Portland, Ore.

Less-invasive procedure helps women avoid hysterectomy

A less-invasive radiological procedure gaining national attention as an alternative to hysterectomy for removing benign growths from a woman's uterus is performed at Oregon Health & Science University's Dotter Interventional Institute.

Uterine fibroid embolization, or UFE, also known as uterine artery embolization, has been performed at OHSU since 1998, but embolization of the uterine artery in treating gynecologic malignancy, postpartum hemorrhage or trauma is a well-established procedure dating back to the 1970s, according to a 2001 paper by former Dotter investigator Robert Andrews, M.D.

The procedure involves threading a tiny tube through a small incision in the groin to the arteries that supply the fibroid. Small particles called emboli are then injected through the tube to block fibroid blood flow, causing it to shrink dramatically. The procedure takes less than two hours, and patients leave the hospital within a day.

John Kaufman, M.D., professor of diagnostic radiology, OHSU School of Medicine, and interventional radiologist at Dotter, said the institute has performed nearly 150 UFE procedures in the last six years. Kaufman, who started a UFE program at Massachusetts General Hospital in 1997 and has carried out all UFEs since arriving at OHSU in 2000, believes it's here to stay. "I think this will become a very integral part of women's health care. For some patients, it's a very good alternative," he said. "But it's not for all patients."

For one, no fibroid is the same. Some growths, such as an adenomyosis, are similar to fibroids, but they don't respond well to embolization. Other fibroids can take the shape of cherries that appear to hang off the edge of the uterus, in which case surgery, but not necessarily a hysterectomy, is needed to remove it.

And there can be other issues: "We don't like to do UFE for somebody having infertility problems related to fibroids, for example, or for a woman desiring to have children," Kaufman said. And, rarely, some people are allergic to the X-ray dye used in angiography, which is required for UFE.

Kaufman says collaboration with OHSU's obstetrics and gynecology team has been key to determining which patients qualify for UFE. "What's important is the consultation and evaluation," he said. "That's why having a team approach is important.

"We think of (UFE) as just one of many elements in the care of gynecology patients."

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