Occlusion of Uterine Arteries Using Transcatheter Embolization

Introduction 

Uterine artery embolization (UAE) is a procedure done to treat conditions affecting the uterus, especially those that can cause bleeding. This method is considered an alternative for surgical interventions such as hysterectomy. Fibroids are noncancerous (benign) growths in the uterus. During UAE, a radiologist uses a catheter to deliver small particles that block the uterine arteries that supply blood to the fibroid. The blockage reduces the blood flow that brings the fibroid. A decrease in blood flow causes fibroids to shrink, and to alleviate the symptoms such as heavy menstrual bleeding and pelvic pain that they often cause. UAE serves as an alternative to surgery to treat fibroids. The procedure takes less recovery time than surgical treatments.

Understanding Uterine Arteries and Conditions

It is important to understand what the uterine arteries are and what conditions may be associated with the uterine arteries when it comes to reproductive health in women. The uterine arteries are major blood vessels that come off the front of the internal iliac arteries and supply blood to the uterus, blood which is critical for both its health and function. Dysfunction of the uterine artery or any condition that impacts the flow of blood through it can impact the overall health and fertility of an individual woman.

• Fibroids: These are noncancerous growths that grow in, on, or outside of the uterus. They tend to be benign and often grow in childbearing years. They can lead to symptoms such as heavy menstrual bleeding, prolonged periods, and pelvic pain.
• Endometriosis: Endometriosis is a physically painful disorder where tissue similar to the lining of the uterus grows off of the uterine cavity; often, they are grown by or are suffocating the uterine artery.
• Pelvic Inflammatory Disease (PID): Pelvic Inflammatory Disease (PID) is an infection within the reproductive organs that can cause harm to the uterine artery and lead to many other health issues.
• UAE (also known as Uterine Artery Embolization): This is a treatment, not a condition, to treat fibroids. It consists of blocking the uterine artery and cutting off the blood supply to fibroids; thus causing them to shrink.

Learning about these conditions and treatment options such as uterine fibroid embolization is critical to women’s health and studies help them to gain knowledge about symptoms, diagnosis, and possible treatments.

Transcatheter Embolization: How it Works

Transcatheter embolization treatment is a medical procedure that blocks blood vessels. Embolization is a low-risk, minimally invasive therapy that intentionally lodges material in order to obstruct blood flow in a specific area. Here’s how the process often goes:

• Preparation: Before the procedure, many people will receive blood evaluations, imaging tests like CT scans or magnetic resonance imaging (MRI), and a review of their health background. It is often necessary to avoid eating or drinking for a certain amount of time ahead of the procedure.
• Gaining Access: The procedure starts with the establishment of a small cut, typically in the groin, to enter a blood vessel. A catheter (a tiny, versatile tube) is then passed beneath the vessel wall and guided to the vessel.
• Stepping through the Proces: The catheter is moved to the target vessel by a series of chosen pathways. Vaccinations are commonly provided to aid the doctor in moving the catheter.
• Embolization: Elements meant to plug the blood vessel are then distributed, always by way of the catheter. These can range in size from tiny beads to coils, or from jellies to dense agents.
• Checking the location and removing the catheter: The place of the catheter is tracked using fluoroscopy (a kind of x-ray) to arrange the medication. The vessels or vessels in the target area are completely blocked using embolic agents. When it is affirmed that the blood has been halted, the catheter is slowly removed.
• Post-procedure care: Probably, some patients will have to lie flat on their back for a short course of time after surgery to deter bleeding from where the catheter was placed. Careful monitoring for complications after the procedure is normal, and many patients are allowed to depart their healthcare facility the day after surgery.

Transcatheter embolization is now performed for many types of conditions, including treatment of uterine fibroids (uterine artery embolization), liver cancer (hepatic artery embolization) and persistent gastrointestinal bleeding. This technique is much less invasive than surgical procedures, and can often be done instead of surgery, or be used as part of a surgical procedure.

