Yes, the consultation and follow-up visits are as important as the procedural expertise. Like any procedure or medication, you need to be evaluated to make sure that you are an appropriate candidate. This ensures that you will have a successful result with minimal risk. Every insurance company also requires this consultation visit to make sure you meet medical necessity for coverage. We do not cut any corners in the care we provide our patients, and this tried-and-true process is followed strictly.
The purpose of the consultation is not to diagnose whether or not you have fibroids. The majority of our patients have already had a pelvic exam and have received an ultrasound diagnosis of uterine fibroids or adenomyosis. The purpose of the consultation is to evaluate your symptoms to see if you meet the medical necessity for the embolization procedure. Additionally, the consultation will determine if you need more advanced imaging. Since the majority of our patients are seeking the non-surgical advanced embolization procedure, more advanced imaging will be required.
The embolization treatment is an advanced procedure that uses sophisticated tools and imaging and cannot rely on a basic ultrasound to ensure that you have a satisfactory result. Before any imaging can be ordered, you must have a consultation; this is also required by a majority of the insurance companies in order to provide coverage for the tests. The consultation is also an opportunity for you to learn about how the procedure is done, the risks, and the expectations. You should always seek a thorough consultation before exposing yourself to any surgery or procedure. We do not cut any corners in the care we provide our patients. This tried-and-true process is followed strictly.
Unfortunately, consultations cannot be done for free. Some clinics may advertise a free evaluation; however, you will still be subject to an official consultation thereafter. This consultation is required in order to determine if you meet the medical necessity for treatment, if there is a need to order any additional advanced imaging or work-up, and to review the procedure, risks and expectations. Any evaluation or visit by the physician will need to be charged. This process requires you to be registered with the practice and establish a patient-doctor relationship, which is legally protected. This process will need to be billed to your insurance, cannot be waived, and is contractually obligated depending on the network. We do not cut any corners in the care we provide our patients. This tried-and-true process is followed strictly.
Absolutely. We strive to make sure that there is no difference in quality between the telehealth and in-office consultation by ensuring a quality experience. The telehealth consultation is provided using a video and audio format so you can see and speak to the specialist who will perform the procedure. We do not have any midlevel or non-physician providers who would substitute for the physician at any point in your care. All of your office visits will be with the same physician.
For a virtual consultation however, it is important that you arrange to be in a quiet and private place at the time of your appointment. Since a majority of patients already have had a pelvic and physical examination with an ultrasound diagnosis, this does not need to be repeated. The consultation is to determine if you meet the medical necessity. This is determined by your symptoms and advanced imaging, which will need to be ordered if not already completed.
A virtual consultation doesn’t affect your evaluation to see if you meet medical necessity. Most patients have only had experience with surgery or regular doctor type visits so it’s hard to understand this process. These are advanced technical procedures that rely on factors other than a physical exam or basic ultrasound study. Most patients coming to the practice already have had a pelvic exam by their OBGYN and come with an ultrasound diagnosis of fibroids. It is not possible to know the exact location of the fibroids, size or behavior by physical examination. This does not provide any additional information than what the doctor already knows about the fibroids. The purpose of the consultation is to determine if you meet the medical necessity or if you will need to have surgery. This is determined by your referral notes from your OBGYN, symptoms, and previous imaging studies. A repeat ultrasound is also not helpful as this is too basic a test before such an advanced procedure.
The doctor will then decide whether you meet the medical necessity to proceed to further work up. As a double board-certified imaging specialist, he relies on your symptoms and imaging to see if you meet the medical necessity. Once you do, he will order the additional work up, and review the procedure, expectations, risks, and outcomes. Our patients will have to undergo an advanced imaging work up, which is ordered at the time of the consultation and to be completed at an outside imaging center to make sure you are a good candidate. This type of imaging cannot be ordered without a consultation. For these reasons, a virtual consultation does not compromise the specialist’s ability to evaluate you; however an in-office visit can be arranged if preferred.
If you already have had an ultrasound demonstrating your diagnosis, a repeat ultrasound is not needed. While an ultrasound maybe adequate for determining the need for surgery, it is too basic for an advanced procedure such as uterine embolization. Since you are not having surgery to remove tissues, this procedure requires advanced uterine imaging that can provide greater detail about the pelvis. As such, repeat ultrasound studies would add very limited information and you would still need advanced uterine imaging. This will be ordered at the time of your consultation. However, if you have never had an ultrasound, one would be ordered.
While a fibroid of any size can be treated, the more appropriate question would be, should it? There is not a “cut off size” because each treatment needs to be tailored to the specific situation. If you think your fibroid may be too large you need to schedule a consultation to review your imaging, symptoms, and specific situation to see if this is something that should be offered to you. Again, a fibroid of any size can be treated; however, there are limitations of every treatment and medication. This requires evaluation by our specialist who has experience with treating fibroids of all sizes to render the best opinion for your specific situation. OBGYNs, primary care doctors, or other physicians who have never seen a UFE procedure would not be able to speak to the experience of such a procedure.
There are a variety of factors that are used to see if you meet the medical necessity for the UFE procedure. This requires a thorough evaluation of your symptoms and review of your imaging results. The ultrasound however is too basic a test for an advanced procedure such as uterine artery embolization. Once evaluated by our specialist, advanced uterine imaging will need to be ordered to make sure you are a great candidate, and the procedure will be successful with minimal risk. While an ultrasound can give some preliminary idea of expectation, it cannot alone determine if you will be a great candidate for the UFE.
