Uterine Artery Embolisation (Fibroid embolisation) in Cyprus
Fibroids are benign (non-cancerous) growths of the womb (uterus). They are very common in women of reproductive age and usually do not cause any problems. If they increase in size and/or number they can cause heavy bleeding (menorrhagia), pain, pressure symptoms or a combination of the aforementioned.
Uterine Artery Embolisation is a procedure in which Dr Zertalis can navigate a fine tube (catheter) into the blood vessels supplying the uterus (uterine arteries) and inject fluid containing very small spheres (embolic particles) in order to block the small arteries and starve the fibroids of their blood supply. This makes the fibroids decrease in size and subsequently provide symptomatic relief.
Benefits
Uterine artery embolisation should be considered in women with symptomatic fibroids of reproductive age who wish to preserve their uterus.
There is scientific evidence demonstrating that uterine artery embolisation results in similar symptom relief, quality of life and patient satisfaction as surgery. Further benefits include faster recovery and less complications with successful control of heavy bleeding (menorrhagia) in 92% and improvement of pressure symptoms in up to 96% of women at 12 months.
Risks
Uterine Artery Embolisation is a safe, effective and accurate procedure, but as with any medical procedure there are some risks and complications that you may uncommonly experience.
Pain: Some patients experience pain after the procedure, often described as period-like pain. This can vary from mild to severe and it tends to be worse 3 to10 hours after the procedure. This can be well managed with painkillers (analgesia).
Bleeding: Risk of bleeding that is significant is rare. Uncommonly you may get a small bruise at the needle entry point in the groin.
Infection: The risk of infection presenting as pain, fever, smelly vaginal discharge and pelvic tenderness occurs in less than 2% of women. This can be managed with antibiotics however in severe cases a hysterectomy (surgical removal of the uterus) may be necessary, although this is rare.
Post-Embolisation Syndrome: This is a common inflammatory response of the body to the procedure of embolisation and starving the uterus and fibroids of their blood supply. It can present as general weakness (fatigue), muscle ache (myalgia), and low-grade fever. This responds well to pain killers such as paracetamol and anti-inflammatories (ibuprofen).
Vaginal Discharge: As the fibroid shrinks and breaks down you may experience vaginal discharge during the first few months of the procedure although this is more common during the first month.
Early Menopause: Less than 5% of women may experience early menopause, although this is more common in women older than 45 years of age. It can take up to nine months to return to a regular menstrual cycle.
Embolisation & Pregnancy: Please consult your fertility doctor if you wish to have the procedure as well as try to get pregnant, as they may advise you to not attempt to get pregnant for six months following the procedure.
Allergy to contrast (X-ray dye): Most adverse events are mild and can be managed safely in our department. A major life-threatening contrast reaction is rare (< 0.005%).
Kidney Impairment: Impairment of kidney function can occur following the treatment due to the contrast agent, the anti-cancer drug or dehydration. You will have a drip placed before the procedure. This is to give you sufficient fluids to minimise the risk of problems with kidney function.
Radiation Risk: Immediate harmful effects such as skin burns, or radiation sickness are extremely rare. The radiation dose you receive during the procedure is monitored to prevent this. On rare occasions the procedure will have to be stopped if the threshold for immediate harmful effects is reached. Increase in lifetime risk of cancer due to radiation per examination is also rare (< 0.001%).
Dr Zertalis will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and remember that even at this stage, you can still decide not to go ahead with procedure if you choose to do so.
Before the procedure
The procedure is performed under local anaesthetic and sedation. You will be asked not to eat or drink for 6 hours before the procedure. Where necessary a blood test may be required. A small and thin plastic tube (cannula) will be placed into a vein in your arm.
Antibiotics and anti-inflammatory medication will be administered prior to the procedure to minimise the risk of infection. Patient controlled analgesia (PCA) is a special device connected to your cannula which will allow you to deliver painkillers to yourself after the procedure by pressing a button. You should expect to be an inpatient for 24 hours.
Please let Dr Zertalis know about any medications you take, any allergies you may have and if you previously have had a reaction to the x-ray dye (contrast).
The procedure
You will be asked to change into a hospital gown and lie on the X-ray table flat on your back. You will have devices attached to your chest, arm and finger to monitor you pulse, blood pressure and oxygen levels. You will be given a sedative to relieve anxiety. This is standard for all minimally invasive interventional radiology procedures performed in Cyprus.
The procedure is performed under sterile conditions and Dr Zertalis will wear sterile gowns and gloves. The skin near the point of insertion at the top of the leg (usually the right groin) will be cleaned with antiseptic and you will be covered with sterile drapes.
Dr Zertalis will use ultrasound to inject local anaesthetic in your groin and place a fine plastic tube (vascular sheath) into the artery (common femoral artery).
Dr Zertalis will use X-ray equipment to navigate and guide another fine plastic tube (catheter) through the sheath into the arteries, which supply the fibroids. X-ray dye (contrast) will be injected through the catheter to identify the fibroids and define the anatomy of your uterus. You may experience a warm feeling in the pelvis – this is normal. The arteries supplying the fibroids are blocked by injecting small spheres suspended in liquid (particles). At the end of the procedure the catheter and vascular sheath are removed and pressure is applied to the groin for 10-15 minutes to prevent bleeding.
Every patient is different, however, expect to be in the radiology department for about 45-60 minutes.
After the procedure
You will be transferred to your ward where your pulse, blood pressure, oxygen levels and the entry site in the groin will be checked by our team at regular intervals. You should expect to be in bed for 6 hours and to stay in hospital for 24 hours. Some women need to stay longer although this is unlikely.
You will be advised to rest at home for 48 hours. If you experience pain, weakness and mild fever this can be well controlled with pain killers and anti-inflammatory medication. Please discuss return to work and exercise with Dr Zertalis as this varies between patients.
Dr Zertalis will organise a follow-up appointment 1 month after the procedure and an MRI scan in 6-9 months to evaluate fibroid size and determine the outcome of the procedure.
