Transradial Uterine Fibroid Embolization Proves Safe and Effective for Women with Smaller Arteries
Alicia Armeli

wrist-image

New research published in the Journal of Vascular and Interventional Radiology showed that transradial uterine fibroid embolization (UFE)—a technique that allows doctors to treat fibroids from the radial artery in the wrist—is safe and effective in women with smaller arteries.1

“Transradial access UFE has been shown to be effective for patients with radial artery diameters that measure greater than 3 millimeters,” says Dr. Sammy Pham, MD, Diagnostic Radiologist at Harlem Hospital Center in New York, NY, and co-author of the study. “And yet, the average female radial artery is much smaller.”

To investigate, Dr. Pham and a team of interventional radiologists reviewed the medical records of 60 women who underwent transradial UFE between October 2013 and August 2015. All women had radial arteries that measured between 2 and 3 millimeters across.

Despite artery size, procedural outcomes showed transradial access to have a technical success rate of 100 percent with no major complications. Two minor adverse effects were reported and included bruising at the access site and temporary constriction of the radial artery, both of which were treated conservatively. After the procedure, the radial artery was seen to be normal in all patients, as well as upon discharge from the hospital and at a 5-week follow up. No further complications were reported.

Traditionally, interventional radiologists have used the femoral artery to perform UFE—a technique called transfemoral access. By making a small nick in the upper thigh, a thin tube called a catheter is threaded through the femoral artery and up into the uterine arteries that supply fibroids with blood. Tiny particles are then injected that block blood flow to the fibroids, causing them to shrink and symptoms to subside.

Instead of targeting the femoral artery, transradial access uses the radial artery in the wrist. In comparison to transfemoral access, research links transradial access to less bleeding at the puncture site, reduced hospital stay, and lower complication rates.2 After the procedure, patient comfort also improves with transradial access. As Dr. Pham points out, “a procedure performed at the wrist instead of the groin allows patients the freedom to move about without constraints, while also preserving their physical modesty.”

These same benefits hold true even among high-risk patients. A 2016 study by Biederman, et al. showed transradial access to have a 100 percent technical success rate with zero complications among morbidly obese patients undergoing different vascular procedures—including UFE.3 Morbidly obese patients are more prone to complications; however, the authors concluded that vascular procedures using transradial access are a safe and viable option for these individuals.

Despite these benefits, working with smaller arteries can pose potential problems. On average, a woman’s radial artery measures about 2.4 millimeters across, which means there’s less space for a catheter to move smoothly through the artery during a procedure. Reduced space between a catheter and the radial artery wall can result in a vasospasm—or a sudden narrowing of the blood vessel. This can make placing a transradial catheter difficult.4

What’s more, less area between a catheter and the artery wall can slow blood flow around the catheter, putting a woman at a greater risk of forming a blood clot.4 However, Dr. Pham explains “Our study showed transradial UFE to have minimal complications and all patients in our study reported a substantial improvement in symptoms at follow-up visits.”

To achieve such results, Dr. Pham and his team take a number of precautions. “Having adequate planning and proper equipment is important even before starting a procedure,” Dr. Pham tells Ask4UFE. “Sufficient anti-clotting medication during the procedure and then using a radial compressive device around each patient’s wrist afterward will help minimize bleeding.”

Uterine fibroids affect up to 80 percent of women by age 50, with African American women most at risk.5 And while these noncancerous growths don’t usually cause a problem, up to 50 percent of women with fibroids will seek treatment for heavy painful periods and bulk symptoms like urinary incontinence.6

Regardless of the access point, UFE has a long-term symptom cure rate that hovers around 90 percent—a statistic studies show to remain stable for 11 years following the procedure. 7  Considered minimally invasive, UFE is a practical option for women who don’t want surgery and for those who desire to keep their reproductive organs intact.

“Transradial access is one more way interventional radiologists have improved the UFE experience,” Dr. Pham says. “Several patients in our hospital, along with studies looking at patient preference, have favored transradial access. But it should be noted that both access points have their advantages and disadvantages and both options should be offered to women seeking UFE.”

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community.

ABOUT THE DOCTOR  Sammy Pham, MD, is a Diagnostic Radiologist at Harlem Hospital Center in New York, NY. With clinical interests in Interventional Radiology and Interventional Oncology, Dr. Pham offers patients cutting edge procedures, ensuring the best patient care possible. 

REFERENCES

  1. Pham, S., Arampulikan, J., Ruiz, D., & Resnick, N. (2016). Safety and efficacy of transradial uterine fibroid embolization via small caliber arterial access. Journal of Vascular and Interventional Radiology, 27(3), S21. doi: http://dx.doi.org/10.1016/j.jvir.2015.12.067
  1. Posham, R., Biederman, D. M., Patel, R. S., Kim, E., Tabori, N. E., Nowakowski, F. S., Lookstein, R. A., Fischman, A. M. (2016). Transradial approach for noncoronary interventions: a single-center review of safety and feasibility in the first 1500 cases. Journal of Vascular and Interventional Radiology, 27(2), 159-166. doi: 10.1016/j.jvir.2015.10.026
  1. Biederman, D. M., Marinelli, B., O’Connor, P. J., Titano, J. J., Patel, R. S., Kim, E., Tabori, N. E., Nowakowski, F. S., Lookstein, R. A., & Fischman, A. M. (2016). Transradial access for visceral endovascular interventions in morbidly obese patients: safety and feasibility. The Journal of Vascular Access, 17(3), 256-260. doi: 10.5301/jva.5000530
  1. Caputo, R. P., Tremmel, J. A., Rao, S., Gilchrist, I.C., Pyne, C., Pancholy, S., Frasier, D., Gulati, R., Skelding, K., Bertrand, O., & Patel, T. (2011). Transradial arterial access for coronary and peripheral procedures: executive summary by the Transradial Committee of the SCAI. Catheterization and Cardiovascular Interventions, 78(6), 823-39. doi: 10.1002/ccd.23052
  1. US Department of Health and Human Services: Office on Women’s Health. (2015). Uterine Fibroids Fact Sheet. Retrieved August 7, 2016, from http://womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html
  1. Soliman, A. M., Yang, H., Du, E. X., Kelkar, S. S., & Winkel, C. (2015). The direct and indirect costs of uterine fibroid tumors: a systematic review of the literature between 2000 and 2013. American Journal of Obstetrics and Gynecology, 213(2), 141-160. doi: 10.1016/j.ajog.2015.03.019
  1. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2, 1-7.