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Care for Uterine Fibroids

New York, NY (Dec 31, 2009)

A pensive-looking woman

In the past several years, clinical studies have validated the use of uterine fibroid embolization (UFE) as first-line therapy for symptomatic uterine fibroids. As a result of high-level clinical trials, many of which involved Columbia and Weill Cornell researchers at NewYork-Presbyterian Hospital, "the data on UFE," said Jonathan Susman, MD, "are better known and understood than for surgical treatments that have been around for decades."

Symptoms related to uterine fibroids develop in 30% to 50% of women by the age of 40 years. According to Neil Khilnani, MD, "the majority of woman with fibroids are best managed conservatively with periodic followup visits to monitor their symptoms." However, he added, when the symptoms affect quality of life, treatment such as hysterectomy, myomectomy, UFE, and investigational treatments such as magnetic resonance imaging – focused ultrasound ablation are indicated. David Trost, MD, noted that while UFE is an option for most patients, a few patients maystill require more invasive procedures such as myomectomy or hysterectomy, which require longer hospital stays and recovery periods. "Myomectomy may not remove all fibroids whereas UFE is a global treatment," said Dr. Susman.

Dr. Neil KhilnaniDr. Neil Khilnani

In UFE, after light sedation and a local anesthetic are administered, a small catheter is inserted in the patient's femoral artery. Using imaging guidance, the interventionalist threads the catheter into the uterine arteries and the arteries supplying the fibroids themselves. An FDA-approved embolic agent consisting of tiny microspheres, biologically inert particles made of a material similar to that used in contact lenses and smaller than grains of sand, is then injected into the arteries that supply blood to the fibroids. This selectively deprives the fibroids of their blood supply, causing them to gradually shrink.

Dr. Jonathan SusmanDr. Jonathan
Susman

According to Dr. Khilnani, UFE causes all fibroids to lose their blood supply 85% of the time. In most of the remaining patients, a very trivial amount of fibroid tissue remains alive. Six months after the procedure, 90% of women who undergo UFE say that their formerly heavy menstrual bleeding has decreased to a normal level, and 80% of women with pain, pressure, bloating, or discomfort in the pelvic area say that this has been largely alleviated.

Dr. David TrostDr. David Trost

Dr. Khilnani noted that the physicians at NewYork-Presbyterian were among the first in the United States to offer UFE to women with symptomatic fibroids. "We were one of the core sites for a multicenter registry to evaluate the safety and efficacy of the procedure. Data from our group have been used to validate the success, safety, and durability of UFE. These data have been published in several landmark articles in both the interventional radiology and gynecology literature. At 5 years, the registry results demonstrate that UFE is as effective as, or more effective than, myomectomy in eliminating the symptoms of fibroids."

"Yet despite these advantages," noted Dr. Susman, "public awareness of UFE is limited. As physicians, we need to educate our patients about this procedure."

Contributing faculty for this article:

Neil Khilnani, MD, is an Attending Radiologist at NewYork-Presbyterian/Weill Cornell Medical Center, and an Associate Professor of Clinical Radiology at Weill Cornell Medical College.

Jonathan Susman, MD, is the Clinical Director, Vascular and Interventional Radiology at NewYork-Presbyterian/Columbia University Medical Center, and an Associate Clinical Professor of Radiology at Columbia University College of Physicians and Surgeons.

David Trost, MD, is an Associate Attending Radiologist at NewYork-Presbyterian/Weill Cornell Medical Center and an Associate Professor of Clinical Radiology at Weill Cornell Medical College.

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