Recovery and Aftercare

Recovery and aftercare are essential for achieving optimal outcomes and preventing complications following transcatheter embolization. The following are important points to remember:

• Rest: Most patients are advised to rest for a few days after the procedure. Avoiding heavy lifting and extensive activity is recommended.
• Pain Control: Some discomfort or pain may be expected after an embolization. Doctors will generally recommend medications for pain control. Be certain to follow instructions for the medicine.
• Wound care: It is important to take care of incision to prevent infection. It is not unusual to have tenderness commonly called a “bruise”, just above the groin area where a small tube (catheter) was inserted into the artery. The amount of tenderness will vary among individuals. Keep the area clean and dry.
• Watch for Complications: Patients should keep an eye out for signs of complications. A fever or chills may be due to infection, or a large bruise or signs of excessive bleeding may be the result of a significant hematoma. Any significant change in urination or an inability to urinate is a serious concern and warrants calling the doctor now. 
• Follow-up: It is important that you schedule and keep all appointments. The researcher will continue to monitor your recovery and evaluate the overall effectiveness of the therapy.
• Staying Hydrated and Well-nourished: Adequate hydration and a balanced diet will assist in the healing process. Some physicians make specific recommendations.
• Gradual Return of Activity: Gradually returning to normal activities per individual healthcare providers.

Adhering to these aftercare instructions will help to ensure a smooth recovery and reduce the risk of complications following a transarterial embolization.

Complications of Transcatheter Embolization

Embolization is generally a safe procedure. As is the case with any medical procedure, complications can occur. Here are some potential complications with  Transcatheter embolization:

• Post-embolization syndrome: Patients often experience pain, fever, and nausea/vomiting. This generally can last several days and is controlled easily with pain/nausea medication.
• Infection: Although very rare, infections can occur at the catheter insertion site or within the embolized area. Signs of infection include fever, redness, swelling, drainage, or pain at the incision site.
• Non-Target Embolization: This is when the material used to block off the blood vessel is accidentally lodged in a blood vessel that was not intended to be treated. This may cause harm to the area where that vessel travels.
• Vessel Damage: As the procedure involves placing a catheter within a blood vessel, it is possible that the blood vessel may be injured, torn, or punctured.
• Blood Clots: There is some risk of developing blood clots within the blood vessel where the catheter is placed. These clots can sometimes travel and cause serious complications such as stroke, or even lung clots (pulmonary embolism).

Although these complications are potentially serious, they are infrequent, and for most patients, the benefits of transcatheter embolization outweigh the risks. You should discuss your individual risk and benefit with your physicians.

Conclusion

Transcatheter embolization is a more delicate and minimally invasive procedure than open surgical ligation. Performed under local anesthesia, it involves threading a small catheter through a large artery and up to the site of the injured vessel. Once there, the physician uses embolic material, such as a small metal coil or chemical agent, to plug the broken vessel. The coil or chemical agent changes the structure of the vessel so it scars over and becomes impassable. This is an effective method of permanently halting bleeding, which carries many risks and can lead to the loss of large amounts of blood.

FAQs

1. How long does the transcatheter embolization procedure take?

The procedure typically takes 1-3 hours, depending on the complexity and the area being treated.

2. Is transcatheter embolization a permanent solution?

For many conditions, like uterine fibroids, it can provide long-term relief. However, it may not be a permanent solution for all patients, and some conditions might require additional treatment.

3. Can transcatheter embolization affect fertility?

It can potentially impact fertility, especially in treatments like uterine artery embolization. Patients planning future pregnancies should discuss this with their doctor.

4. Are there any dietary restrictions post-procedure?

There are generally no strict dietary restrictions post-procedure, but patients are advised to eat light meals and gradually return to their regular diet.

5. Can transcatheter embolization be repeated if needed?

Yes, the procedure can be repeated if necessary, especially if the initial embolization did not fully treat the condition or if the condition recurs.