A randomized comparison of transradial and transfemoral access in uterine artery embolization

Abstract

We aimed to compare duration of uterine artery embolization, radiation exposure, safety and quality of life associated with the procedure in patients undergoing uterine artery embolization using transradial and transfemoral access. METHODSThis randomized controlled trial was conducted from February 2013 to March 2017 in three hospitals. Transradial access was used in 78 patients and transfemoral access in 75 patients. Clinical characteristics of the patients were comparable between the two groups. Patients were evaluated for the success and duration of the procedure, radiation exposure, major and minor complications. Quality of life associated with the procedure was assessed among patients with uterine fibroids. RESULTSEmbolization procedures were successfully performed in all patients in both groups. The duration of uterine artery embolization (32.27±7.99 vs. 39.24±9.72 minutes, p < 0.001), uterine artery catheterization time (12.36±5.73 vs. 19.08±6.06 minutes, p < 0.001) and radiation exposure (0.28±0.14 vs. 0.5±0.21 mZv, p < 0.001) were significantly lower in the transradial access group. The rate of major (0% vs. 2.7%, p = 0.37) and minor (11.53% vs. 17.3%, p = 0.42) complications was comparable between the two groups. Transradial access was associated with a statistically significant improvement in the quality of life associated with the procedure among patients with uterine fibroids. CONCLUSIONTransradial access in uterine artery embolization has the same efficacy and safety compared to transfemoral access. This access reduces radiation exposure and duration of the procedure.

Efficacy and Safety of the Transracial Approach (TRA) Versus. Transfemoral Approach (TFA) in Uterine Artery Embolization (UAE) for the Management of Uterine Fibroids; A Systematic Review and Meta-Analysis

“…Thrombosis of the brachial artery, which may cause hand ischemia, is the most serious complication of the transbrachial approach. The transaxillary approach may cause thrombosis of the axillary artery and hematoma which may compress the brachial nerve [23] . In the last decades, TRA has been used for UAE [8] .…”

“…The PRISMA flow demonstrates the results of our search in different databases as shown in (Figure 1). We included four studies that have our inclusion criteria [22][23][24][25] . 425 women suffering from uterine fibroids and indicated to have UAE were analyzed in our study.…”

“…1. Mean procedural time (min): A total of 359 patients were analyzed from three studies [22][23][24] that reported this outcome. We found that there was a reduction in the duration of the procedure in the TRA group (MD= -7.13 [-9.92, -4.35], (P = 0.001).…”

“…3. Radiation exposure: Radiation exposure was reported by two studies [22,23] . We found that there was no significant difference between both groups (MD= -0.14 [-0.35, 0.08]), (P = 0.21).…”

“…A total of 335 women were analyzed from two studies [22,23] that reported minor access site complications. We found that both approaches cause the same rate of minor access site complications (OR= 0.69 [0.33, 1.43]), (P = 0.32).…”