Uterine fibroid embolisation (2022) – online course

Description

Please note that this course is no longer CME accredited.

Authors: V. Bérczi and K. Pyra

Reviewers: A. Barnacle, T. Bilhim, M. Krokidis, C. Nice and L. Ratnam

This course corresponds to chapter 2.2.1.1.9 Arterial problems in obstetrics and gynaecology in the European Curriculum and Syllabus for Interventional Radiology.

Abstract

A uterine fibroid (leiomyoma) is a specific type of benign tumour that occurs in the muscle cells of the uterus, a condition affecting approximately 20-40% of premenopausal women. However, only 5-10% of premenopausal women actually develop symptoms due to fibroids, such as painful or heavy periods, frequent urination or pelvic pain. The main factors that determine if a fibroid results in symptoms are growth and location. The exact cause of uterine fibroids is unclear, and treatment is typically not needed if there are no symptoms. After menopause, they usually decrease in size. Treatment should be considered in patients who report symptoms associated with the presence of fibroids, starting with the least invasive methods. Pharmacological treatment, myomectomy, HIFU and embolisation are some examples. Each method has its own indications. Fibroid size, number and location are three potential predictors of successful UFE. Good cooperation with the gynaecologist is ideal to enable informed decisions and an appropriate choice of therapy for the patient.

The UFE is not technically very complicated for experienced interventional radiologists but requires gentleness and patience. The procedure usually proceeds similarly, differing only with vascular access (femoral artery, brachial, radial) and the equipment used. Transradial access was (in women up to 178 cm height) shown to have similar technical and clinical outcomes recently, with low access site complications associated with both approaches [1]. The aim is to place the catheter selectively into the uterine artery and then safely embolise it using particles. Certain steps should be kept in mind because, if ignored or performed carelessly, they will have corresponding consequences.

UFE is a safe treatment option leading to a substantial improvement in quality of life and symptom control with exceptionally low rates of serious complications in the majority of patients. The five-year QoL outcomes are equal in both groups (hysterectomy vs UFE) with no difference in major complications. Embolisation is an important alternative due to its high efficiency and low invasiveness.

Learning objectives

• Gain an understanding of the vascular anatomy relevant to uterine fibroid embolisation (UFE)
• Understand the pathophysiology of uterine fibroids and become familiar with their clinical presentation
• Understand the role of radiological imaging modalities prior to endovascular treatment
• Understand the role of medical, surgical and endovascular treatment options for UFE
• Understand the role of embolisation in the management of uterine fibroids
• Understand the indications and contraindications for UFE
• Recognise the limitations of current embolisation techniques
• Understand the principles of UFE, as well as likely outcomes and potential complications
• Understand the differences between post-embolisation syndrome and unusual but normal symptoms after embolisation as well as potential complications, and become familiar with the published literature relating to these different outcome points.

Further information

This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for Interventional Radiology and corresponds to chapter 2.2.1.1.9 Arterial problems in obstetrics and gynaecology.

The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around one hour.

The acquired CME Certificate will be available in the myCIRSE area under CIRSE Academy.

The enrolment period of this course is linked to the validity of the All-Access Pass.

Release date: July 2022