What is UFE? - Side Effects and Complications
In general, UFE is safe and well tolerated. While side effects and complications can occur, they are considerably less frequent than with the surgical alternatives of myomectomy or hysterectomy.
Almost all patients have some degree of crampy pelvic pain for the first 6-8 hours following the procedure, managed with a morphine PCA (patient controlled analgesia) pump that allows delivery of IV pain medications by pushing a button. The cramping is much improved by the next morning and patients are discharged home. Cramping may persist for a few days but is usually well controlled with NSAIDs (motrin) and oral narcotics as needed. Most patients are back to their usual activities in 7-10 days.
Spotting or a brown discharge may occur for days to weeks after the procedure. In ~5% of cases a submucous fibroid may detach from the uterine wall, fall into the cavity, and pass out the vagina. If the fibroid is too large to pass it may require assisted removal by a gynecologist. Fibroid expulsion can occur days to several months after the procedure.
While UFE is much less invasive than the surgical alternatives, there remains the possibility of complications. Minor complications related to angiography occur in <5% of cases. These include bleeding or bruising at the catheter entry site. Rarely (<1%) the femoral artery can be damaged or may develop clot, compromising flow to the leg. Allergic reactions to the xray dye may occur and can be treated. Those patients with a history of allergic reaction to xray dye should be pre-medicated prior to the procedure.
Serious complications are very uncommon. The most serious are four deaths following UFE. A patient in England developed a serious infection following the procedure. She underwent hysterectomy but developed infection in her bloodstream and died from multi-system failure, two weeks later. A patient in the Netherlands recently died from infection following UFE. A 65 year old woman in Italy (she would not have been treated with UFE in this country due to her age) and a patient from the USA each developed a blood clot in the leg that moved to the lungs (pulmonary embolism) and caused death. These are the only deaths reported worldwide following an estimated 100,000 UFE procedures, for an incidence of 1:25,000. For perspective, the risk of death following an elective hysterectomy is 1:1,000-1:1,500.
Injury to the uterus from infection or ongoing ischemia (inadequate collateral blood supply to the normal part of the uterus) requiring hysterectomy occurs in <1%. Non-target embolization of particles to unintended vessels can occur but is unusual. The significance of this complication depends on the particular vessel embolized. This is very unlikely to occur with careful fluoroscopic monitoring by an experienced Interventional Radiologist.
The measured average dose of radiation from the procedure is comparable to that of several barium enemas or pelvic CT scans. This is well below the threshold for developing any expected adverse effects to the patient or her future offspring. While there have been scattered reports of radiation induced skin injury, these have occurred following prolonged (3-4 hour) procedures. We have not observed any radiation injuries in our seven year experience at the Center.
Most women will resume normal periods within a few months of UFE. For patients under 45 years of age there has been a 1-2% incidence of amenorrhea (no more periods) following UFE. For perimenopausal women >45yo the incidence is up to 15-20%. When amenorrhea is accompanied by menopausal symptoms of hot flashes, irritability, and vaginal dryness hormone replacement therapy can be considered and discussed with your gynecologist.
"Since relocating from the area, I just wanted to let you know that I have had no complications from the procedure, all of my symptoms have been relieved and my uterus has decreased dramatically (from 20 to 10 wks). I could not be more pleased with the result. Thanks so much for all of your help."
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