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Post Procedure Information for Patients After Uterine Artery EmbolizationImmediately After the Procedure Almost every patient will spend the night in the observation unit. This is still considered an outpatient procedure as your total time in the hospital is less than 24 hours. Some patients with very mild post embolization syndrome will go home the same afternoon. When do I go Home? The primary symptoms of post embolization syndrome that will limit ability to do well at home are pain and nausea and vomiting. Initally we will use intravenous nacotics and anti-nausea medications. You will control how much pain medication you receive using a Patient Controlled Analgesia (PCA) Pump. We will also start you on an oral pain medication like Vicodin as well as an anti-inflammatory medication like Naprosyn. Once your symptoms are controlled with oral medications and you are able to drink well enough to maintain a good urine output you can go home. What To Expect At Home After the Procedure Most women will experience, to varying degrees, some form of post-embolization syndrome. The most commonly reported symptom of the syndrome is pelvic pain, which persists for a minimum of 2-3 days and may be present for as long as a week or two after the procedure. Post-embolization syndrome also causes other symptoms that are generally described as flu-like (fever, malaise). Like post-operative pain, it is most severe in the hours and days immediately following the procedure and diminishes with time. It is generally well controlled by the use of pain medications. Unlike post-operative pain it will not limit your activity. Limitations on exercise or work will not be imposed after the first 2 days. You may do whatever you feel up to doing. The size of the fibroids and the uterus will diminish slowly with time with the maximum effect seen within the first 6 months, and, typically, within 2-3 months. Menstrual cycles will be interrupted and will be abnormal for a period of 3-4 months. Most women, but not all, will have return of normal menses. Post Embolization Regimen The first six hours are generally spent in bed to allow the artery in your leg to recover from the procedure. At that point in time you may get up and move around but I still prefer that you keep your activity level minimal. After the first 24 hours, you may move about your normal everyday activities provided that they are not too active and you avoiding lifting or carrying objects above 10 pounds. You can go to the store and buy groceries but don't go spend the day at the mall. By 48 hours you can resume all of your usual activities and do anything you feel like doing. I will ask that you not use tampons for the first month after your procedure and that you avoid intercourse until any post-embolization dranage stops. You will take two medications after the procedure for 7 days. The first is an antibiotic called Levaquin to help control infection. The second is a Non-Steroidal Anti-Inflammatory Drug (usually Naproxen or Ibuprofen) to help control the inflammation that occurs post embolization. You will also have prescriptions for a narcotic pain medicine (Tylenol #3 or Vicodin) to take as needed for pain. You will also be prescribed Phenergan suppositories to use as needed for nausea. These medications can be changed depending upon your preferences or allergies. When to Call Us
On the day of the procedure, the risks involved relate primarily to
the fact that you are undergoing an arteriogram with delivery of particles
that are designed to block blood flow. The most common complication that
occurs after an angiogram is to have a hematoma or collection of blood
form around the entry site into the artery. Less commonly, the arterial
puncture sites may not heal normally and you can develop a pseudoaneurysm
or arterial-venous fistula. Damage to the artery supplying the leg can
also affect function of the leg and can cause pain, particularly in the
foot. In general, these complications occur in only 1-2% of patients and
even the worse complications are generally readily fixable with simple
non-surgical and surgical procedures.
Non-target embolization is also another complication that could occur.
This occurs when the particles that are intended for the uterus end up
in some other part of the body. For this procedure, the worse area that
these could end up in would be in your foot. However, since superselective
catheters are being used, non-target embolization is generally limited
to the pelvis, if it occurs at all, where generally there are no sequelae.
Non-target embolization can cause pain or loss of function or tissue death
in areas other than the uterus, if it occurs. This complication would be
very rare. Patients can also have allergic reactions to medications given
during the procedure, such as antibiotics, sedatives, pain medications
or the contrast material used.
Delayed complications arising from this procedure would be more likely
related to tissue cell death within the uterus or the fibroids (or elsewhere
in the case of non-target emboli). This could lead to the formation of
localized areas of infection (abscess) that could require drainage tube
placement or even hysterectomy to treat. In the 3 series referenced above
in the literature, this complication occurred in 2% of patients. Some women
have developed a chronic endometritis after embolization that manifests
as a chronic vaginal drainage. Symptoms of infection generally don't
develop until 7-10 days post procedure and chronic endometritis may not
be diagnosed until 2-3 months post procedure. Generally most women
feel noticeably better by post procedure day 3 and really feel great by
around day 14. Treatment Failure Approximately 15% of patients either have no effect from the embolization or the entire embolization cannot be performed secondary to the presence of small or difficult to catheterize uterine arteries. In this instance, you would require surgery for definitive therapy. The response rate is also variable. On average, fibroids shrink in size, approximately 50-60%. Some patients have less of a response; others have more. In general, the entire uterine volume diminishes roughly 40%. These changes occur slowly with time and take on average 2-3 months to be seen. If no effect has occurred within 6 months, then none probably will. Long-term Effects The application of uterine artery embolization to the treatment of uterine fibroids is a relatively new procedure and therefore long-term data is not available. The longest follow-up to date reported in the series from France has been 5 years. Based on the information we have, most women will resume their normal menstrual cycle. Pregnancy can occur after embolization and women have successfully carried children to normal birth. The risk to the baby's well being in regards to intrauterine growth retardation or other problems are not known. The advantage of hysterectomy over uterine artery embolization is that the entire fibroid can be examined under the microscope. The occurrence or presence of cancer within the fibroid is very rare, but has been demonstrated in other patients. The diagnosis is very difficult to make, even if the entire fibroid is available for microscopic evaluation. Therefore, pre-embolization percutaneous biopsy of your fibroids would not be useful in excluding the presence of cancer. Because the presence of unknown cancer is so rare, that potential risk is not felt to be a reason not to perform this procedure. Post-embolization follow-up with your gynecologist for annual exams will still be required. The other issue that is not known about uterine artery embolization is what the recurrence rate is for fibroids. In the surgical series, when patients have their fibroids removed, preserving their uterus, recurrence of fibroids has been shown to occur. Theoretically, this should occur at a lower rate with embolization because the entire uterus is treated. However, the answer to this question is not known.
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Vascular and Interventional
Radiology | Department of Diagnostic and
Interventional Imaging | |||||
