What is involved before the procedure?
You may have been referred to Dr. Crowe by your GP or gynaecologist who will have performed an examination and possibly arranged imaging tests such as an ultrasound or MRI scan. If you are not currently under the care of a gynaecologist Dr. Crowe can recommend one of his gynaecology colleagues. Dr. Crowe first meets you in the out-patient department to discuss the procedure and answer any questions you may have.
Although you will probably already have had an ultrasound scan it is routine to perform an MRI scan before proceeding to embolisation. MRI very accurately defines the size and location of the fibroids and, more importantly excludes other conditions that can mimic fibroids. If the MRI scan shows suitability for embolisation arrangements will be made for admission for the procedure itself.
The Day of the Procedure
On the day of the procedure you will be admitted and clerked in by the nursing staff. A pregnancy test is routinely performed prior to the procedure and it is routine to insert a bladder catheter. This is for your own comfort as you will need to lie flat for several hours after the procedure. More importantly, however, the catheter keeps the bladder empty during the procedure as the contrast or dye injected to show the arteries is excreted by the kidneys and ends up in the bladder. Without a catheter the views the radiologist gets of the uterine arteries would be obscured.
Embolisation can be painful in the few hours after the procedure. Dr. Crowe’s preference is to set up a PCA (patient controlled analgesia) morphine pump which runs through a small drip in the back of your hand and allows you to give yourself small doses of morphine as required. A small cannula is placed in a vein in your arm before the procedure starts. The amount of discomfort felt by patients varies enormously and the advantage of a PCA pump is that you are in complete control of the painkillers and can use as much or as little as you need. Some patients do not actually need to use the morphine pump but find it reassuring to know it is there if needed.
On arrival in the X-Ray theatre you will be given antibiotic injections and suppositories which prevent the introduction of any infection at the time of the procedure.
The procedure itself
Most patients have a some sedation though not essential. Local anaesthetic is injected in the groin. This may just sting a little for a few minutes but will then go numb. A small nick of only a few millimetres is made at the crease at the top of the leg to access the femoral artery, and a tiny tube (catheter) is inserted into the artery. The catheter is steered the catheter through the arteries to the uterus using X-ray imaging to guide the catheter’s progress. Some contrast or dye is injected to show the arteries and act as a ‘roadmap’ and can make you feel warm all over. The catheter is advanced into the uterine artery beyond any branches going to the cervix.
Only when in a safe position without risk of particles entering arteries to other organs such as the bladder are the particles injected. The tiny particles (made of polyvinyl alcohol or PVA) are precisely calibrated in size to wedge in the arteries supplying the fibroids. They are pushed along by the bloodflow and cannot reflux back into other parts of the body. Over several minutes, the arteries are slowly blocked. The embolisation is continued until there is nearly complete cessation of flow in the uterine artery.