Who Performs UFE? Radiologists and Vascular Surgeons

Quick Answer

Uterine fibroid embolization is usually performed by an interventional radiologist, according to ACOG and RadiologyInfo. Some vascular surgeons, who also do catheter-based arterial procedures, perform it too, ideally working with a gynecologist. Ask any doctor about their UFE experience, workup and aftercare.

Uterine fibroid embolization is usually performed by an interventional radiologist. Both ACOG and RadiologyInfo, the patient site of the major radiology societies, say so. But UFE is a catheter-based procedure inside the arteries, and some vascular surgeons, who are also trained in catheter-based arterial work, perform it as well. Whoever does the procedure, the most useful questions are about their experience with UFE specifically, how they work with your gynecologist, and how they will care for you afterward.

For an overview of the procedure itself, see our main page on uterine fibroid embolization (UFE).

What skills UFE requires

UFE is done from inside the blood vessels. The doctor places a thin tube (catheter) into an artery in the groin or wrist, steers it under live X-ray guidance into both uterine arteries, and releases tiny particles to block the vessels feeding the fibroids. That calls for:

Skill with catheters and wires in small, winding arteries
Reading angiograms (X-ray pictures of the arteries) in real time, including spotting connections to the ovarian arteries
Using X-ray carefully to keep radiation dose low
Managing pain, nausea and other symptoms in the days after the procedure
Working with a gynecologist on diagnosis, other options and follow-up

No single specialty owns all of these. In practice, UFE is a team effort.

Interventional radiologists

Interventional radiologists are doctors who specialize in image-guided procedures through small openings in the skin. ACOG's patient FAQ says, "A doctor called an interventional radiologist usually performs UAE," and RadiologyInfo describes the interventional radiologist as the doctor who performs UFE in a catheterization lab or, occasionally, an operating room. The main professional guidelines for UFE, from the Society of Interventional Radiology (SIR) in the US and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), were written by interventional radiology societies.

Vascular surgeons

Vascular surgeons treat diseases of the arteries and veins, using both open surgery and catheter-based (endovascular) techniques such as angioplasty, stenting and embolization. Embolizing the uterine arteries uses the same catheter skills, but it has historically been outside what most vascular surgeons do.

A 2018 paper in the Annals of Vascular Surgery described a UFE program run by vascular surgeons working with gynecologists. The first author was a vascular surgeon at Yale School of Medicine, and the co-authors were from Rutgers Robert Wood Johnson Medical School, where the program was based. The authors noted that UFE remains outside the clinical scope of most vascular surgeons, partly because of established referral patterns. Over 18 months:

26 embolizations were performed (24 on both sides and 2 on one side), with 100% technical success.
There were no complications during or after the procedures.
21 women (87.5%) reported complete symptom relief at their last visit; 3 (12.5%) still had bleeding and had a hysterectomy at 12 months.
All patients were observed for 23 hours for pain control.

The program also shows what a careful setup looks like. Patients were included only if their fibroids were shown on MRI and an endometrial biopsy was negative. Women who wanted a future pregnancy, or who had a previous embolization, were not offered UFE in that program. Follow-up included pelvic ultrasound at 1, 3 and 6 months and then yearly. The referring gynecologists came to prefer the vascular surgery service for UFE because it could work up, admit, treat and follow up patients.

This is a small series with short follow-up (an average of 7.4 months), so it shows that the model can work, not how it compares with larger programs. The authors concluded that, within a collaborative program, vascular surgery can play a prominent role in providing safe and effective UFE.

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This article is part of our Fibroid Treatment Guide.

The rest of the team

Good UFE care usually involves more than one specialist:

Gynecologist: confirms the diagnosis, checks the lining of the uterus and cervical screening, discusses medication and surgical alternatives, and handles problems such as retained fibroid tissue. In the 2018 program above, every patient had MRI and a negative endometrial biopsy before UFE.
Radiologist reading the MRI: the CIRSE 2015 guideline names contrast-enhanced MRI as the preferred imaging test before UFE.
Nursing and anesthesia staff: sedation, monitoring and recovery care.

