#9 Doppler-Guided Uterine Artery Occlusion

Overview

Fibroid tumors occur in upwards of 40% of women older than 35, triggering pelvic pain, pregnancy complications, and heavy bleeding. One third of the 600,000 hysterectomies performed each year in the United States are for uterine fibroids, non-cancerous abnormal growths of fat in the wall of the uterus that can grow to the size of a cantaloupe. While this disease has such a major impact on the lives of millions of women, it is rarely discussed because it’s not cancer.

Women with fibroids often bleed excessively during their periods and can become anemic. In addition to urinary frequency, because of pressure on the bladder, and excessive back pain, many women have significant discomfort and take pain medication during their periods. Fibroids can reduce fertility—especially when they are located in the uterine cavity—and often trigger a variety of obstetric complications, including premature birth.

Over the last decade, several procedures have been introduced to help women avoid major surgery for this condition, but hysterectomy remains the most common treatment for fibroids. However, it is a major surgery and does not preserve the uterus.

There is a new, non-invasive approach to treat fibroids called Doppler-guided uterine artery occlusion, or DUAO, that could prove to be attractive to many women and their physicians. This experimental procedure is currently undergoing pivotal clinical trials at centers throughout North America and Europe.

“This procedure offers great promise,” says Marie Paraiso, M.D., Co-Director of the Program for Female Pelvic Medicine and Reconstructive Surgery at the Cleveland Clinic. “It has the potential to offer women who have failed medical therapy a noninvasive procedure that’s an alternative to hysterectomy, surgical removal of uterine
fibroids, and uterine fibroid embolization.”

Here is how DUAO works: After being given an epidural injection in a hospital outpatient setting to provide patient comfort and minimize lower limb movement during treatment, a special clamp is placed through the vagina by the gynecological surgeon. With the assist from Doppler-guidance provided by crystals located at the tips of the clamp, the surgeon locates the two uterine arteries by the special sound waves and occludes the arteries. This generally takes only 15 minutes to accomplish.

This simple mechanical compression is temporary and after six hours, the clamp is removed, restoring blood flow to the uterus. However, during the period that the clamp is in place, the fibroids are starved of oxygen and nutrients, and start to die. The uterus, however, can sustain itself during the temporary artery occlusion. Eventually the excess fibroid tissue will slough off and get reabsorbed by the body, resulting in a significant decrease in fibroid-related size and symptoms.

Where Are They Now

This is an innovative method to treat uterine fibroids, which are benign muscular tumors of the uterus that are a common cause of pelvic pain and heavy menstrual bleeding. It offers women who have failed medical therapy a minimally invasive alternative to hysterectomy. Through temporary occlusion of uterine arteries, this technology can significantly reduce fibroid size and related symptoms.

The experimental procedure is currently undergoing pivotal clinical trials at centers throughout North America and Europe. A pilot study to determine optimal procedure steps to obtain and maintain uterine artery occlusion with the Doppler-guided device was initiated in 2010, but was terminated in 2011 because further internal evaluation of the device was needed.

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