Uterine Artery Embolization as a Management Strategy for Uterine Fibroids: A Review of Mechanism and Evidence

 Uterine Fibroids: An Overview

Uterine Fibroids, or leiomyomas, are growths of a tumor which are not cancerous and develop within or in the vicinity of the uterus. The development of these growths involves smooth muscle cells and connective tissue, and they are different in size, number and position. There are some cases when fibroids can without symptoms while for some other females they tend to cause so many problems in terms of health.

The prevalence of fibroids is alarmingly high, particularly in the reproductive population, with estimates indicating that about 70–80% of women will have fibroids in their reproductive years. It is believed that changes in the levels of progesterone and estrogen among other factors, genetic predisposition and even lifestyles are responsible for formation of fibroid.

Symptoms and Consequences of Uterine Fibroids

Fibroids, while often clinically benign, may produce a myriad of symptoms that can be quite uncomfortable or even incapacitating due to their volume, location and quantity. The extent of these symptoms can adversely hamper a patient’s quality of life. Universal symptoms related to uterine fibroids may involve the following:

1. Heavy Bleeding or Longer Menstrual Periods: One of the primary medical complications of women suffering from fibroids is menorrhagia, an abnormally heavy menstrual period which in some cases, causes anemia and tiredness.
2. Pain and pressure in the Pelvic Region: These fibroids can expand in size and encroach on other structures and organs causing pain or discomfort in the lower abdominal and pelvic areas.
3. Urinary Frequency or Urinary Incontinence: The higher up in size the fibroid is the more likely it is to press onto the bladder and cause frequent trips to the washroom or the inability to fully empty the bladder.
4. Constipation: In some occasions, the fibroids that develop in the backside of the uterus can press against the rectum leading to constipation or difficulty in passing stool.
5. Pain During Intercourse: Some women report pain in the course of sexual intimacy especially where the fibroids are located at the cervix or lowermost part of the uterus.
6. Reproductive Issues: They are further capable of causing problems in containing pregnancy for instance when they distort the cavity of the uterus or block the fallopian tubes and prevent the process of implantation. In some instances, there is a link between these fibroids and repeated episodes of loss of pregnancy.

Considering the multifactorial and complex nature of the signs, treatment is recommended for females who suffer from the fibroids. Conventional surgical approaches like hysterectomy or myomectomy have for a long time been the mainstay treatment of fibroids. Nevertheless, low-risk methods, especially Uterine Artery Embolization (UAE), have been developed and are highly efficient with no large surgical intervention required.

Traditional Surgical Methods vs. Uterine Artery Embolization (UAE)

1. Total Hysterectomy: Total removal of the uterus is a surgical procedure for treatment of uterine fibroids. It is a radical treatment; however, loss of fertility is one of the most devastating potential sequelae as it cannot be conserved in women of child bearing age. Therefore, it can have significant psychological effects on reproductive women.
2. Myomectomy: Myomectomy is surgical procedure that involves excising only the fibroids while preserving the uterus. as such, it is considered more conservative since women do not lose the ability to conceive and carry a baby. however, myomectomy remains a big operation and therefore carries risks like bleeding and sepsis and the risk of developing fibroid again.
3. Uterine Artery Embolization (UAE): This is a minimally invasive technique that entails cutting off the blood supply to the fibroids, where they gradually reduce in size and eventually disappear. This procedure provides non-surgical treatment for myomectomy and hysterectomy associated with less downtime and fewer chances of complications.

Dr. Sandeep Sharma, Head of Interventional Radiology (IR) Facilities, has mastered the uterine artery embolization technique for treating patients with fibroids. Following his deep experience in body as well as neuro intervention that exceeds 16 years, Dr. Sharma provides a unique treatment which is effective, requires no major surgery, and improves the management of fibroids in women.

Uterine Artery Embolization: Procedure and Benefits

Uterine artery embolization is accomplished by blocking the blood supply to the fibroids resulting in a decrease in their size and eventually death. This is a minimally invasive procedure done by interventional radiologists including Dr. Sharma who employs imaging to assist in the procedure ensuring it is done safely and accurately.

