Northside Radiology Associates, P.C.

Uterine Fibroid Embolization

Uterine fibroids are the most common tumor of the female genital tract. They are sometimes referred to as "fibroids" or as leiomyomas or simply myomas. They are not cancerous (benign) growths that develop in the smooth muscle layers within the uterus.

Approximately 50% of American women have fibroids within their uterus and 1/3 of these women are symptomatic.

Symptoms range from bleeding to pressure symptoms. The type of symptoms depends on the location, size and number of fibroids.

Bleeding symptoms include heavy prolonged menstrual periods as well as unusual bleeding in between periods, which can lead to anemia.

Pressure symptoms include pelvic pain, urinary frequency or even incontinence, and constipation. The pelvic pain or pressure is usually secondary to the fibroid compressing nearby structures, or caused by the weight of the fibroid.

The bulk of the fibroid can also cause pressure on the urinary system causing increased frequency of urination, including the need to get up in the night. This can also lead to incontinence in some cases. Increased pressure on the bowel can lead to constipation and bloating.

1. Subserosal fibroids which develop under the outside covering of the uterus and expand outwardly through the wall giving the uterus a knobby appearance. These usually do not affect bleeding, but can cause pelvic pain, back pain and generalized pain symptoms.
2. Intramural fibroids which develop within the lining of the uterus and expand inwardly or outwardly, increasing the size of the uterus. This is most common location for fibroids, and can cause bleeding or pressure symptoms.
3. Submucosal fibroids, which are just under the lining of the uterus. These are most often associated with bleeding symptoms.

Usually, diagnosis of fibroids occurs during a gynecological examination where the physician feels the fibroids during a physical exam.

This is often confirmed with a trans-abdominal ultrasound, or in some cases, a transvaginal ultrasound. The fibroids can also be confirmed using magnetic resonance imaging (MRI), which is our preferred method of visualizing the fibroids prior to uterine artery embolization. MRI is our preferred method of evaluation because it gives the best visualization of the fibroid, its location, and the rest of the pelvis, including the ovaries. This supplies us with the necessary pre-procedural information.

MEDICAL MANAGEMENT

Usually, medical management is the first therapy for uterine fibroids. Medical therapy includes treatment with non-steroidal anti-inflammatory agents such as Motrin or Naprosyn. Birth control pills or progesterone agents may also be utilized.

Another medication that may be used in certain circumstances is Gonadotropin releasing hormone agonists. (GnRH) Common trade names for this are Lupron, Syneral, and Zoladex. These medications act by blocking the production of hormones by the ovary, particularly estrogen. Commonly, these drugs cause symptoms similar to those in patients experiencing menopause. These include hot flashes, as well as mood changes. They can also cause some more serious side effects, such as osteoporosis, or a decrease in a density of the bones. Thus, their use is usually limited to approximately 6 months. Unfortunately, fibroids usually regrow after this period of time.

Hysterectomy has proven to be a reliable method of treatment for women with uterine fibroids that are causing bleeding or pain. The most important advantage of hysterectomy is the ability to completely cure the disease with no chance of recurrence. Many women seek alternative treatment methods that allow them to avoid the major surgical risks, the psychological effects, and the inconvenience of hysterectomy and a 5-8 week recovery. Several newer methods are now available for treating fibroids while leaving the uterus in place.

Myomectomy is a surgical procedure performed by gynecologist that involves the removal of individual fibroids while keeping the uterus in place.

There are several methods of performing this procedure:

1. A standard surgical method by an abdominal incision.
2. A laparoscopic method through a smaller incision. In this case, the gynecologist uses a small camera in the abdomen to visualize the uterus and special instruments to remove the fibroids.
3. Hysteroscopically. In this case the gynecologist uses the camera within the uterus and removes those fibroids which are on the inner surface of the uterus.

Bleeding and other complications are slightly higher than those seen with hysterectomy. Myomectomy appears to be successful in approximately 80% of women in controlling their symptoms. Unfortunately, approximately 30% of the fibroids do re-grow and cause a recurrence.

Myomectomy is considered the standard treatment for those patients desiring future child bearing. However, in some cases, the gynecologist may not feel that a myomectomy is appropriate due to the possibility that it will cause pelvic scarring. In these cases the gynecologist may recommend alternative therapies such as fibroid embolization.

Uterine Artery Embolization

Uterine Artery Embolization is a procedure performed by an Interventional Radiologist. An Interventional Radiologist is a physician who specializes in using imaging guidance (x-ray, ultrasound, CT scan, and MRI scan) to perform minimally invasive procedures to treat different diseases.

A small nick is made in the skin, usually in the right groin (less than 1/8 of an inch), at the crease at the top of the leg. A tiny tube (catheter) is inserted into the artery at this level. Local anesthesia will be given so that this needle puncture is not painful. Thus, the only thing the patient should feel during the examination is the initial numbing and the remainder of the procedure should be painless.

Using x-ray guidance the radiologist will guide the catheter into the appropriate place within the uterine artery and perform the embolization.

The Interventional Radiologist will then slowly inject tiny particles (polyvinyl alcohol, gel foam, or Embosphere®) into the artery. These particles flow to the fibroid first and wedge in these vessels and remain there. After a few minutes the arteries are slowly blocked. The same procedure is repeated on the other side so that the blood flow is blocked from the right and left uterine arteries. Once the embolization is complete, an arterogram is repeated to confirm the results. All of this is done through the same single, tiny nick in the groin.

85-90% of patients after uterine fibroid embolization will have a clinical success. This means that their pelvic pain or bleeding symptoms have resolved so that no future therapy is needed.

