Interventional News: An Overlooked Option — More Women Can Benefit From UFE
By Dave Yeager
Vol. 18 No. 7 P. 28
Uterine fibroid embolization (UFE), a minimally invasive, less expensive alternative to hysterectomy, is being underutilized, according to a study presented at the Society of Interventional Radiology's annual scientific meeting in March. Prasoon P. Mohan, MD, MRCS, an assistant professor of clinical IR at the University of Miami Miller School of Medicine, and colleagues analyzed data from the 2012 and 2013 Nationwide Inpatient Sample (NIS), which is the largest all-payer inpatient health care database in the country, to quantify the use of UFE relative to hysterectomy. The NIS samples 20% of US hospitals each year and uses statistical tools to extrapolate a national estimate.
Mohan's team used billing codes to determine the number of fibroid cases that were treated with UFE and hysterectomy, respectively. The researchers found that 167,650 hysterectomies were performed in these cases vs 2,470 UFE treatments. UFE resulted in hospital stays of 2.16 days vs 2.32 days for hysterectomy and cost approximately $21,583 vs $33,104. Women who chose UFE had more chronic conditions than did women who chose hysterectomy. In addition, rural hospitals performed 0.4% of UFE treatments but 9.4% of hysterectomies, and small hospitals performed 7.9% of UFE treatments vs 67.4% in large hospital systems.
Access and Education
"Access is an issue for UFE," Mohan says. "Not all of the rural communities will have either the specialists or the facilities to do the procedure, but by raising awareness and working with OB/GYNs, patients can be referred to a nearby center. It's an overnight stay, so it's not as hard for people to get to a place where it's done and stay over."
Along with access, Mohan says education about the benefits of UFE is a challenge. He emphasizes that informing patients of all treatment options can be life changing. Approximately nine out 10 women who undergo the procedure experience significant improvement or cessation of symptoms, but many are unaware of UFE. To increase awareness, Mohan says interventional radiologists need to educate patients and collaborate with OB/GYNs.
"We need to collaborate more," Mohan says. "It's a win-win situation. Not all patients are suitable for UFE and, at the same time, not all patients are suitable for surgery. So we can be complementary; that's my feeling. And in the practices where collaboration is being done, it has worked perfectly."
Who Should Have UFE?
Fibroids develop from uterine muscular wall tissue and can vary in size from small to very large. Women who are overweight, are black, are older than age 40, have high blood pressure, have had no children, or have a first-degree relative with fibroids are at higher risk of developing them. Fibroids are usually asymptomatic but can cause heavy menstrual bleeding, pelvic pressure or pain, abdominal enlargement, pain with intercourse, constipation, and frequent urination. Most women—the National Institutes of Health estimates nearly three out of four—will develop fibroids by age 50.
During a UFE procedure, an interventional radiologist inserts a thin catheter into a wrist or groin artery and guides it to the fibroid's blood supply. Particles the size of sand grains are released and block the small vessels that feed the fibroid. Typically, the fibroid softens, bleeds less, and shrinks. Mohan says the main side effect is severe cramping in the first 12 to 24 hours after the procedure, which is treated preemptively with nonsteroidal anti-inflammatory drugs and a pain pump.
Not all women are candidates for UFE, however. For example, Mohan says there are still questions about whether women who plan to have children should undergo the procedure, and he recommends myomectomy in those cases. There may also be cases where hysterectomy is the best option. Whichever option may be most suitable, Mohan says women need to know that UFE is a viable possibility.
"UFE is a safe, effective, minimally invasive option which is very well tolerated in many patients, but it's been two decades since this technology was introduced, and it still lags far behind hysterectomy," Mohan says. "It is vitally important that anyone who comes for treatment of fibroids be presented with all of the possible treatment options, and then they can make their own informed choice."
— Dave Yeager is the editor of Radiology Today.