Uterine Artery Embolization (UAE)

Uterine artery embolization (UAE) is a minimally invasive procedure performed by interventional radiology in which both uterine arteries are catheterized via femoral or radial access and embolized with calibrated microspheres (300-700 µm) or polyvinyl alcohol particles. The goal is to reduce blood flow to the uterus or specific lesion, causing infarction of fibroids, regression of adenomyosis, or hemostasis in postpartum hemorrhage and arteriovenous malformations.

Indications include symptomatic uterine fibroids (heavy menstrual bleeding, bulk symptoms, pelvic pain) in women who wish to preserve the uterus, adenomyosis with severe symptoms, postpartum hemorrhage refractory to medical management, uterine arteriovenous malformations, and recurrent pregnancy loss with vascular malformations. Pre-procedural MRI characterizes lesion size, location, and vascularity, and rules out adenomyosis, sarcoma, or pedunculated subserosal fibroids that respond poorly. Hysterectomy or myomectomy remain alternatives based on patient priorities, fertility, and lesion characteristics.

The procedure is performed under conscious sedation or general anesthesia using femoral (or radial) arterial access; bilateral uterine artery catheterization with microcatheter and particulate embolization is achieved with stasis or near-stasis as endpoint. Post-procedure pain (post-embolization syndrome) is treated with patient-controlled analgesia, NSAIDs, and antiemetics. Follow-up includes 3- and 6-month MRI, symptom assessment, and management of post-embolization syndrome, premature ovarian failure (rare), expulsion of fibroid fragments, and rare complications including ischemic uterine injury or sepsis. Fertility outcomes are case-dependent; UAE is generally considered for women with completed childbearing or those accepting potential fertility risk.