In Reply to: Case 497_03 -- Embolization of uterine fibroids posted by Editor on April 18, 1997 at 11:18:29:
As of today I have performed 29 of these cases, and the UCLA group a bout the
same number. The following results are NOT a formal presentation, but a rough
statement of outcomes (We plan to assemble our data and be able to publish in
about 6 months):
Results: All patients have had significant improvement in menometrorrhagia, with
normal menses maintained. Most patients have had significant improvement in bulk
symptoms (pain, fullness, etc.)
Recovery period: The initial 6-12 hours post-procedure is very uncomfortable, with
patients requiring IV narcotics for control of acute ischemic pain. Almost all have
felt much better by the following morning and are discharged on oral medication. About
10-15% have further severe pain requiring further medication or readmission. The pain
tails off over several days and almost all patients feel back to baseline by POD #8-10
(compare with hysterectomy/myomectomy with recovery periods of several weeks).
Complications:
1 patient developed severe post-embolization syndrome and went on to
hysterectomy on POD #12 because of suspected infection. The fibroid weighed 7kg, the
surgery was practically bloodless, and all cultures were negative.
1 patient developed a small groin hematoma.
In one patient a coil was displaced proximally during catheter withdrawal, coming to rest
partially in the Uterine A., and partly in the Anterior Division trunk. This resulted in
thrombosis of the Anterior Division on that side, which is clinically silent.
1 patient had a grand-mal seizure 24 hours post-procedure. Her workup included an EEG, which
was abnormal. The patient finally admitted to a history of seizure disorder, which she had
hidden from our team for fear that we would not perform the embolization.
1 patient developed severe nausea and vomiting from IV Morphine post-procedure, and developed
a Mallory-Weiss tear. The UGI bleed was self-limited and there have been no further problems
with this patient.
We are continuing to refine the technique and anesthesis/analgesia protocols, with an aim
to develop a protocol that will allow us to discharge patients 6-10 hours oafter the procedure.
The important issue for developing a program is to work with an interested Gynecologist who is
willing to screen patients. So far, about half of the patients who have sought screening are
candidtates for the procedure. A significant portion of the rest can be funneled into the Gynecologist's
practise for other procedures and management options. Many Gynecologists (justifiably) see this procedure
as a threat to their operative caseload, and will be unwilling to work with us in this manner, at
least initially.