Uterine Fibroid Embolisation (UFE)
Presentation
Large fibroid uterus, mass sensation. MRI pelvis showed to be amendable to UAE.
Indication
Uterine artery embolisation (UAE) for a fibroid uterus.
Technique
Patient on PCA pump. Pre procedure IV paracetamol and PR diclofenac sodium given. Informed written consent obtained. Patient specifically counselled regarding possible ovarian anastomosis and early menopause - she has agreed to continue as she already feels perimenopausal at present. MRI imaging reviewed - dominant supply is from the right uterine artery. U/S guided left CFA puncture. 4F long sheath and 4F C3 catheter up and over to the right IIA. Angiography identified the large right uterine artery with extensive supply to the enlarged uterus with the known very large fibroid at its fundus. The right uterine artery was embolised with 9 vials of 2mls Embozene: one 700 microns, three 900 microns, three 1100 microns, two 1300 microns. The left IIA was then cannulated with a catheter and wire - unstable catheter position. The uterine artery was selectively catheterised with a Progreat 2.7F microcatheter and wire. Angiography confirmed position. The left uterine artery was then embolised with one 2ml vial of 700 microns Embozene to stagnation. Total Embozene vials used : 10 vials ( 20 mls) Sheath, catheter and wire removed and haemostasis achieved by manual groin compression. No immediate complications.
Outcome
Partial success. Symptomatic improvement at follow up. Minimal size decrease on imaging follow up.
Discussion
Progressive particle sizing to ensure complete occlusion of large fibroid feeding vessels. Utilising microcatheters for stable, selective vessel cannulation when navigating complex anatomy. Thorough counselling regarding ovarian anastomosis and risk of non-target embolisation and subsequent infertility during informed consent for UAE.