On November 19, 2004, major media outlets around the world published reports that U.S. National Security Advisor Condoleezza Rice, who had just been nominated as the next Secretary of State at the time, underwent an interventional procedure for uterine fibroids (fibroid embolization surgery), causing a strong reaction among the majority of fibroid patients.
The procedure was performed by interventional radiologist James Spies, and took an hour and a half to complete, ending at 10:15 a.m. that day, with Rice returning to her hospital room safely. At the doctor’s request, Rice spent the night in the hospital, then returned home on the 20th and to work on the 22nd.
Why did Rice undergo the procedure with an interventional radiologist instead of an OB/GYN? Why was she in the hospital for only one night?
Uterine fibroids are common benign tumors of the reproductive system in women of childbearing age, with an incidence of 20% to 25% [1]. Patients may have varying degrees of pelvic pain, uterine bleeding, abdominal distention, bladder rectum and other pressure symptoms.
Traditional treatment methods mainly include.
1, drug treatment. It is mainly hormone therapy, which is effective in shrinking fibroids and reducing symptoms, but the course of treatment is long and slow, and the long-term application of toxic side effects is great.
2, surgical treatment. Myoma removal, recurrence rate is high, 25%-30%; total hysterectomy, traumatic, painful, and also has an impact on endocrine, especially young patients who want to retain the uterus is difficult to accept the surgery.
The uterine fibroid embolization procedure that Rice underwent was different from the traditional surgical method, and was a minimally invasive interventional procedure that required no incision. A small 2 mm incision is made in the femoral artery of the patient’s thigh, and a very thin catheter is passed along the vessel into the uterine artery, which is then superselected to the fibroid supply artery, where an embolic agent is injected. In this way, the blood and nutrient supply to the fibroids is blocked and the fibroids are gradually reduced or eliminated for the purpose of treatment.
This treatment is less invasive, leaves no scars after surgery, has fewer complications, is quick to recover, and is easily accepted by patients, who can get out of bed the day after surgery. It has become the first choice for patients with uterine fibroids in many countries.
As early as in the 1990s, hospitals in China carried out arterial embolization interventions to treat uterine fibroids, and achieved remarkable results. However, because the word “intervention” is a foreign word, many patients know little about “interventional” therapy, and those who could have received minimally invasive surgery have been subjected to “major surgery” due to lack of medical knowledge. In contrast to hysterectomy, embolization of benign fibroids is minimally invasive, results in rapid recovery, and is more easily controlled.
What kind of fibroid patients are suitable for uterine artery embolization?
1.hemorrhage caused by fibroids (heavy menstrual flow, prolonged menstruation)
2.Lumbar and abdominal pain caused by fibroids
3.Pelvic distention and pain caused by fibroids, rectal pressure symptoms
4.Symptoms of recurrence after fibroid removal, except for malignant change.
What kind of fibroid patients are not suitable for uterine artery embolization?
1. Contraindications for angiography, including heart, liver, kidney and other important organ dysfunction, abnormal coagulation mechanism
2, acute and chronic gynecological inflammation cannot be effectively controlled
3, other relative contraindications include postmenopause, severe atherosclerosis and advanced age patients
4.Uterine arteriovenous fistula.
Prevention of adverse reactions and complications after uterine fibroid embolization
1.Pain. Pain is a common intraoperative and postoperative adverse reaction, which may be related to the degree of embolization of the embolic agent into the pathological vascular bed of fibroids. Postoperative pelvic pain is the most prominent reaction after uterine fibroid embolization therapy, and symptomatic treatment generally disappears in 2 to 14 days, and the degree and duration of pain are positively correlated with tumor size[2] .
2, nausea, vomiting and fever. They improve and disappear after 3 to 5 days of symptomatic treatment.
3. Postoperative antibiotics are routinely applied to prevent infection. Endometritis, pus accumulation and uterine perforation are the most serious complications after uterine artery embolization. To prevent complications, its key to control infection and routinely give antibiotics for 3 to 6 days, which can be extended for large myomas.
As a medical practitioner, I can’t tell you what I feel whenever I look at the obstetrics and gynecology wards where one by one patients with fibroids are waiting to have their uterus taken away.
The vast majority of these patients could be treated with safe, non-scarring methods that do not remove the uterus, but the commercialized system of medical operation in China makes many patients pay for the interests of doctors and hospitals.
Uterine fibroids, a very common disease, almost every woman will have them in her lifetime, only, only a few patients cause symptoms, but, this minority is definitely not less. This disease could have been treated by puncturing a small 2 mm hole in the groin into the femoral artery, then sending a very thin catheter (about 2 mm in diameter) in, through multiple vessels into the uterine artery, and then using an even thinner catheter (about 1 mm in diameter).