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Uterus Saved A minimally invasive procedure can control benign
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“Uterine fibroid embolization is a simple treatment
DAVID M. HOVSEPIAN, MD “The Comprehensive Fibroid Center gives women an avenue to find out more about the procedure and the doctors who perform UFE at Washington University.” DAVID M. HOVSEPIAN, MD
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LAST YEAR, Kristin Macon of Webster Groves MO, found out that a large fibroid was causing her heavy periods, pressure in her lower abdomen and frequent urination. It also had caused her uterus to grow to the size of a 16-week pregnancy. Her gynecologist told Macon she had only one treatment option: a hysterectomy. “I was very upset,” Macon says. “I was 44 years old, and I didn’t want to have a hysterectomy.” At least 20 to 40 percent of American women have uterine fibroids, non-cancerous growths that develop in the muscular wall of the uterus. For African-American women, that number may be considerably higher. About 25 percent of women with fibroids develop symptoms like Macon’s; in some women, the heavy menstrual bleeding can lead to anemia, requiring a blood transfusion. These benign tumors also can cause pelvic pain and infertility. For women with troublesome fibroids, hysterectomy was the principal treatment for many years. During a hysterectomy, the uterus is removed surgically. Women who have this surgery often spend several days in the hospital and must recuperate for four to six weeks. They also lose the ability to bear a child, and psychologically, some women lose a part of their gender identity. In the past two decades, new, less drastic treatments have become available, including myomectomy and uterine fibroid embolization (UFE). A myomectomy is a surgical procedure performed by a gynecologist that involves removing individual fibroid tumors while leaving the uterus in place. It is the standard treatment for women who plan to have children, but it is a more complicated operation than a hyster-ectomy, requires general anesthesia and may miss problem-causing fibroids. The other alternative is UFE, an innovative procedure that shrinks fibroids by cutting off their blood supply. David M. Hovsepian, MD, associate professor of radiology, and Suresh Vedantham, MD, assistant professor of radiology, have been performing the procedure at the School of Medicine for five years. The minimally invasive procedure takes about an hour, and patients are sedated but do not undergo general anesthesia. One of the biggest advantages of UFE is a shortened recovery time—an overnight stay in the hospital and a week or so off from work.
During a uterine fibroid embolization, plastic beads fed through a catheter will starve a tumor’s blood supply. During UFE, an interventional radiologist makes a tiny nick—less than one-fourth of an inch—in the patient’s groin and inserts a small tube, or catheter, into an artery. With X-ray guidance, the catheter is threaded through the artery to the uterus and then sends a shower of plastic beads, each the size of a grain of sand, into the artery supplying blood to the fibroid tumor. The particles follow the blood flow into the fibroids, then wedge into the vessels, essentially “starving” the tumors of blood and causing them to shrink. About 90 percent of women who undergo the UFE procedure get relief from their symptoms, and their fibroids shrink measurably, says Hovsepian, who also is an associate professor of surgery and director of Washington University’s Comprehensive Fibroid Center. “I’m very excited about this procedure,” Hovsepian says. “It’s a simple treatment that can have a huge impact.” Uterine fibroid embolization had its beginnings in the early 1990s, when a French doctor named Jacques Ravina performed preoperative embolization in a group of women in an attempt to decrease blood loss during myomectomy. Many women were so happy with the results—the fibroids shriveled and the bleeding stopped—that they cancelled their planned myomectomies. The investigators then conducted a multicenter trial and had the same results. At the University of California, Los Angeles (UCLA), doctors heard about the French group’s published reports and, in 1996, began studying uterine fibroid embolization. In a study of 11 women who had had previous treatment for fibroids who underwent embolization, the procedure was very successful. Hovsepian, who has a clinical interest in gynecologic interventional radiology, was intrigued when he saw the UCLA researchers present the data. “Uterine fibroid embolization was a new application of an old technique,” he says. “We had been embolizing uterine arteries for decades, mostly for trauma, postpartum hemorrhage and other uterine conditions responsible for severe bleeding. I think embolization for fibroids will prove beneficial for many women.” Hovsepian established the Comprehensive Fibroid Center at Washington University in 1998, along with Vedantham; Thomas J. Herzog, MD, associate professor of obstetrics and gynecology, division of gynecologic oncology; and Valerie S. Ratts, MD, assistant professor of obstetrics and gynecology, division of reproductive endocrinology. “The comprehensive fibroid center gives women an avenue to find out more about the procedure and the doctors who perform UFE at Washington University,” says Hovsepian, information they weren’t always receiving from their primary care doctor or gynecologist. The center, which now is one of the largest fibroid treatment centers in the Midwest, is one of 26 core sites in a national registry to study long-term outcomes of UFE on pregnancy and recurrence rates. “It’s still a relatively new procedure,” says Ratts, “but if a patient is close to menopause, UFE may provide symptom relief for several years. Getting women to menopause is the key. At menopause, fibroids typically shrink and stop causing problems.” Since 1996, more than 15,000 women in the United States have undergone UFE for their fibroids, including Kristin Macon, who under- went UFE in October 2002. It was a welcome alternative to hysterectomy. “It has helped symptoms that I was feeling before the surgery, and it gave me an option other than going through major surgery,” says Macon. “I think many women want a less invasive procedure for fibroids.” Deborah Booker of Clayton MO, couldn’t agree more. Fifteen years ago, she had a myomectomy, and her obstetrician/gynecologist warned her then that the fibroids might return. A few years ago they did; Booker’s physician told her a hysterectomy and UFE were her options. She had UFE at the Comprehensive Fibroid Center in September 2002. Booker, who also is associate dean and director of external
relations at the university’s Olin School of Business, was back at
work after a week and exercising at the gym three weeks after her procedure.
“I was out of commission for six weeks after the myomectomy, and
since I do have a comparison, I can say having UFE was much, much easier
on me and my family.”
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