Indications and Patient Selection
- Heavy menstrual bleeding (menorrhagia) — primary indication
- Bulk symptoms — pelvic pressure, urinary frequency, dyspareunia
- Symptomatic fibroids confirmed on MRI or US
- Desire for uterine preservation
- Failed or declined medical therapy
- Submucosal, intramural, and subserosal fibroids
- Pedunculated subserosal fibroid — relative contraindication
- Adenomyosis — coexistent; response rates lower
Technical Overview
- Bilateral femoral or radial arterial access
- Pelvic angiography — identify uterine arteries
- Selective uterine artery catheterization — 2.7–3 Fr microcatheter
- PVA particles 500–700 µm or Embospheres 500–700 µm
- Endpoint — near-stasis in uterine artery
- Bilateral embolization — same session
- MRI pre-procedure — fibroid mapping, submucosal component
- Post-UFE MRI at 3 months — fibroid infarction, volume reduction
Full UFE Procedure Playbook
Catheter technique, particle selection, troubleshooting variant anatomy, and post-procedure management
Outcomes and Complications
- Symptom improvement — ~85–90% at 12 months
- Fibroid volume reduction — 40–60% at 3 months
- Postembolization syndrome — pain, fever, nausea (1–2 weeks)
- Premature ovarian insufficiency — <1% in women under 40
- Amenorrhea — 2–3% in reproductive-age women
- Fibroid expulsion — submucosal fibroids (managed conservatively)
- Non-target embolization — ovarian artery collaterals
- Hysterectomy rate at 5 years — ~15–20%