ACOG's 2021 practice bulletin supports UFE as an option for women who want to keep the uterus, with counseling about the limited data on pregnancy afterward. That counseling is easier when the doctor doing the procedure and your gynecologist talk to each other.

What credentials like FACS and RPVI mean

Letters after a doctor's name can be confusing. Here is what two common ones mean, factually:

Credential	What it is	What it does not mean
Board certification	The doctor has passed a specialty board's training requirements and exams (for example, in vascular surgery or interventional radiology)	It is not specific to UFE
FACS (Fellow of the American College of Surgeons)	A surgeon who is board certified, submitted a 12-month surgical case list, practiced at least 365 days at one institution after training, had references from other Fellows and passed an interview	It is a general surgical credential, not a UFE credential
RPVI (Registered Physician in Vascular Interpretation)	A certification, administered by APCA/Inteleos, in interpreting vascular ultrasound studies; the only such credential accepted by the Vascular Surgery Board of the American Board of Surgery	It is about ultrasound interpretation, not embolization

David Fox, MD, FACS, RPVI, is a board-certified vascular surgeon in Manhattan who performs UFE. You can read more about his background on his physician profile. As with any doctor, the questions below will help you judge whether the fit is right for you.

Questions to ask any doctor who performs UFE

These apply whether your doctor is an interventional radiologist or a vascular surgeon:

How many UFE procedures do you perform in a typical year?
What imaging do you need before deciding I am a candidate, and who reads it?
Will a gynecologist be involved in my evaluation and follow-up?
Where will the procedure be done, and will I go home the same day or stay overnight?
Do you use the wrist or the groin, and what kind of sedation?
How do you manage pain and nausea afterward?
Who do I call after hours, and who treats me if a complication happens?
What follow-up visits and imaging do you schedule?
What do you recommend if my symptoms return?

For a longer checklist, see questions to ask before UFE. To learn what the day itself involves, read what happens during UFE, and to check whether UFE suits you, see am I a candidate for UFE.

Choosing well

The specialty name on the door matters less than specific experience with UFE, a careful workup, a clear plan for aftercare and a good working relationship with your gynecologist. A doctor who explains the trade-offs honestly, including the higher chance of needing another procedure compared with surgery and the limited pregnancy data, is a good sign. To compare UFE with every other fibroid treatment, see our fibroid treatment guide.

Frequently Asked Questions

What kind of doctor does uterine fibroid embolization?

Usually an interventional radiologist, according to ACOG and RadiologyInfo. Some vascular surgeons also perform it, and a gynecologist is normally involved in the evaluation.

Can a vascular surgeon perform UFE?

Yes. Vascular surgeons perform catheter-based procedures in the arteries, and a 2018 paper described a vascular surgery-based UFE program at Rutgers with 100% technical success in 26 procedures and short follow-up. The authors noted that most vascular surgeons do not currently perform UFE.

Does a gynecologist do UFE?

Gynecologists usually do not perform the embolization itself, but they play a key role: confirming the diagnosis, checking the uterine lining, discussing alternatives and helping with follow-up.

What does RPVI mean?

Registered Physician in Vascular Interpretation. It certifies expertise in interpreting vascular ultrasound studies. It is not an embolization credential.

What should I ask a doctor before UFE?

Ask how many UFEs they do each year, what imaging they need, whether a gynecologist is involved, where the procedure happens, how pain is managed, who to call after hours and what follow-up is planned.

Keep Reading

Sources

Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.

Living with heavy periods, pelvic pressure or other fibroid symptoms? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether uterine fibroid embolization is right for you. Call (212) 362-3470 or request a UFE consultation online.

Who Performs Uterine Fibroid Embolization? Interventional Radiologists, Vascular Surgeons and the Team