Interventional Radiology a New Frontier at William Osler Health Centre

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It got to the point where even making a trip to the grocery store was cause for great anxiety for 40-year-old Rehana Coovajia. She suffers from Leiomyomas also known as fibroids, muscle tumours of the uterus that are very common in the general population and affect 20-40 per cent of all women of childbearing age. This extremely painful condition also causes heavy bleeding. For more than a year, Rehana was a hostage to this condition rarely venturing to go out. Fearing that surgery was her only option, she read an article in the newspaper about a relatively new non-surgical procedure that embolizes fibroids to treat her condition. Rehana was relieved to learn that the procedure was available to her in her own backyard at William Osler Health Centre’s Brampton Memorial Hospital Campus.

“I was very happy when my doctor was able to refer me to someone at my own hospital. Until then I didn’t know what I was going to do and thought I would have to have a hysterectomy and I really didn’t want that,” says Rehana.

Dr. Leslie Vanderburgh, an interventional radiologist [Dr. Vanderburgh is a medical specialist who uses radiologic imaging to guide tiny catheters through the body to treat a wide variety of conditions that once required surgery] at the Brampton Memorial Hospital Campus, has been doing the embolization procedure since 1999 and is one of only a handful of physicians in Ontario participating in this experimental procedure which began in France in the early 1990s.

“Fibroids are muscle tumours of the uterus that are very common in the general population (they affect 20-40 per cent of all women of childbearing age.),” explains Vanderburgh. “They arise from a single smooth muscle cell that has lost the proper signalling to stop growing. Over time the muscle tumours get larger and may start to cause problems.”

Until recently, the most common procedure of treating fibroids has been the myomectomy, which is the surgical removal of the fibroid. Another surgical procedure is the laparotomy, which entails making an incision on the uterus where the fibroids are located. In some cases a hysterectomy is done to treat the problem but that means the complete removal of the uterus. In each of these cases, there is always a greater risk of bleeding and complications such as infection.

“We offer patients a non-surgical alternative for treating this condition,” says Vanderburgh. For many women, especially of childbearing years, it is important that they are able to keep their uterus intact. Embolization is much less invasive and there is a much shorter recovery time which is another plus for today’s active woman.”

The procedure works like this. A small skin nick is made in the groin region to facilitate placement of a catheter (a hollow tube about the size of a spaghetti noodle) into the femoral artery. A preliminary arteriogram is performed to map the pelvic vascular anatomy. The catheter is steered into one of the uterine arteries and small (grain of sand sized) particles of polyvinyl alcohol (PVA) or Embospheres are mixed with x-ray dye and injected until the blood supply to the fibroids is occluded. The same is applied to the other uterine artery, usually from a single catheter insertion site. The procedure takes from 60-90 minutes. Most patients are observed for 23 hours then discharged home the next day.

To date, Dr. Vanderburgh has performed more than 200 embolization procedures and estimates that for 80-90 per cent of patients the condition improves dramatically with little or no regrowth. “What is surprising about this procedure is that there is actually less chance of the fibroids reoccurring than with the surgical removal of the fibroid. In fact, there is a 20 to 30 per cent regrowth occurrence for myomectomies. “I believe the patient benefits tremendously from this procedure. There is less trauma, less bleeding, and a much quicker recovery,” notes Vanderburgh.

Rehana Coovajia couldn’t agree more. “I can’t believe the difference having this procedure has made in my life. I don’t get dizzy anymore, there is less cramping and bleeding and I really feel much better. I had a week of recovery and that was it. The procedure was not uncomfortable at all and there was no pain. I’m really glad I had this done. My first reaction afterwards was to give Dr. Vanderburgh a hug to say thanks. My life is back to normal and I’m very active again.”

While the final trial results are not yet complete, Dr. Vanderburgh is confident that this procedure will soon become the new standard of practice for the treatment of fibroids. “I believe the future of interventional radiology is very bright and it’s growing in Canada. With fewer surgeons available I think we have to look at other ways of treating these types of conditions. The results are very positive and I have little doubt this procedure will play a leading role in treating fibroids. The fact that most patients who have fibroids are candidates for embolization is another strong indicator that this has the potential to become the new standard of treatment for fibroids.”

Rehana has no problem recommending the procedure to women suffering as she did. “I wish more doctors would tell their patients about this. If I hadn’t read about it in the paper I may not have known it was available and right in my own backyard. It really has changed my life for the better and all I can say is thank you.”