The size of the fibroids usually decrease approximately 40-70% in 6 months and greater at a year. Most patients return to their normal activities within one week after the treatment. One major advantage of uterine embolization is that it is a global treatment in that it treats every fibroid in the uterus. This procedure also enjoys a very low serious complication rate of less than 1%.

Consultation, Procedure Day and Follow-Up

Prior to uterine fibroid embolization, every patient needs to be seen by a gynecologist and a pelvic examination needs to have been performed in the last 4-6 months. In addition, a Pap smear needs to have been done in the last 6 months, which should be normal. Any information regarding the most recent office visit and Pap smear would be useful to bring to the consultant (such as notes from a recent office visit). For many patients who have had abnormal bleeding an endometrial biopsy may be obtained. This is done to be certain that endometrial cancer is not present prior to the embolization. The decision of whether an endometrial biopsy is necessary can be made at the time of the consultation. It is not necessary to have an endometrial biopsy prior to the consultation visit. Any patient who has had a previous pelvic infection (for ex: gonorrhea or chlamydia) should have cultures sent.

At the time of the consultation the patient will meet with the Interventional Radiologist who is to perform the procedure. At this time any questions about the procedure and what to expect should be answered. In addition, we will use this time to obtain pertinent gynecological and general information that is related to the fibroid embolization. This usually lasts approximately 45 minutes to an hour.

An MRI of the pelvis needs to be obtained prior to the embolization. This need not be done prior to the consultation, but if it has been done at another institution the films and report should be brought during the consultation visit. Many patients find it easier to have the MRI performed the same day the consultation is performed in order to get the busy work out of the way.

On the night prior to the procedure, you should not have anything to eat or drink by mouth unless given special instructions to the contrary. The reason for this is so we can safely give you medication during the procedure. If you take prescription drugs, these can be taken by mouth with a sip of water.

The scheduling office will give you a specific time to arrive for admission procedures and paperwork registration. A room will be assigned at this time, however, usually the patient will come to the interventional holding area prior to the procedure. Blood samples will be sent and an IV catheter will be placed prior to the procedure in our nursing area. Usually a catheter will be placed in the bladder so that the bladder will remain empty throughout the procedure. This is done because the bladder is directly in front of the uterus and can obstruct our vision of the uterus during the procedure.

During the procedure itself the patient is sedated and usually sleeps throughout the procedure. In addition, local anesthesia will be given at the puncture site so that the needle puncture is not painful. Please refer to the treatment options section for a more detailed description of the actual procedure.

Upon completion of the procedure the patient will stay in the hospital for a short (less than 24 hours) stay. More than 90% of the patients are discharged the following morning with discharge medications. The patient may expect some crampy abdominal pain, but usually this improves significantly by the morning of the discharge. Most patients return to normal activities 4 days to 1 week following the procedure.

The patients are given a number to access the interventional radiologist who performed the procedure (or the interventional radiologist on call) as well as our nurse coordinator regarding questions after the procedure. In addition, a follow up visit in our offices is usually done approximately 2-4 weeks after the procedure.

A follow up MRI is usually performed 4-6 months after the procedure. In addition, often the patient can expect to have phone calls from either the nurse coordinator or the physician the day after the procedure and then 6 months after the procedure has been performed.

Northside Hospital

Northside Hospital has long been considered the premier women’s care hospital in the Atlanta area. The hospital is dedicated to giving patients the most current and up to date options for treatment for all their health care problems.
Northside Hospital

About Us

Our doctors who perform fibroid embolization:

Dr. Levy received his medical degree from New York University School of Medicine in New York, New York, in 1995. He received honors there and was a member of the elite academic honor society, Alpha Omega Alpha. He then completed an internship in Internal Medicine at Lenox Hill Hospital, New York, New York. He served as a resident at the Mallinckrodt Institute of Radiology at Barnes Hospital in St. Louis, Missouri, from 1996-2000. Mallinckrodt Institute is well known worldwide for it’s cutting edge technology and high quality radiologic services. He then served as a fellow in vascular and interventional radiology at the Mallinckrodt Institute of Radiology as well.

In 2000, Dr. Levy was certified by the American Board of Radiology in Diagnostic Radiology. He is a staff diagnostic and interventional radiologist at Northside Hospital in Atlanta, Georgia.

Dr. Levy is a member of several professional societies, including the Society of Cardiovascular and Interventional Radiology, The American College of Radiology, The American Medical Association and The Radiologic Society of North America. He has lectured in Atlanta as well as the St. Louis area on several interventional radiology topics and has published educational and research papers.

Dr Levy has lectured both nationally and locally on the topic of uterine artery embolization.

Dr. Pont received his medical degree from the University of Medicine and Dentistry of New Jersey. He received honors there and was a member of the elite academic honor society Alpha Omega Alpha. He completed 3 years of a surgical residency at Brown University, Rhode Island Hospital, from 1983-1986. He then completed a radiology residency from 1986-1990, also at Brown University, Rhode Island Hospital. Dr. Pont then had a fellowship in neuroradiology with training in neurointerventional procedures at the Wake Forest University, Bowman Gray School of Medicine, from 1990-1992. Dr. Pont was certified by The American Board of Radiology in 1990.

Dr. Pont has been on staff with Northside Hospital as a diagnostic and interventional radiologist since 1992. Dr. Pont has also pioneered a cutting edge kyphoplasty program at Northside Hospital.

Dr. Pont is a member of multiple medical societies, including The American Board of Radiology, The Radiological Society of North American, The American Medical Association, The American Society of Neuroradiology among others.

You or your physician can contact our interventional nurse at (404) 851-6063. Dr. Levy or Dr. Pont can be reached through the department secretaries, Barbara Hays or Linda Reece, at (404) 851-6323.