Fibroid Embolisation

Fibroid embolisation is a relatively new non-surgical technique the first case having been carried out in France in 1991. So far the longest follow-up period is 5 years but results are very encouraging with a success rate of over 85%. In the UK, France and the United States over 5,000 procedures have been carried out and although there is a complication rate this is less than with surgery. The technique is an interventional radiological technique in which a consultant radiologist inserts a small tube into the femoral artery and groin and under x-ray tv control the two arteries which supply the uterus are selectively catheterised and embolised with tiny particles of a solid substance called PVA poly vinyl alcohol. These particles are like tiny grains of sand silt up the vessels around the fibroids which, deprived of their nutrition, die and shrink. The normal uterine tissue is not damaged. The procedure involves 2 nights in hospital and a week off work.


Uterine Artery Embolisation

Uterine artery embolisation (embolization) for fibroids is a relatively new procedure first carried out in France in a small number of cases in the early 90s.  Since then there have been a number of publications on the technique.  The procedure which is non surgical involves the occlusion of blood vessels supplying uterine fibroids.


Procedure

A tiny catheter is inserted under local anaesthetic into an artery in the right groin.  Under X-ray control a micro catheter is introduced selectively into each of the two arteries that supply the uterus.  The micro catheter is passed approximately half way down the artery and then fine particles of a solid substance called PVA (Poly Vinyl Alcohol) are injected through the catheter into the uterine artery.  The particles are carried to the leash of vessels supplying the fibroids.  These vessels become silted up thereby depriving the fibroid of blood which dies and shrinks.  PVA is an inert harmless material which has been used to occlude vessels in other parts of the body for decades.  Small platinum coils may rarely be placed in the uterine artery.  This again is a common embolic material used for decades.

The procedure is technically demanding and requires an experienced Interventional Radiologist to perform it.


Following the procedure the patient usually experiences pain over the next 12 to 24 hours.  The pain varies from mild to severe and is controlled by intravenous and oral analgesics.  Occasionally over the next 3-4 weeks the patient may experience cramps and occasionally some bleeding and if the fibroids are large a mild intermittent temperature.  Patients spend 2 days in hospital and are usually advised to take a full 2 weeks off work.  In our series the average time to patients feeling completely 'normal' is 2.2 weeks. During the procedure intravenous sedation is administered as required.

The complete process of fibroid shrinkage or expulsion (which happens in approximately 15 - 20% of patients) takes about 6 to 9 months. However, most patients notice a considerable improvement in their symptoms within 3 months.


Results of Dr Walker's series, Royal Surrey County Hospital/London Clinic

Dr W J Walker, Consultant Interventional Radiologist at the Royal Surrey County Hospital and the London Clinic, has so far carried out fibroid embolisation on over 1,000 patients over 7 years.  This has received considerable national coverage. In 1996 Dr Walker commenced an ethically approved trial of fibroid embolisation at the Royal Surrey County Hospital which later included the London Clinic.

The results of the trial indicate a very high success rate of 86% with a low incidence of complications i.e. less than 1% incidence of infective complications requiring hysterectomy, a 6% incidence of failure or recurrence, a less than 2% (4 patients) incidence of amenorrhoea (no periods) under the age of 45, and a 6% incidence of troublesome vaginal discharge.  Satisfaction rates (i.e. where patients stated on follow up that they were satisfied with the procedure and would recommend it), for the procedure were over 90%.  Fibroid shrinkages were over 60%.

In our series we have had 45 pregnancies and the results of these pregnancies are summarised in the Table below.

Pregnancy Data September 2004


Number of pregnancies after embolisation 45
Successful deliveries 25
Ongoing pregnancies 6
Miscarriages 10
Ectopic pregnancy 1
Abortion (unwanted pregnancy) 3




Fibroids and Hormone Replacement Therapy.

Fibroids are one of the contraindications to hormone replacement therapy (HRT). This is because the latter can stimulate the growth and activity of fibroids. If however, an embolisation is carried out, except in rare circumstances, all the fibroids are killed and therefore cannot be stimulated by hormone replacement therapy. Thus fibroids are not a contraindication for hormone replacement therapy following embolisation.


About Dr Walker

Dr Woodruff John Walker is a Consultant Diagnostic & Interventional Radiologist. He qualified as a doctor at the Middlesex Hospital in 1970, trained in Radiology at the Groote-Schuur Hospital in Cape Town and carried out his first embolisation for gastro-intestinal haemorrhage in 1976. Since that time he has published numerous articles and chapters on Interventional Radiology and Interventional and Diagnostic Gynaecology. 

In addition to those publications, he has published a further 19 articles and chapters on fibroid embolisation and presented 43 papers at national and international meetings.

He has personally carried out more than 1,000 fibroid embolisations as part of the Royal Surrey and London Clinic trial.

Dr Walker is Lead Gynaecological Cancer Radiologist at the Royal Surrey County Hospital which is a national referral centre for gynaecological cancer.


Dr Walker can be contacted at:

Email: wjwalker@doctors.org.uk

Secretary: 01483 451273


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