Prospective Study of Elective Bilateral Versus Unilateral Femoral Arterial Puncture for Uterine Artery Embolization

Abstract

The purpose of this study was to assess the effect of elective bilateral femoral arterial punctures for uterine artery embolization (UAE) of symptomatic fibroids on fluoroscopy and procedural time, patient dose, and ease of procedure. We conducted a prospective study of UAE with either the intention to catheterize both uterine arteries using a single femoral puncture (n = 12) or elective bilateral arterial punctures from the outset (n = 12). The same two operators undertook each case. Main outcome measures were total procedure time, fluoroscopy time, dose-area product (DAP), and total skin dose. A simulation was then performed on an anthropomorphic phantom using the mean in vivo fluoroscopy parameters to estimate the ovarian dose. Bilateral UAE was achieved in all patients. None of the patients with initial unilateral arterial puncture required further contralateral arterial puncture. The mean fluoroscopy time in the group with elective bilateral punctures was 12.8 min, compared with a mean of 16.6 min in patients with unilateral puncture (p = 0.046). There was no significant difference in overall procedure time (p = 0.68). No puncture-site complications were found. Additional catheters were required only following unilateral puncture. The simulated dose was 25% higher with unilateral puncture. Although there was no significant difference in measured in vivo patient dose between the two groups (DAP, p = 0.32), this is likely to reflect the wide variation in other patient characteristics. Allowing for the small study size, our results show that the use of elective bilateral arterial punctures reduces fluoroscopy time, requires less catheter manipulation, and, according to the simulation model, has the potential to reduce patient dose. The overall procedure time, however, is not significantly reduced.

Radiation Exposure During Uterine Artery Embolization: Effective Measures to Minimize Dose to the Patient

“…The fact that both Bratby et al and Costantino et al found no significant difference but only a slight tendency toward lower radiation exposure for the bilateral approach is probably mainly attributable to the small sample sizes investigated [24,27]. However, in both studies, fluoroscopy time at least was significantly shorter.…”

“…The measures they used to reduce patient dose were simple and should be known to all interventional radiologists: optimized sourceimage and object-image distances, avoidance of magnification, tight collimation, reduction of image frequency during angiographic runs to one image every other second, and documentation of the angiographic endpoint using lastimage-hold (LIH) instead of another angiographic run. Many studies on radiation exposure during UAE followed and are compiled in Table 3 [16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Selective Embolisation of a Heavily Bleeding Cervical Fibroid in a Pregnant Woman

“…In addition, reduction of fluoroscopy time can be achieved by performing UFE with bilateral access and parallel instead of sequential embolisation [11,12]. The combination of bilateral access and measures to reduce radiation exposure is also applicable during perioperative temporary balloon occlusion of the internal iliac arteries as a prophylaxis in cesarean section in pregnant women at risk for peri-and post-partum hemorrhage [13].…”

Complications of Fibroid Embolisation

“…Pulsed fluoroscopy with a low frame rate and careful coning should be used as the mainstay of intra-procedural imaging and angiographic runs should be avoided as much as possible (Bratby and Belli 2008;Braude et al 2000;Goodwin et al 2003). Bilateral femoral arterial puncture technique has been shown to reduce fluoroscopy time and catheter manipulation compared to a unilateral access technique, with a 25 % reduction in simulated dose (Bratby et al 2007). The same study demonstrated that the overall fluoroscopy time and patient dose are generally very low.…”