In March 2003, I had UFE.

In March 2003, I had UFE. It was successful in that I had 60% shrinkage of 4 primary fibroids and 50% shrinkage of the uterus size, more than expected by the doc because of the size of my uterus (24-26 weeks.) Recently, I started experiencing debilitating pain. I ended up in the ER two months ago. My stomach and uterus felt like they were contracting, and the contractions wouldn’t stop. The doc there said I needed an emergency hysterectomy and that the MRI showed uterine necrosis. I didn’t believe her and requested pain management and checked out. I saw my primary doc the next day, who said it could be uterine necrosis, or it could be fibroid degeneration. She recommended hysterectomy, but that we could plan for it and have it under optimal conditions. I’m not a great candidate for major surgery because I have thallassemia and want to avoid it if possible. She set me up to see another interventional radiologist and an internal medicine doc for their opinions. The IR doc said my UFE was “textbook perfect” but that I had new fibroids. He counted 20 fully embolized and necrotic fibroids, 6 partially embolized fibroids, and 12 new fibroids. The embolized fibroids make up 75% of the uterus, and the 12 new ones are in what he called my “25% viable uterus.” My uterus has grown in size somewhat, and you can’t see the endometrial stripe very well in the MRI – it’s shadowy and has a broken-line appearance. He said there was fluid in the abdomen, but that he couldn’t conclude from the MRI that there was any uterine necrosis. He wanted to re-emoblize me and thought it would be successful. But, he’s never performed a re-embolization before. The internal medicine doc said that he was concerned that my uterus has grown so much since I had the UFE, and with my family history of breast cancer, and the ongoing pain I was in when I never had pain before (not even when I elected to have the UFE) he recommended a hysterectomy. Meanwhile, my regular doc called the IR who perfomed my original UFE. That doc said that the MRI was being misread, that the UFE was in every way a success, that there was no indication of uterine necrosis from the MRI, and that the pain I was having was not, in his opinion, uterine related. He suggested that they do a colonoscopy and check out an ovarian cyst that showed up on the MRI. I saw my regular doc and she again recommended hysterectomy. She gave me lupron and more pain killers and we’ve been working on getting my hematocrit up. Since I’ve been on lupron, the pain is much, much less. I just found out about FAS and am wondering if FAS could be done 3 years after a UFE. What happens to the PVA particles from the UFE if FAS is done? Are they removed as well, or do they remain? What if there is uterine necrosis? Can FAS “fix” that? Thank you, Kay H.

Dear Kay-
The chances of uterine necrosis are pretty small-this usually occurs much closer to the time of the UFE. However, having said that, yours are some of the reasons we do not recommend this procedure for long term success with fibroids.
FAS can help you…we have performed our procedure on many women after UFE because it does not usually work for multiple tumors. We could remove your fibroids, but the PVA particles would not be touched. Also..if any part of your uterus was necrotic we would remove it and reconstruct the viable healthy muscle. Wondering if you have had a recent angiogram to see if the embolized vessels re-canulated? This might explain some of the new growth.