Step-by-Step Overview of the UAE Procedure

1. Pre-procedural Evaluation:
   Prior to conducting UAE, Dr. Sharma takes the time to understand the details of the patient’s past and present information. Imaging studies like ultrasound or MRI are ordinarily carried out to examine the number, size and position of the fibroids. This pre-procedural assessment avoids administering additional treatment that the patient does not necessarily need.
2. Accessing the Arteries:
   This procedure is performed under local anesthesia. Access is taken either transfemoral/transradial to cannulate the uterine arteries using catheter and guide wires.
3. Embolization:
   After the catheter has been inserted and placed, very small embolic particles are injected into the uterine arteries above the fibroids, causing obstruction of their blood supply. The particles are designed to be just the right size to obstruct the vessels that supply blood to the fibroids while sparing any surrounding normal tissue. Since the fibroids are not nourished due to the blood supply blockage, they gradually shrink and eventually perish.
4. Post embolization recovery:
   Patients are retained in the hospital Following the procedure for some hours to watch out for immediate complications. Thus most patients are discharged home on the same or next day with little recovery period. In most cases, Dr. Sharma recommends medications and anti-inflammatory drugs to minimize the discomfort that occurs this time.

UAE for the Treatment of Fibroid: the Advantages of Uterine Artery Embolization

1. Minimally Invasive:
   UAE is classified as a minimally invasive procedure, which means that it does not involve large cuts or extensive body dissection. The small incision made in the artery heals quickly without leaving much scar as well as leads to a very short healing process than surgical methods.
2. Fertility Preservation:
   UAE provides benefit to women who want to have a uterus in them the option to do so, thus is a good substitute in place of hysterectomy for women who still want to get pregnant.
3. Less Time Spent Recovering:
   It takes less time to recover from UAE than it takes to go to their normal life from a hysterectomy or a myomectomy. The majority of patients are able to resume their usual routines within a week, in contrast to conventional operations, which may require several weeks or even months for full recovery.
4. Result Oriented Approach:
   A significant number of patients have reported improvement in their symptoms management during and after a few months of undergoing UAE treatment for fibroids which ma also be attributed to the success rates studies conducted on UAE Treatment for Fibroids.

Dr. Sharma has skills when it comes to carrying out a UAE Procedure which means the patients should have the expected outcome with low chances of the patients suffering any complications.

5. Fewer Chances of Recurrence:
While it is possible for fibroids to grow back following a myomectomy procedure the same cannot be said following embolization of the uterus owing to the fact that the procedure aims the blood supply to every fibroid present and not only those that have been cut out.

6. Less Complications:
UAE entails less complications like infections, bleeding out excessively and even injuring adjacent organs than major surgical operations that are performed. An injection is given to the patient before the procedure starts thus there is no general anesthesia which carries its own risks.

Although Dr. Sandeep Sharma’s qualifications in uterine artery embolization are unrivaled, his 16-year long practice in both neuro intervention and vascular intervention, makes him an exceptional uterine artery embolization expert.

He became the first interventionist of uterine artery embolization for fibroid treatment due to his rich academic interventional radiology training and our patient-centric treatment practice.

Besides taking care of patients, he also has dedicated himself in research work to advance this field with use all modern means possible.

This helps to follow the best embolization techniques which help to avoid complications and enhance treatment outcomes. Due to the use of imaging, he is able to do the procedure in an efficient and augmented reality way.

By ensuring that he is always updated on the new inventions in interventional radiology, he is able to provide care of the highest quality to his patients.

CONCLUSION

Uterine fibroids can bring a lot of distress to women, resulting in symptoms like heavy bleeding, pelvic pains, and problems with conceiving. Hysterectomy and myomectomy have been the most compatible treatments for fibroids in the past; however, uterine artery embolization is a less invasive and extremely effective approach.

Thanks to Dr. Sandeep Sharma’s profound skills in interventional radiology, UAE is performed in a way that addresses the problems of fibroids nearly in a risk-free manner and in a significantly shorter time frame. With Dr. Sharma’s way of doing UAE, women are able to avoid risk of infertility and the adverse effects of extensive surgeries considered more effective which many patients prefer.