Uterine Fibroid Embolization via Transradial versus Transfemoral Arterial Access: Technical Results

Abstract

AIM: This study was designed to compare the safety and feasibility of uterine fibroid embolisation (UFE) via transradial access (TRA) and transfemoral access (TFA).
 MATERIAL AND METHODS: A retrospective analysis was conducted for 2 cohorts: 13 cases with already established TFA (from February 2016 to September 2018) and the first 11 procedures performed via TRA (from October 2017 to October 2018). Indications for embolization included: heavy menstrual bleedings (n = 18), lower urinary tract symptoms (n = 2), pelvic pain (n = 3) and abdominal pain (n = 1). One interventional radiologist and one fellow performed all procedures at one institution. Technical success, procedural time, access site complications as well as feedback from patients were assessed for analysis.
 RESULTS: Technical success was achieved in 24/24 cases (100%). Unilateral uterine artery embolisation was performed in 7 cases (29.1%) and bilateral in 17 cases (70.8%). Mean procedure time was 72.4 minutes in TFA group, and 60.3 minutes in the TRA group. Mean fluoroscopy time was 25.3 minutes in the TFA group and 21.1 minutes in the TRA group. Access site-related and overall adverse events did not vary significantly among the study cohorts.
 CONCLUSIONS: TRA represents a safe and feasible approach for UFE with a comparable safety profile to TFA.

Experience with trans radial uterine artery embolisation for uterine fibroids in a tertiary center in Saudi Arabia

“…Our experience agrees with Gjoreski, et al [1] in the comparison of routes used, where it was evident that the Trans-Femoral route in comparison to the Trans-radial one, took longer time to perform, was associated with more exposure to luoroscopy, increased demand on post procedure site physical pressure for hemostasis and possibly more length of hospital stay. In accordance, the trans-radial route gained increased popularity amongst the treating physicians as well as the patients.…”

“…The length of hospital stay in our study was longer than other studies [1], and that can be explained by our strict adherence and following of the meticulous protocol of our institute provided for pain management and prophylactic measures set to avoid infection and thrombosis. However, with the good outcome, increased demand on the procedure and acquired experience, a shift to short hospital stays rather than the current prolonged one can be implemented in future.…”

“…We encountered an isolated case of left arm pain that was eventually relieved by symptomatic treatment and most probably was not related to the procedure and is not a reason to change our policy like Gjoreski, el al. [1] where routine ultrasound check up of the radial artery, one month postprocedure was done to check on arterial patency .…”

“…The 20% -30% recurrence of symptoms post-embolization and with the availability of voluminous data illustrating the correlation of several factors affecting the outcome, Gjoreski, et al [1] suggested the study of the heights of patient as a prognostic factor for the outcome. In an analogous manner, we tried to review a factor, which was not encountered before in the literature, that demonstrates the relationship between Body Mass Index of patients and its correlation with the percentage reduction of ibroid size.…”

Intraoperative transradial angiography augments safe hysterectomy for uterine fibroids in the setting of ambiguous arterial anatomy: a case report

“…A retrospective study of TRA in uterine artery embolization by an experienced interventional radiology group found a 100% technical success rate with no major adverse complications recorded, including no radial artery occlusions at 1-month follow-up. Furthermore, a retrospective study completed by an interventional radiology group and gynecologic group also found that TRA had a 100% technical success rate in uterine fibroid embolization and determined that TRA (60.3 minutes) required less procedural time than TFA (72.4 minutes) [13]. Finally, it should be noted that intraoperative vascular consultation in TAH-BSO is a rare event and likely is unpreventable because it is dependent on the surgeon’s clinical assessment and intraoperative findings.…”