Yes, every patient will need to have an MRI for the UFE procedure. Since you are not having surgery to remove the abnormal tissues, it is important to have advanced imaging of the uterus to make sure there is no cancer and that the remainder of the uterus and pelvis are healthy. The MRI also determines the type, number, size, and behavior of the fibroids or adenomyosis extent. An ultrasound is a basic test that does not provide nearly as much information as an MRI. This ensures that you will have a great response to the treatment and prevent any unforeseen complications.
You do not have to have IV contrast; however, 99% of our patients get their MRI completed with contrast. The contrast allows the doctor to see how the fibroids would respond to the embolization particles. You can think of it like a black and white photo versus a color photo. There is a lot more information offered with contrast. You can decide not to have it, but the doctor may not be able to estimate how great a response your fibroids will have.
Embolization procedures are specifically part of the training process of a Vascular & Interventional Radiologist. No other specialty trains physician in uterine artery embolizations other than a residency and fellowship in Vascular & Interventional Radiology. Surgeons and OBGYNs are not trained in embolizations and do not perform this procedure. If a specialist is performing this procedure and is not a Board-Certified Vascular & Interventional Radiologist,they are practicing outside their scope of training without malpractice coverage. Additionally, these practitioners would not be accredited by any hospital or facility to perform the UAE procedure as there would be a high liability due to their lack of training. This would be equivalent to an eye surgeon practicing heart surgery.
Your consultation and treatment will be performed by our Double Board-Certified Vascular & Interventional Radiologist. We do not have any midlevel or non-physician providers that would substitute for the physician at any point in your care. All of your office visits will be with the same physician.
Our specialist has a high success rate, has performed a high number of uterine embolization procedures and is also versed in more complex organ embolizations. You can rest assured you will be in the best hands compared to other specialists who infrequently perform this procedure.
Our specialist performs a high number of embolization for not only the uterus but also in other more high risk and complex organs, such as the kidney, liver, lung and others. Patients are often surprised how quick and simple the UAE procedure was for them, but this comes at the experience of our specialist who performs a variety of complex embolization cases safely. Our specialist also takes on more complex fibroid and adenomyosis cases than other centers.
Experience however is not always about the number of cases a specialist has performed. A specialist who has been doing surgery poorly or average for 30 years is NOT experienced. An experienced surgeon can perform easy and complex cases with good outcome, safely and without complication. Anyone can be taught to cook but not everyone can be a Michelin star chef.
Depending on your area of residency, the uterine artery embolization may be offered by practitioners of varying levels of experience. Not all UFEs are performed in the same manner. For example, a training center or academic hospital will have residents in training that will often over embolize or place too many beads into the artery causing unnecessary pain and injury to the uterus. Other practitioners for example may use products or techniques that research has proven to be less effective and outdated.
Our specialist continually keeps up with the research to make sure that he brings the best and newest technology to our practice. We are also always collecting feedback from patients and modifying how we provide care so that patients have the best level of experience.
The first step is to have a consultation with our UAE specialist who is an expert at identifying a good candidate based on hundreds of previously treated patients and their outcomes. There are a lot of nuances and details in selecting the right candidate for the UAE procedure. While some clinics may rush the consultation process to schedule a procedure, a successful outcome is more important to our practice and that requires a thorough evaluation before the procedure so that only the right candidate is selected. The right candidate has the correct combination of symptoms, fibroids or adenomyosis type, and MRI findings on the pelvic imaging.
Yes, UAE can treat both adenomyosis and fibroids at the same time. Our specialist has treated a number of patients with adenomyosis or with both fibroids and adenomyosis.
After myomectomy, 50% of patients will have a fibroid recurrence within two years. The reason this happens is that myomectomy cannot remove all types and sizes of the fibroids in the uterus, especially if the only imaging you have had is ultrasound as this does not show every size fibroid. If you had fibroids recur within two years, these are actually just growths of fibroids that were already there. This is not the case with UFE. Ninety percent of patients after the UFE procedure no longer require any further treatment for their fibroids. The reason for this is that the UFE procedure treats all of the fibroids in one treatment. In fact, the UFE procedure is ideal for someone with too many fibroids as they share a common blood supply.
The purpose of the UFE procedure is to block the blood flow to the fibroids. While they are not surgically removed, the fibroids cannot survive without blood flow and as such they are slowly recycled by the body. Some fibroids can also pass with the menstrual cycle the first few months after the procedure. Currently, some kidney and liver cancers are treated with a similar non-surgical method either by embolization or freezing. Similarly, these kidney and liver cancers become inactive and shrink in size leaving just a remnant of dead tissue behind. These dead cancer tissues also do not need to be removed. Our specialist not only treats benign fibroid tumors of the uterus but also cancerous tumors of the liver, lung, and kidneys without surgery.
Patients can return to their regular activities in 1-2 days; however, the recommended recovery time is seven days. This is not due to surgical pain or large surgical incision pain but due to potential cramping that results from the fibroid shrinking. Every patient has a different level of pain length, duration and tolerance so this is the recommended average.
The typical wait for the non-surgical UFE procedure is four weeks. Once you have completed the necessary work up and advanced imaging, we can provide you some dates for consideration.
We cannot tell if your insurance will cover your procedure or what the cost will be until we know that you meet the medical necessity for this type of advanced procedure. Not every patient is a great candidate, and it is important to have a consultation to evaluate your symptoms, imaging, and expectations to see if you would be a good fit for this type of treatment. Once our specialist documents that you do meet the medical necessity, and that the procedure will be successful with minimal risk, then we can obtain authorization and cost of the procedure.