What is neuro-endovascular therapy?

Neuro-endovascular therapy is a minimally invasive procedure used to treat complex vascular lesions in the head, neck, and spine. Using microcatheters and devices such as balloons, platinum coils, liquid adhesive, and stents, the interventional radiologist navigates from the femoral artery or vein to treat the abnormal target vessels. Navigation is assisted by real-time, bi-plane digital-subtraction angiography and real-time fluoroscopy. Patients whose neurovascular lesions have been determined to be untreatable by conventional surgical techniques are often candidates for neuro-endovascular therapy.

Who is eligible for neuro-endovascular therapy?

Neuro-endovascular therapy is used in the treatment of:

• Intracranial aneurysms
• Vasospasms following subarachnoid hemorrhage
• Embolic strokes
• Symptomatic intracranial atherosclerosis
• Arteriovenous malformations (AVMs), dural arteriovenous fistulas (AVFs)
• Carotid cavernous fistula - post-traumatic or spontaneous

What is uterine fibroid embolization?

Uterine fibroid embolization (UFE) represents a relatively new approach to treating fibroids. UFE is a minimally invasive procedure used to treat symptomatic fibroids by blocking the supply of blood to the fibroids. Using angiographic techniques similar to those used in heart catheterization, the interventional radiologist places a catheter into the uterine arteries. By injecting small particles into the arteries, the arteries feeding the fibroids are blocked. By cutting off the blood supply, the fibroids shrink and symptoms are resolved.

Who is eligible for uterine fibroid embolization?

Women with symptomatic fibroids are candidates for UFE. Any woman, regardless of the size and location of her fibroids, can undergo UFE. Some women have been able to achieve pregnancy after having UFE. UFE offers a minimally invasive option to surgery.

What is the pre-procedure evaluation?

An interventional radiologist sees the patient for consultation at the hospital. During the evaluation, patients are fully informed about the risks and benefits of the procedure, as well as about expected results.

How is the procedure performed?

The procedure is done in the hospital with an overnight stay after the procedure. The patient is sedated using local anesthesia. In general the procedure takes 1 to 1½ hours. Initially a needle is used to enter the femoral artery. The catheter is advanced over the branch of the aorta and into the uterine artery on the opposite side of the puncture. A second arterial catheter is then placed from the opposite femoral artery to the other uterine artery. Using an angiogram, the uterine arteries are located. After the arteriogram, particles of poly vinyl alcohol are injected into the artery until blood flow to the fibroids stops. The catheter is then re-positioned into the other uterine artery and the process is repeated. After the procedure, the patient is on bed rest for 6 hours to allow the puncture site to heal sufficiently.

What are the results?

The expected average reduction in the volume of fibroids is 50% in three months, with reduction in the overall uterine volume of 35%. This reduction may be greater in some patients and less in others. Bleeding symptoms usually resolve immediately.

What are the risks of UFE?

Complications are anticipated in less than 3% of patients. Serious possible complications include injury to the uterus from decreased blood supply or infection. Hysterectomy to treat either of these complications occurs in less than 1% of patients. The chance of other significant complications is less than 1%. As the outcome of pregnancy following UFE is unknown, we do not recommend the procedure for women who plan to have children.

What is the post-procedural care?

Each woman undergoing the procedure experiences varying degrees of pelvic pain and discomfort. The discomfort is most severe in the first 24 hours and women are given medication to control their discomfort. After an initial period of 6-8 hours bed rest, patients with mild to moderate symptoms may be discharged. Most patients are hospitalized overnight and are discharged home the next morning. Patients are discharged home with prescriptions for both narcotic pain medication to be used as needed and ibuprofen to help control uterine cramping.

For elective consultation, please contact Spectrum Medical Group.