you have had the opportunity for your opinion to be taken into account, and that you feel quite certain that you want the procedure doing. If, after full discussion with your
doctors, you do not want the fibroid embolisation carried out, then you must decide against it.

Who will be doing the fibroid embolisation?
A specially trained doctor called a Radiologist. Radiologists have special expertise in using x-ray equipment, and also in interpreting the images produced. They need to look at these images while
carrying out the procedure. Consequently, Radiologists are the best trained people to insert needles and fine catheters into blood vessels, through the skin, and place them correctly.

Where will the procedure take place?
The procedure will be carried out in the specially adapted Interventional Suite in the x-ray department.

How do I prepare for fibroid embolisation?
You need to be an in-patient in the hospital. You will probably be asked not to eat for 6 hours beforehand. You will be asked to put on a hospital gown. A plastic cannula will be put into a vein usually in the back of your hand. If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium, the dye used for kidney x-rays and CT
scanning, you must also tell your doctor about this.

What actually happens during fibroid embolisation?
You will lie on the x-ray table, generally flat on your back. You will also have a monitoring device attached to your chest and finger, and may be given oxygen through small tubes in your nose. The radiologist will keep everything sterile and will wear a theatre gown and gloves. The skin near the point of insertion, probably the groin, will be swabbed with antiseptic, and then most of the rest of your body covered with a theatre drape. The skin and deeper tissues over the artery in the groin will be anaesthetised with local anaesthetic, and then a needle will be inserted into this artery. Once the radiologist is satisfied that this is correctly positioned, a guide wire is placed through the needle, and into this artery. Then the needle is withdrawn allowing a fine, plastic tube, called a catheter, to be placed over the wire and into this artery.

The radiologist will use the x-ray equipment to make sure that the catheter and the wire are then moved into the correct position, into the other arteries which are feeding the fibroid. These arteries are called the right and left uterine arteries. A special x-ray dye, called contrast medium, is injected down the catheter into these uterine arteries, and this may give you a hot feeling in the pelvis. Once the fibroid blood supply has been identified, tiny particles are injected through the catheter into these small arteries which nourish the fibroid. This silts up these small blood vessels and blocks them so that the fibroid is starved of its blood supply. At the end of the procedure, the catheter is withdrawn and the radiologist then presses firmly on the skin entry point for several minutes, to prevent any bleeding.

Will it hurt?
When the local anaesthetic is injected, it will sting to start with, but this soon passes off, and the skin and deeper tissues should then feel numb. You may feel some discomfort during the procedure itself. However, there will be a nurse, or another member of staff, standing next to you and looking after you. If the procedure does become too painful for you, then they will be able to arrange for you to have some painkillers through the needle in your arm. As the dye, or contrast medium, passes around your body, you may get a warm feeling, which some people can find a little unpleasant. However, this soon passes off and should not concern you.

How long will it take?
Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Some fibroid embolisations do not take very long, perhaps an hour. Other embolisations may be more involved, and take rather longer, perhaps over two hours. As a guide, expect to be in the x-ray department for about two hours.

What happens afterwards?
You will be taken back to your ward on a trolley. Staff on the ward will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no untoward effects. They will also look at the skin entry point to make sure there is no bleeding from it. You will generally stay in bed for at least 3 hours, until you have recovered.

Are there any risks or complications?
Fibroid embolisation is a safe procedure, but there are some risks and complications that can arise, as with any medical treatment. There may occasionally be a small bruise, called a haematoma, around the site where the needle has been inserted, and this is quite normal. If this becomes a large bruise, then there is the risk of it getting infected, and this would then require treatment with antibiotics. Most patients feel some pain afterwards. This ranges from very mild pain to severe crampy, period-like pain. It is generally worst in the first 12 hours, but will probably still be present when you go home. It can be controlled by pain killers while you are in hospital. You may be given further tablets to take home with you. Most patients get a slight fever after the procedure. This is a good sign as it means that the fibroid is breaking down. The pain killers you will be given will help control this fever. A few patients get a vaginal discharge afterwards, which may be bloody. This is usually due to the fibroid breaking down. Usually, the discharge persists for approximately two weeks from when it starts, although occasionally it can persist intermittently for several months.
This is not in itself a medical problem, although you may need to wear sanitary protection.

If the discharge becomes offensive and if it is associated with a high fever and feeling unwell, there is the possibility of infection and you should ask to see your gynaecologist urgently. The most serious complication of fibroid embolisation is infection. This happens to perhaps two in every hundred women having the procedure. The signs that the uterus is infected after embolisation include great pain, pelvic tenderness and a high temperature. Lesser degrees of infection can be treated with antibiotics, and perhaps a small operation on the womb, a “D and C” (Dilatation and Curettage). Once severe infection has developed, it is generally necessary to have an operation to remove the womb, a hysterectomy. If you feel that you would not want a hysterectomy under any circumstances, then it is probably best not to have fibroid embolisation performed.

What else may happen after this procedure?
Some patients may feel very tired for up to two weeks following the procedure, though some people feel fit enough to return to work three days later. Some patients may be advised to take at least two weeks off work following embolisation. Approximately 8% of women have spontaneously expelled a fibroid, or part of one, usually six weeks to three months afterwards. If this happens, you are likely to feel period like pain and have some bleeding.  A very few women have undergone an early menopause, the change of life, after this procedure. This has probably happened because the process has started prior to the embolisation.

Some of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Do satisfy yourself that you have received enough information about the procedure, before you sign the consent form. Fibroid embolisation is considered a safe procedure, designed to improve your medical condition and save you having a larger operation. There are some risks and complications involved, and because there is the possibility of a hysterectomy being necessary, you do need to make certain that you have discussed all the options available with your doctors.

Please remember that this leaflet is intended as general information only. It is not definitive, and the RCR(Royal College of Radiologists) and the BSIR (British Society of Interventional Radiology) cannot accept any legal liability arising from its use. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please therefore always check specific advice on the procedure or any concerns you may have with your doctor.

Our contact number is 01908 996934 and we are available from 8.30am until 5pm, Monday to Friday. Please do not hesitate to contact us, we will be happy to answer any queries that you may have.

Royal College of Radiologists 06/02. Handbook of interventional Radiology and Angiography. 2nd edition Mosby, Myron Wojtowycz. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please therefore always check specific advice on the procedure or any concerns you may have with your doctor.