- Is UFE a painful procedure?
- How long is the recovery period?
- What happens to the particles that are injected?
- When will I notice relief from fibroid related symptoms?
- If this procedure does not adequately relieve my symptoms, what options do I have?
- Don't I need the veins which you are closing with the laser?
- Why don't you treat the varicose veins that I can see directly with the laser instead of treating the greater saphenous vein?
- How much pain will I experience during EVLT?
- How will you decide which procedure, kyphoplasty or vertebroplasty, is best for me?
- After my fracture is treated, can another fracture still occur?
Patients usually experience mild discomfort when local anesthesia is injected into the groin area. The anesthesia numbs this area so that during the initial insertion of the catheter only a pressure sensation is felt. Once the catheter is in the arterial system no pain is felt during further movement of the catheter since no nerve endings are present within these arteries. Following the injection of particles into the arteries supplying the fibroids, patients begin to gradually experience cramps in the pelvic area. The severity of the cramping pain varies widely from patient to patient: some patients experience mild discomfort while others will experience more severe pain. This pain typically lasts four to six hours and then begins to gradually decrease in severity. The pain can be managed either with intravenous morphine and anti-inflammatory medication or with medication administered via an epidural. In our experience, patients tend to receive better pain control with an epidural; however, the choice of which option is best should be decided in consultation with one of our physicians.
Most patients have significantly decreased pain four to six hours following the procedure and can be sent home at that time. Other patients, however can have significant persistent discomfort. These patients are typically admitted for at least an overnight stay in the hospital so that they can continue to receive intravenous pain medication. When patients are sent home they are allowed to resume their usual activities except for strenuous activities which they should avoid for at least 24 hours. Any residual pain at home is managed with oral medications. Patients may experience a flu-like syndrome which consists of tiredness, an "achy" feeling and mild fever which usually resolves about a week following the procedure. Our patients are therefore advised to take at least a week off from work.
The particles we most commonly use in our practice are made out of a plastic called "PVA". This material remains lodged in the small arteries that supply the fibroids and is not broken down by the body. This material has been used for decades within the human body and has shown no proven long term adverse effects.
It depends on what types of symptoms you are experiencing. If you are experiencing heavy vaginal bleeding, this should diminish within days if not sooner. Of course, if you only experience heavy bleeding during your menstrual periods, you will not notice an improvement until your next period. It should also be noted that light spotting is not unusual following UFE and usually stops within days to weeks following the procedure. If your symptoms are primarily back pain, pelvic pain, urinary frequency or constipation, relief may not be noticeable for up to three months. This is because these symptoms are primarily caused by the uterine fibroids pressing on adjacent nerves and organs. Relief from these symptoms, therefore, does not occur until the fibroids have sufficiently decreased in size which can take up to three months.
When a patient does not have satisfactory symptom relief within the expected time frame, the next step is to obtain a follow-up MRI. If the MRI shows that the fibroids still have significant residual blood flow, a second UFE can be performed to block this residual flow. If the MRI shows that the fibroids have no significant blood flow, options other than UFE can be considered. These options include endometrial ablation, myomectomy and hysterectomy.
The veins which are treated with laser ablation (EVLT) are functioning abnormally. Instead of returning blood to the heart they are allowing blood to flow back down into the legs. In this situation, most blood leaves the legs through other veins which are part of the deep venous system. Once the abnormal veins are closed or ablated with the laser, blood continues to flow back to the heart through the deep venous system.
Most of the varicose veins which which stand out visually are actually located too superficially to be safely treated with laser ablation (EVLT). Because they are so close to the skin, the risk of causing a skin burn is unacceptably high. Our strategy at Valley Endovascular is to treat the highest primary source of abnormal blood flow with laser ablation first, usually the greater saphenous vein. Any of the more superficial veins which continue to cause discomfort or which are cosmetically undesirable can then be treated with either ambulatory phlebectomy (microphlebectomy) or sclerotherapy.
Prior to EVLT the tissues around the greater saphenous vein are injected with a local anesthetic. This causes a temporary discomfort. Once the anesthesia has taken effect, most patients experience little or no discomfort during the actual EVLT procedure. Following the procedure, patients usually feel soreness or a "tight" sensation along the treated vein. This typically lasts at least a day, but can be felt for several days in other patients.
Each procedure has its advantages and disadvantages. A major advantage of kyphoplasty is that it not only affords pain relief, but also at least partially reverses the loss of height and the kyphosis (hunched over posture) caused by the fracture. Studies also suggest that kyphoplasty has a lower incidence of cement leakage into the surrounding tissues in patients with fractures secondary to cancer. The advantages of vertebroplasty are that it can typically be performed without general anesthesia, smaller needles are used, and patients usually can go home on the day of the procedure. Our approach at Valley Endovascular is to perform kyphoplasty whenever it can be safely performed. In patients who are at high risk for complications from general anesthesia we tend to perform vertebroplasty with local anesthesia and sedation. However, each patient is individually assessed by our physicians, and, together with the patient, the most appropriate treatment plan is chosen.
Patients who have had a vertebral compression fracture are at increased risk for having future compression fractures at other levels in the spine. The likely reason for this is that the underlying weakening of the bones, osteoporosis, is usually present in the other bones of the spine as well as in other parts of the body. Therefore, it is important that osteoporosis be treated either by your primary care physician or by a specialist known as an "endocrinologist".
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