Uterine Artery Embolization
Updated On: July 23, 2026
Anesthetic Approaches
Severe pain starts on the table - infarcting a large fibroid load produces cramping pain comparable to labor, beginning while the particles go in. Set up the analgesia before the first side is embolized rather than chasing it in recovery.
The pain is visceral and cramping - it responds to opioid and to non-steroidal anti-inflammatories together, and neither alone does the job well. Build a multimodal plan that continues at home, because the pain does not stop when the patient does.
A superior hypogastric block helps - the uterine afferents run with the sympathetic fibers, and a block placed by the operator at the end covers exactly the pain the procedure causes. Ask whether it is being offered, because it changes your opioid plan.
Nausea rides with the pain - visceral pain, opioid load and post-embolization syndrome all point the same way, and vomiting is what keeps these patients in overnight. Give antiemesis prophylactically rather than as rescue.
This is usually an awake case - moderate sedation with local at the groin is standard, and the patient can tell you when the cramping starts. Deep sedation is a choice, not a default, and it turns a day case into a longer recovery.
Ovarian collaterals are the risk - non-target embolization into an ovarian branch can cause ovarian failure, which matters enormously to a patient who chose this procedure to keep her uterus. Expect the operator to spend time on the angiogram before injecting.
Ask about future pregnancy - the answer changes the counseling and sometimes the technique, and it is a conversation that should already have happened. If it clearly has not, say so before the procedure rather than afterwards.
Post-embolization syndrome is expected - low-grade fever, malaise and pain over the first few days is the normal course, not infection. Say that to the patient and write it down, because the alternative is an emergency department attendance and antibiotics.
Groin hemostasis is your problem too - a sheath comes out of a femoral artery in a patient who is about to sit up in pain. Watch the site during recovery, and treat a rising groin swelling as bleeding rather than as bruising.
Lead and step back - the operator crosses the bifurcation and runs both sides, so screening time is longer than the procedure looks. Wear the lead and thyroid shield, and move away during acquisition.
Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it's going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient's arms.
High post-operative pain (general considerations): Plan ahead to treat pain in the postoperative period. If not contraindicated, consider hydromorphone or other long-acting analgesics along with adjuncts such as Ofirmev and/or toradol. Where possible, give during the operative period to limit pain in the postoperative period. Where applicable, consider peripheral nerve blocks and/or epidural interventions.
Fluoroscopy / Xray (general considerations): Have lead aprons and thyroid shields available. Alternatively, distancing yourself 3 to 6 feet will reduce scatter radiation to 0.1% to 0.025% respectively. Occupational maximum exposure to radiation should be limited to a maximum average of 20 Sv (joules per kilogram - otherwise known as the Sievert/Sv) per year over a 5 year period. Limits should never exceed 50 Sv in a single year.
Off-site (general considerations): Extra precaution should be taken preoperatively if the surgery is planned off-site (away from the OR or your normal work spaces). Depending on your facility setup, it's wise to take emergency airway equipment and drugs with you that would be necessary to treat the gamut of anesthesia emergencies.
Fibroids are hormone-responsive smooth muscle tumors of the uterus, and they depend on a blood supply that arrives almost entirely through the uterine arteries. Embolizing both uterine arteries with small particles infarcts the fibroids while the myometrium, which has a richer collateral supply from the ovarian and vaginal vessels, survives. The fibroids then shrink over months. The same procedure is used acutely for postpartum hemorrhage and for a bleeding uterus after other treatments have failed, and that version is a different case entirely. For the elective fibroid patient the operation is a day case with a groin puncture and no incision, and the whole clinical problem is that infarcting a large volume of muscle produces genuinely severe cramping pain that begins on the table and lasts for hours.
Femoral or radial access - a sheath is placed and a catheter advanced into the aorta, then down into the internal iliac artery on one side.
Selective uterine catheterization - the uterine artery is entered with a microcatheter, and the anatomy is checked for ovarian collaterals that must not be embolized.
Particle delivery - calibrated particles are injected slowly until flow in the uterine artery slows to a standstill, and the endpoint is judged on the fluoroscopic screen rather than by volume.
The second side - the catheter is brought across the aortic bifurcation and the same is done on the other uterine artery, because embolizing one side alone does not work.
Sheath removal and recovery - hemostasis is achieved at the groin and the patient goes to recovery for several hours of pain and nausea management before discharge.
Uterine artery embolization is chosen by patients who specifically want to avoid a hysterectomy or a myomectomy, and the analgesic plan is what decides whether they think it was worth it. That is not a comfort argument. A patient in uncontrolled pain in a radiology recovery area, hours from the ward, with a groin puncture and nobody who knows the expected course, is the commonest reason these day cases become admissions. The plan should be written before the case, not assembled afterwards.
The emergency version of this procedure shares almost nothing with the elective one. Embolization for postpartum hemorrhage is done on a bleeding, often coagulopathic patient who may have arrived from the operating room, and it belongs with the resuscitation pages rather than this one. If the booking says uterine artery embolization, establish which of the two you are being asked to do before you plan anything.