November 25, 2004

With Fibroid Procedure, Rice Avoided Hysterectomy

How many women have ever heard of the procedure Condoleezza Rice underwent to remove uterine fibroids?

Probably not many, although the minor surgical procedure, known as uterine fibroid embolization or uterine artery embolization, has been available in Florida for at least four years as an alternative to the more radical hysterectomy for the removal of the uterine growths.

"The patient has to have a doctor who likes the procedure and refers to someone he knows has experience," says Dr. Henry Pevsner, an interventional radiologist and former family doctor in West Palm Beach.

(The embolization procedure is performed by radiologists, rather than by gynecologists, who do hysterectomies.)

He said the surgery is usually performed in hospitals where radiologists offer the treatment.

Although noncancerous fibroids are very common, according to the Society of Interventional Radiology - 20 to 40 percent of women 35 and older have uterine fibroids of a significant size - most fibroids don't cause symptoms such as excessive bleeding and pain that would prompt surgery.

But when they do, the fibroids are the most frequent indication for hysterectomy in premenopausal women. And of the 600,000 hysterectomies performed annually in the United States, for every woman who undergoes it, one-third are due to fibroids.

That's 200,000 hysterectomies, compared with the estimated 13,000 to 14,000 embolization procedures performed annually in the United States, according to the radiologist society -

Not everyone, however, is a candidate for this less invasive procedure.

Pevsner said women who have hard calcified fibroids without a good blood supply - the procedure cuts off blood that feeds the fibroid - aren't good candidates.

Other contraindications can include very big fibroid tumors, abnormalities of the uterine lining, or the question of cancer being present.

But in general, Pevsner said, the procedure compares favorably to hysterectomy, which removes the uterus and sometimes the ovaries, for those patients who qualify.

With an embolization, the radiologist goes in through the groin and inserts a catheter into the artery. Using imaging, the physician guides the catheter through the artery and then releases tiny particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroid tumor.

This blocks the blood flow, causing it to shrink and die.

Pevsner explains it this way, "They spray a nontoxic material that blocks the arteries for a while.

"When you send your little messengers downstream to (build) their dams, they'll go with the flow and block more arteries to the tumor. You haven't cut off all the blood supply everywhere, so you have enough blood supply to help heal the body.

"If they're benign, this works well."

The Society of Interventional Radiology says 90 percent of women who have the procedure experience significant or total relief of heavy bleeding and other symptoms.

As of October, there is also another procedure, ExAblate, approved by the Food and Drug Administration to remove fibroids in a less invasive manner than hysterectomy.

The technology uses highly focused ultrasound to ablate, or destroy, fibroid tumors.

The patient lies inside an MRI scanner and highly focused ultrasound waves are directed into the body. The ultrasound waves raise the temperature of the fibroid tissue, leading to its destruction.

ExAblate is an outpatient procedure and has minimal recovery time, with patients typically returning to their normal daily activities within one to two days.

University MRI in Boca Raton is one of seven locations in the United States that now offers this procedure.

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